Cholera (patient information)

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Cholera

Overview

What are the symptoms?

What are the causes?

Who is at highest risk?

When to seek urgent medical care?

Diagnosis

Treatment options

Diseases with similar symptoms

Where to find medical care for Cholera?

What to expect (Outlook/Prognosis)?

Possible complications

Prevention

Cholera On the Web

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Images of Cholera

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Directions to Hospitals Treating Cholera

Risk calculators and risk factors for Cholera

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor(s)-in-Chief: Meagan E. Doherty; Tarek Nafee, M.D. [2]; Sara Mehrsefat, M.D. [3]; Aysha Anwar, M.B.B.S[4]

## Overview

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Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae. The infection is often mild or without symptoms, but sometimes it can be severe. Approximately one in 20 infected persons has severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In these persons, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.

## What are the symptoms of Cholera?

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The following is a list of symptoms commonly associated with people who have developed cholera:

* Abdominal cramps
* Dry mucus membranes or mouth
* Dry skin
* Excessive thirst
* Glassy or sunken eyes
* Lack of tears
* Lethargy
* Low urine output
* Nausea
* Rapid dehydration
* Rapid pulse
* Sunken "soft spots" (fontanelles) in infants
* Unusual tiredness
* Vomiting
* Watery diarrhea that starts suddenly and has a "fishy" odor

## What are the causes of Cholera?

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Cholera is caused by the bacterium Vibrio cholerae. The bacteria releases a toxin that causes increased release of water in the intestines, which produces severe diarrhea. Cholera occurs in places with poor sanitation, crowding, war, and famine. Common locations for cholera include:

* Africa
* Asia
* India
* Mexico
* South and Central America

People get the infection by eating or drinking contaminated food or water. A type of vibrio bacteria also has been associated with shellfish, especially raw oysters.

## Who is at highest risk?

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Risk factors for the development of cholera include:

* Exposure to contaminated or untreated drinking water
* Living in or traveling to areas where there is cholera
* Displacement of large numbers of people following a natural disaster (e.g., earthquakes, hurricanes, refugee camps, etc.)

## Diagnosis

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Tests that may be done include:

* Blood culture
* Stool culture

## When to seek urgent medical care?

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Call your health care provider if :

* You develop severe watery diarrhea
* You have signs of dehydration, including:
* Dry mouth
* Dry skin
* "Glassy" eyes
* Lethargy
* No tears
* Rapid pulse
* Reduced or no urine
* Sunken eyes
* Thirst
* Unusual sleepiness or tiredness

## Treatment options

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Cholera can be simply and successfully treated by immediate replacement of the fluid and salts lost through diarrhea. Patients can be treated with oral rehydration solution, a prepackaged mixture of sugar and salts to be mixed with water and drunk in large amounts. This solution is used throughout the world to treat diarrhea. Severe cases also require intravenous fluid replacement. With prompt rehydration, fewer than 1% of cholera patients die. Antibiotics shorten the course and diminish the severity of the illness, but they are not as important as rehydration. Persons who develop severe diarrhea and vomiting in countries where cholera occurs should seek medical attention promptly.

## Diseases with similar symptoms

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* Viral gastroenteritis
* Salmonellosis
* Enterotoxigenic E. coli
* Food poisoning

## Where to find medical care for Cholera?

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Directions to Hospitals Treating Cholera

## What to expect (Outlook/Prognosis)?

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Severe dehydration can cause death. Given adequate fluids, most people will make a full recovery.

## Possible complications

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* Severe dehydration
* Death

## Prevention of Cholera

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The U.S. Centers for Disease Control and Prevention does not recommend cholera vaccines for most travelers. (Such a vaccine is not available in the United States.) Travelers should always take precautions with food and drinking water, even if vaccinated. When outbreaks of cholera occur, efforts should be directed toward establishing clean water, food, and sanitation, because vaccination is not very effective in managing outbreaks. The risk for cholera is very low for U.S. travelers visiting areas with epidemic cholera. When simple precautions are observed, contracting the disease is unlikely. All travelers to areas where cholera has occurred should observe the following recommendations:

* Drink only water that you have boiled or treated with chlorine or iodine. Other safe beverages include tea and coffee made with boiled water and carbonated, bottled beverages with no ice.
* Eat only foods that have been thoroughly cooked and are still hot, or fruit that you have peeled yourself.
* Avoid under-cooked or raw fish or shellfish, including ceviche.
* Make sure all vegetables are cooked and avoid salads.
* Avoid foods and beverages from street vendors.
* Do not bring perishable seafood back to the United States.

## Sources

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* http://www.cdc.gov/nczved/divisions/dfbmd/diseases/cholera/
* http://www.nlm.nih.gov/medlineplus/ency/article/000303.htm

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