Overview
Cholera is an acute diarrheal illness caused by the bacterium Vibrio cholerae. It spreads through water or food contaminated with the bacteria, most often in areas without access to clean water and proper sanitation.
Disease Summary
- Category
- Infectious Disease
- Cause
- Vibrio cholerae bacteria
- Transmission
- Contaminated water or food, spread through the fecal-oral route
- Body System
- Digestive
- Preventable
- Yes
- Curable
- Yes
Symptoms
Common Symptoms
Most people with cholera have mild symptoms or none at all. When symptoms do occur, they typically include the following.
Watery Diarrhea
Often described as looking like rice water, and can be very frequent and large in volume.
Vomiting
Commonly accompanies diarrhea, particularly early in the illness.
Muscle Cramps
Result from rapid loss of fluids and electrolytes.
Thirst
An early sign that the body is losing fluids faster than they can be replaced.
Danger Signs
Seek urgent medical attention immediately if any of the following develop.
Sunken Eyes
A visible sign of severe dehydration requiring urgent rehydration.
Little or No Urination
Indicates the body is critically low on fluids.
Skin That Stays Pinched
When pinched skin is slow to return to normal, it signals significant dehydration.
Extreme Fatigue or Irritability
Can indicate the body is struggling with severe fluid and electrolyte loss.
Diagnosis
Clinical Assessment
In areas where cholera is common, healthcare workers can often recognise likely cholera from symptoms and the pattern of illness in the community.
Stool Testing
A stool sample confirms the presence of Vibrio cholerae. Treatment for severe diarrhea begins immediately and is not delayed while waiting for results.
Rapid Dipstick Test
A rapid test can quickly confirm cholera in remote or outbreak settings, helping guide faster treatment and public health response.
Laboratory Tests
Rapid Cholera Dipstick Test
Quickly confirms Vibrio cholerae infection, particularly useful in outbreak settings and remote areas.
Stool Culture
The definitive method for confirming Vibrio cholerae and identifying the specific strain involved.
Electrolyte Panel
Assesses the severity of dehydration and guides fluid and electrolyte replacement.
Treatment
Oral Rehydration Solution (ORS)
The single most important treatment for cholera. Replaces fluids and electrolytes lost through diarrhea and vomiting, and successfully treats the majority of cases alone.
Intravenous Fluids
Used for people with severe dehydration who cannot drink enough fluids on their own.
Prevention
Access clean drinking water
Drinking treated, boiled, or bottled water significantly reduces the risk of cholera infection.
Practise safe food handling
Thoroughly cooking food and avoiding raw or undercooked seafood from unclear sources reduces exposure.
Wash hands regularly
Frequent handwashing, especially before eating and after using the toilet, helps prevent the fecal-oral spread of cholera.
Consider oral cholera vaccination
WHO-prequalified oral cholera vaccines are available and can help prevent and control outbreaks in at-risk areas.
Risk Factors
High Risk
These individuals are more likely to develop severe illness or complications.
- Young children
- People with limited access to healthcare
- People with pre-existing malnutrition
Increased Risk
These groups have a higher chance of acquiring cholera.
- People living in areas with unsafe drinking water
- People affected by flooding or natural disasters
- People living in crowded settings with poor sanitation
Exposure Factors
Environmental and behavioural factors that increase the risk of cholera transmission.
- Contaminated water sources
- Inadequate sewage treatment
- Consuming raw or undercooked seafood from contaminated waters
Complications
Severe Dehydration
Rapid fluid loss can lead to shock and organ failure if not treated promptly.
Electrolyte Imbalance
Loss of key electrolytes can affect heart rhythm and muscle function.
Shock
Untreated severe dehydration can progress to shock, a life-threatening drop in blood flow to organs.
When to Seek Medical Care
Signs of Severe Dehydration
Sunken eyes, extreme thirst, or little urination require immediate medical care.
Persistent Watery Diarrhea
Ongoing large-volume diarrhea, especially with vomiting, needs prompt evaluation and rehydration.
Confusion or Extreme Weakness
Can indicate advanced dehydration and requires emergency care.
Prognosis
Excellent with Prompt Rehydration
Over 99 percent of people survive cholera when rehydration treatment begins promptly.
Poor if Untreated
Without treatment, up to half of people with severe cholera can die from dehydration.
Full Recovery is Typical
Most people recover fully within a few days once adequately rehydrated.
Differential Diagnosis
Typhoid Fever
Typhoid fever shares the same fecal-oral transmission route and risk conditions as cholera, but typically presents with prolonged fever rather than sudden severe watery diarrhea.
Other Diarrheal Illnesses
Many bacterial, viral, and parasitic infections cause diarrhea. Cholera is distinguished by the volume and watery character of the diarrhea and by stool testing.
Food Poisoning
Common food poisoning usually causes milder, shorter-lived symptoms compared to the rapid, severe dehydration seen in cholera.
References
World Health Organization (WHO)
World Health Organization guidance on cholera epidemiology, prevention, and vaccination.
Centers for Disease Control and Prevention (CDC)
Clinical guidance and public health information on cholera transmission and treatment.
Mayo Clinic
Patient-focused overview of cholera symptoms, causes, and complications.
Frequently Asked Questions
Can cholera be cured?
Yes. With prompt oral or intravenous rehydration, over 99 percent of people with cholera survive and recover fully.
How does cholera spread?
Cholera spreads through water or food contaminated with Vibrio cholerae, most often through the fecal-oral route in areas with inadequate sanitation.
Can cholera be prevented?
Yes. Access to clean water, proper sanitation, safe food handling, and oral cholera vaccines are all effective preventive measures.
Is everyone who is infected with cholera severely ill?
No. Most people infected with cholera have mild symptoms or none at all, though they can still spread the bacteria to others.