Cholera: Signs, symptoms and treatment

cholera

What is cholera?

Cholera is a highly contagious bacterial infection of the bowel caused by eating food or drinking water contaminated with the bacterium Vibrio cholerae.

The infection can be asymptomatic (no obvious symptoms) to severe or life threatening. The most common symptom is severe continued watery diarrhea. Vomiting may occur in the early stages for a few hours. Fever is rare.

Most people reported to have cholera have had a history of traveling to a cholera affected area. Symptoms may take up to 2-5 days to appear and it’s life-saving to start re-hydrating as soon as possible and at least within 3-4 hours.

Cholera is an ‘urgent notifiable condition’ which means doctors and pathologists need to report a diagnosis of cholera by telephone to the Australian government health authorities.

All cases of cholera are to be reported to The World Health Organization (WHO) and nearby countries by the Australian Government Department of Health and Ageing.

How is cholera caused or transferred?

Cholera usually occurs by a person consuming food or water exposed to faecal contamination. Higher risks include eating undercooked seafood from coastal waters, drinking inadequately treated water or adding contaminated ice to drinks. Places with poor sanitation are higher risk areas.

It is rare for cholera to be transferred from one person to another.

Transfer only occurs between people from the ingestion of water or food containing the cholera bacteria due to inadequate handwashing and cleanliness.

Cholera bacteria can persist in an infected person’s faeces for seven to 14 days.

Who is most at risk of Cholera?

Individuals most at risk when exposed to cholera are:  

  • children;
  • elderly;
  • suffers of gastric achlorhydria (low or no acid in the stomach);
  • breastfeeding mothers; and
  • individuals in regions of unsafe drinking water, unclean hygiene and inadequate sanitation.

Complications

 The table shows the possible severity of symptoms when the condition worsens:

Cholera symptoms and of level of severity

Low risk

Moderate risk

High risk

Abdominal pain – loss of appetite, constipation, diarrhea, nausea and vomiting

 

Coughing – airway pain and shortness of breath

Lack of concentration – fatigue, hyperactivity, headache, sweating, dizziness, weakness and impaired coordination

Other problems – fever, polyuria (excessive urination), muscle pain, pruritis (itchy skin), ocular (eye) pain and irritation.

Severe abdominal pain – diarrhea, melena(blood in faeces) and vomiting

 

Chest pain – pain when taking a deep breath, weakness with breathing, wheezing and shortness of breath

Altered alertness – confusion, hallucination, blurred vision, seizure, muscle rigidity, slurred speech and fainting

Abnormal heart conditions – bradycardia (slow heart rate), tachycardia (fast heart rate), chest pain, hypertension (high blood pressure) and hypotension (low blood pressure)

Excruciating abdominal pain (from haemorrhage or perforated gut)

 

Coma – paralysis and seizure

Lethal heart conditions – severe bradycardia, severe tachycardia, respiratory arrest and cardiac arrest

Discoloured skin – bluish grey skin and oedema (swelling)

Changes in urine production – oliguria (low urine output)  and anuria (severe reduction of urine) 

Adapted from: TABLE: Signs and symptoms by severity category (Modelled after Persson et. al.,1998 and includes SPIDER database elements).

Tests and diagnosis

The diagnosis of cholera requires a specialist laboratory test of faecal specimen to identify the bacteria.

Treatment

Immediate treatment is required as cholera  can worsen within hours.

The treatments depend on the severity of the symptoms:

  • drinking oral rehydration solutions (ORS) containing fluid and salts;
  • intravenous rehydration;
  • antibiotics (although cholera can be antibiotic resistant); and
  • zinc combined with cholera vaccine (containing recombinant cholera toxin B subunit).

 Prevention

The World Health Organization (WHO) recommends focusing on prevention of cholera with adequate handwashing, safe water and food precautions.

The oral killed whole cell B subunit vaccine may be appropriately recommended for travellers if the region considered for entry is a high risk area (oral solution).

Simple measures to avoid getting cholera include:

  • avoiding ice in drinks;
  • using bottled water for drinking, brushing teeth, washing your face and hands;
  • eating foods that have been thoroughly cooked and are still hot, and
  • only eating meat and seafood if well cooked.

Call your General Practitioner immediately if you have been in a high risk area and have developed diarrhea and/or some vomiting.

Last Updated: March 25, 2021

myDr
Author: myDr

References

1. A case of cholera. Australian Government - Department of Health. Updated September 13, 1998. Accessed March 24, 2021. https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-pubs-cdi-1998-cdi2208-cdi2208b.htm 2. Centres for Disease Control and Prevention. TABLE: Signs and symptoms by severity category (Modelled after Persson et. al.,1998 and includes SPIDER database elements). Published December 11, 2001. Accessed March 24, 2021. https://www.cdc.gov/niosh/topics/pesticides/pdfs/pest-sitablev6.pdf 3. Das B, Verma J, Kumar P, Gosh A, Ramamurthy T. Antibiotic resistance in vibrio cholerae: Understanding the ecology of resistance genes and mechanisms. Elsevier. 2020;38(1):A83-A92. doi: 10.1016/j.vaccine.2019.06.031. https://www.sciencedirect.com/science/article/pii/S0264410X19307935?via%3Dihub 4. Neilson A, Mayer C. Cholera - Recommendations for prevention in travellers. Aust Fam Physician. 2010;39(4):220-6. doi: 20372681. https://www.racgp.org.au/download/documents/AFP/2010/April/201004neilson.pdf 5. Nelson E, Harris J, Glenn Morris J, Calderwood S, Camilli A. Cholera transmission: The host, pathogen and bacteriophage dynamic. Nat Rev Microbiol. 2009;7(10):693-702. doi: 10.1038/nrmicro2204. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3842031/ 6. Qadir M, Arshad A, Ahmad B. Zinc: Role in the management of diarrhea and cholera. World J Clin Cases. 2013;1(4):140-142. doi: 10.12998/wjcc.v1.i4.140. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3845954/#:~:text=CONCLUSION-,In%20diarrhea%20and%20cholera%2C%20reduced%20water%20and%20electrolyte%20absorption%20is,impacts%20in%20cholera%20and%20diarrhea 7. World Health Organization. Prevention and control of cholera outbreaks: WHO policy and recommendations. Published 2021. Accessed March 24, 2021. https://www.who.int/cholera/technical/prevention/control/en/#:~:text=About%2075%25%20of%20people%20infected,affects%20both%20children%20and%20adults

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