Cholera

Cholera is a sickness caused by bacteria. These bacteria often get into water supplies that are not clean. The main symptom of cholera is severe diarrhea, which can lead to extreme loss of fluids, called dehydration. If not treated quickly, cholera can be deadly, even for people who were previously healthy. It can kill within hours.

In developed countries, modern systems for cleaning water and sewage have made cholera very rare. However, cholera still affects parts of Africa, Southeast Asia, and Haiti. The chance of a major outbreak is higher when people are forced to live in crowded areas, often due to poverty, war, or natural disasters. These situations often mean there are not enough toilets or clean water.

Fortunately, cholera is treatable. The most important treatment is to replace the fluids lost through diarrhea. A simple, inexpensive solution of salt and sugar mixed with water can prevent death from dehydration.

Many people who come into contact with the cholera bacteria (Vibrio cholerae) don't get sick and don't even realize they've been infected. However, they can still spread the bacteria to others because they pass it in their stool for a period of 7 to 14 days. This happens through contaminated water.

Most cholera cases that do cause symptoms result in mild to moderate diarrhea. This kind of diarrhea is often hard to distinguish from diarrhea caused by other things. But some people develop more serious cholera symptoms, typically within a few days of being infected.

Cholera infection can cause several symptoms:

• Severe Diarrhea: Cholera diarrhea strikes suddenly and can quickly lead to a dangerous loss of fluids. This can be as much as a liter of fluid per hour. The diarrhea often looks like pale, watery rice water.
• Nausea and Vomiting: Vomiting is common, especially in the early stages of the illness, and can last for several hours.
• Dehydration: Dehydration can start within hours of the first symptoms and can range from mild to severe. If you lose 10% or more of your body weight, you have severe dehydration.

Signs of Cholera Dehydration: Dehydration shows itself in several ways. You might feel irritable and tired. Your eyes might look sunken, your mouth dry, and you'll likely feel extremely thirsty. Your skin will be dry, wrinkled, and slow to return to its normal shape when pinched. You might urinate very little or not at all. Low blood pressure and a rapid or irregular heartbeat are also signs of severe dehydration.

Dehydration from cholera can cause a rapid loss of essential minerals, called electrolytes, in your blood. These minerals help maintain the right balance of fluids in your body. Losing this balance is called an electrolyte imbalance.

Cholera is rarely a problem in developed countries. Even where cholera is found, you're unlikely to get it if you're careful about food safety. However, cholera cases do happen worldwide.

If you have severe diarrhea after traveling to a place where cholera is active, it's important to see a doctor right away. This is especially true if you have severe diarrhea. Severe diarrhea can lead to dangerous dehydration, which needs immediate medical attention. Don't delay getting help if you think you might have been exposed to cholera and are experiencing severe diarrhea.

Cholera is a serious illness caused by a type of bacteria called Vibrio cholerae. This bacteria produces a harmful substance (a toxin) in the small intestine. This toxin makes the body release a lot of water, leading to severe diarrhea and rapid loss of fluids and important minerals (electrolytes). This loss of fluids can be life-threatening if not treated quickly.

Importantly, not everyone who comes into contact with Vibrio cholerae bacteria will get sick. However, people who are infected can still spread the bacteria in their stool. This means the bacteria can easily contaminate food and water sources.

The most common way people get cholera is through contaminated water. This contaminated water can come from various sources:

• Water sources: Surface water, like lakes and rivers, or well water, can become contaminated with Vibrio cholerae. This is especially true in areas with poor sanitation, where sewage mixes with drinking water sources. Crowded living conditions and inadequate sanitation make people more vulnerable to large cholera outbreaks.

• Seafood: Eating raw or undercooked seafood, particularly shellfish, can expose you to Vibrio cholerae bacteria. Some areas, like the Gulf of Mexico, have been linked to recent cholera cases in the U.S. This is because the bacteria can live in the water where seafood grows.

• Fruits and vegetables: Unwashed or unpeeled raw fruits and vegetables can become contaminated with the bacteria. This is more common in areas with cholera outbreaks. In developing countries, fertilizers made from uncomposted animal waste or irrigation water containing raw sewage can contaminate produce in the fields.

• Grains: In regions with a high risk of cholera, grains like rice and millet can become contaminated if they are cooked and then left at room temperature for a long time. This allows the cholera bacteria to multiply.

Cholera can affect almost anyone, except babies who get some protection from their mothers' breast milk if the mothers have had cholera before. However, some things make you more likely to get sick or to get very sick with cholera.

Here are some risk factors:

• Poor sanitation: Cholera thrives where it's hard to keep things clean, like a safe water supply. This is often seen in refugee camps, poor countries, and areas hit by disasters like famine, war, or natural disasters. Dirty water and food are key factors in spreading the disease. Poor hygiene practices also play a significant role.
• Low stomach acid: Cholera bacteria don't like acid. Your stomach acid usually fights off the infection. But if you have lower-than-normal stomach acid levels, for example, if you are a child, older adult, or take medicines like antacids, H2 blockers, or proton pump inhibitors, you have less protection and are more vulnerable. These medications reduce the acidity in your stomach.
• Household contact: If someone you live with has cholera, you're at higher risk of getting it. Close contact spreads the bacteria easily.
• Blood type O: Doctors aren't sure why, but people with blood type O are more likely to get cholera than people with other blood types. This increased risk is about twice as high.
• Raw or undercooked seafood: While cholera outbreaks are rare in developed countries, eating raw or undercooked shellfish from areas where the bacteria are present increases your risk dramatically. This is because the bacteria can live in the shellfish.

Cholera can be very dangerous and even deadly. The most serious cases happen when the body loses a lot of water and salts (electrolytes) very quickly. This can cause death within a few hours. If someone doesn't get treatment, even if the illness isn't as severe, they can still die from becoming extremely dehydrated and going into shock. This can happen a few hours or a few days after the first signs of cholera appear.

While shock and severe dehydration are the most dangerous outcomes of cholera, there are other serious problems that can develop:

• Low blood sugar (hypoglycemia): When someone with cholera is very sick, they might not be able to eat, which can lead to dangerously low blood sugar levels. Blood sugar is the body's main fuel. This is especially risky for children, as it can cause seizures, loss of consciousness, and even death.
• Low potassium levels: Cholera causes the body to lose a lot of potassium (a mineral) through diarrhea. Very low potassium levels can seriously harm the heart and nervous system, and can be life-threatening.
• Kidney failure: The kidneys filter waste and extra fluids from the body. If they stop working properly, these waste products and fluids can build up, putting a person at risk of death. In cholera, kidney failure is often a problem along with shock.

Cholera is uncommon in the United States. Most cases are connected to travel to places where cholera is more common or to eating contaminated seafood, especially seafood caught in Gulf Coast waters that hasn't been cooked properly.

If you're traveling to a place where cholera might be a concern, you can greatly reduce your risk by taking these steps:

• Wash your hands often with soap and water. This is very important, especially after using the restroom and before eating or preparing food. Make sure to scrub your hands together with soap and water for at least 15 seconds before rinsing. If soap and water aren't available, use an alcohol-based hand sanitizer.

• Drink only safe water. This means bottled water, or water that you've boiled for at least one minute, or treated with a water purification tablet or similar product. Even for brushing your teeth, use bottled water or treated water. Hot drinks are usually safe, as are canned or bottled beverages. However, wipe down the outside of the container before opening it. Don't add ice to drinks unless you made the ice yourself from safe water.

• Eat only completely cooked and hot food. Avoid street food whenever possible. If you do eat from a street vendor, make sure the food is cooked right in front of you and is served hot.

• Avoid raw or undercooked seafood and sushi. This includes any kind of raw or partially cooked fish or shellfish.

• Choose fruits and vegetables you can peel yourself. Bananas, oranges, and avocados are good choices, as you can remove the outer skin. Avoid salads and unpeeled fruits like grapes and berries, as these are harder to clean and might carry bacteria.

By following these simple precautions, you can significantly lower your chance of getting cholera while traveling.

Cholera is a serious illness, and its symptoms are often very clear in places where it's common. However, the only sure way to know if someone has cholera is to find the bacteria in a sample of their stool.

Doctors in remote areas can now use quick tests called cholera dipsticks. These tests quickly show if someone has cholera. This is important because it helps prevent deaths during outbreaks. Knowing quickly if someone has cholera allows health officials to act faster to stop the spread of the illness.