Cholera

What Is Cholera?

Cholera is a bacterial infection that affects the small intestine, leading to sudden onset of watery diarrhea and rapid fluid loss. It is caused by ingestion of water or food contaminated with the toxin-producing bacterium Vibrio cholerae. Cholera occurs most often in regions with limited access to clean water, inadequate sanitation, and overcrowded living conditions.

While many infections are mild or asymptomatic, severe cases can lead to dehydration within hours. Cholera remains a global public health threat, especially in areas affected by natural disasters, conflict, and poor infrastructure. Fast diagnosis and immediate rehydration can dramatically reduce the risk of severe outcomes.

Causes of Cholera

Cholera is caused by toxigenic strains of the bacterium Vibrio cholerae. These bacteria produce a powerful toxin (cholera toxin) that disrupts the normal flow of sodium and water in the intestines, leading to large volumes of watery stool.

How the Infection Begins

Once ingested, the bacteria travel to the small intestine, attach to its lining, and release cholera toxin. This toxin causes the body to secrete water and electrolytes into the intestine, resulting in severe diarrhea and dehydration if untreated.

How Cholera Spreads

Cholera is primarily transmitted through the fecal–oral route. The most common sources include:

• Drinking water contaminated with fecal matter
• Eating food washed or prepared with contaminated water
• Raw or undercooked seafood from contaminated waters
• Food handled by someone with poor hand hygiene

High-Risk Conditions

• Areas with inadequate sanitation systems
• Refugee or displacement camps
• After natural disasters (floods, earthquakes)
• Overcrowded urban regions with poor access to clean water

Importantly, cholera does not spread through casual person-to-person contact, making water and sanitation improvements the most effective means of prevention.

Symptoms of Cholera

Symptoms typically appear within 12 hours to 5 days after exposure. Many infections are mild, but severe cases require urgent treatment.

Common Symptoms

• Watery diarrhea that begins suddenly
• Nausea
• Vomiting
• Leg cramps

Signs of Dehydration

• Dry mouth and thirst
• Reduced urination
• Fatigue or weakness
• Rapid heart rate
• Dizziness

Severe dehydration can be life-threatening if not treated promptly with rehydration therapy.

Complications

The most serious complication of cholera is severe dehydration, which can lead to:

• Low blood pressure
• Kidney dysfunction
• Electrolyte imbalances
• Shock (in very severe cases)

With proper treatment, most people avoid these complications and recover quickly.

Diagnosis

Diagnosing cholera involves evaluating symptoms and confirming infection through stool sample testing. In outbreak settings, rapid diagnostic tests help guide quick public health responses.

Laboratory culture is the most accurate method, but rapid testing can speed treatment decisions when laboratory capacity is limited.

Treatment

Cholera treatment focuses on replacing lost fluids and electrolytes. When addressed quickly, treatment is highly effective.

1. Oral Rehydration Solution (ORS)

ORS is the primary treatment. It contains a precise balance of salts, glucose, and water that helps the body reabsorb fluids efficiently.

2. Intravenous (IV) Fluids

Used for moderate or severe dehydration when ORS alone is not enough.

3. Antibiotics

Antibiotics are given in some cases to shorten illness and reduce fluid loss, especially during outbreaks.

4. Zinc Supplementation

Zinc is often recommended for children to help reduce the duration and severity of diarrhea.

Prevention

Preventing cholera depends on improving water quality, sanitation, and hygiene practices.

Safe Water Practices

• Use clean, treated water for drinking and cooking
• Boil water when necessary
• Store water in clean, covered containers

Food Safety

• Wash hands before handling food
• Eat thoroughly cooked meals
• Avoid raw seafood in high-risk areas

Sanitation and Hygiene

• Proper waste disposal
• Handwashing with soap
• Clean toilets and sanitation facilities

Vaccination

Oral cholera vaccines provide protection in high-risk regions or during outbreaks. They do not replace basic sanitation measures but help reduce transmission.