Cholera is an infection of the small intestine caused by the bacterium Vibrio cholerae. It causes a large amount of watery diarrhea.

Cholera is an acute illness characterized by watery diarrhea. The toxin released by the bacteria causes increased secretion of water and chloride ions in the intestine, which can produce massive diarrhea. Death can result from the severe dehydration brought on by the diarrhea.

Cholera occurs in epidemics when conditions of poor sanitation, crowding, war, and famine are present. Endemic areas include India, Asia, Africa, the Mediterranean, and more recently, South and Central America, and Mexico. The infection is acquired by ingesting contaminated food or water.

A type of vibrio bacteria also has been associated with shellfish, especially raw oysters. Risk factors include residence or travel in endemic areas and exposure to contaminated or untreated drinking water.

• Sudden onset of watery diarrhea
  • Stool looks like water with flecks of rice in it
  • Diarrhea has a "fishy" odor
• Rapid dehydration
• Rapid pulse (heart rate)
• Dry skin
• Dry mucous membranes or dry mouth
• Excessive thirst
• Glassy eyes or sunken eyes
• Lack of tears
• Lethargy
• Unusual sleepiness or tiredness
• Low urine output
• Sunken "soft spots" (fontanelles) in infants
• Abdominal cramps
• Nausea
• Vomiting

Note: Symptoms can vary from mild to severe.

Tests that may be done include:

• Blood culture
• Stool culture

The objective of treatment is to replace fluid and electrolytes lost through diarrhea. Depending on your condition, you may be given fluids by mouth or through a vein (intravenous). Antibiotics may shorten the time you feel ill.

The World Health Organization (WHO) has developed an oral rehydration solution that is cheaper and easier to use than the typical intravenous fluid. This solution of sugar and electrolytes is now being used internationally.

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

• Severe dehydration
• Death

Call your health care provider if you develop profuse watery diarrhea.

Call your health care provider if you have signs of dehydration, including rapid pulse, dry skin, dry mouth, thirst, "glassy" eyes, lethargy, sunken eyes, no tears, reduced or no urine, and unusual sleepiness or tiredness.

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.

Crump J, Bopp C, Greene KD, Kubota KA, Middendorf RL, Wells JG, Mintz ED. Emergence of toxigenic Vibrio cholerae O141 causing cholera-like diarrhea and bloodstream infection in the United States. Journal of Infectious Diseases. 2003;187:866-868.

Steinberg EB, Green KD, Bopp CA, Cameron DN, Wells JG, Mintz ED. Cholera in the United States, 1995-2000: trends at the end of the millennium. J Infect Dis. 2001; 184: 799-802.