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Cholera is an infection of the small intestine that causes a large amount of watery diarrhea.

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
• The Mediterranean

People get the infection by ingesting contaminated food or water.

A type of vibrio bacteria also has been associated with shellfish, especially raw oysters.

Risk factors include:

• Exposure to contaminated or untreated drinking water
• Living in or traveling to areas where there is 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 (heart rate)
• Sunken "soft spots" (fontanelles) in infants
• Unusual sleepiness or tiredness
• Vomiting
• Watery diarrhea that starts suddenly
  • Diarrhea has a "fishy" odor
  • Stool looks like water with flecks of rice in it

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 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

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.

V. cholerae; Vibrio

Gotuzzo E, Seas C. Cholera and other vibrio infections. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 325.

Updated by: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.