Cholera: What is it? Causes, Symptoms, Diagnosis, Treatment and Prevention

This is a bacterial infection caused by drinking contaminated water.

Infection of the small intestine caused by Vibrio cholerae bacteria is called cholera.

There are many types of bacteria that are believed to be responsible for causing cholera, and this infection occurs in varying degrees of severity.

This infectious disease, which is caused by a bacterial toxin , affects the absorption of water in the small intestine.

In severe cases, it produces violent diarrhea in just a few days.

The dangerous aspect of cholera is the great loss of fluid that can occur in a short space of time. It is particularly dangerous in children in developing countries.

If left untreated, fluid loss can be fatal within 24 hours of developing the disease.

On the other hand, the treatment is simple: replace the fluid with the correct combination of sugar and salts, since the water alone is not adequately absorbed.

But severe cases require hospitalization, where fluids can be delivered directly into the bloodstream through a drip.

Cholera is not really a tropical disease, but it is related to hygiene standards and the quality of drinking water.

Improved sanitation and hygiene remain the basic foundation of cholera control in countries where it occurs.

Vibrio cholerae bacteria are highly contagious and cause painless, watery, and profuse diarrhea that can quickly lead to severe dehydration and death if not treated right away. The bacteria are excreted through the feces.

One of the most common ways to obtain it is to drink water contaminated by the feces of the victims of the disease.

The Vibrio cholerae O-group 1 bacteria live in close association with zooplankton, particularly the tiny crustaceans known as copepods.

It is not unusual for a single copepod to provide a home for 10,000 vibrio cholerae, enough bacteria to cause disease. Cholera now kills about 5,000 people a year.

In the Middle Ages, it killed perhaps millions of people a year and continued to be a major killer in Europe until the 19th century when its connection to contaminated water was discovered and the incidence of the disease was greatly reduced with a better sanitation.

Cholera reached Latin America for the first time since 1895. New strains have now appeared in India, Bangladesh, and other parts of Asia.

Causes of cholera

Cholera is caused by a specific bacteria: Vibrio cholerae.

Currently there are many serogroups of the bacteria, but only O1 and O139 cause epidemic outbreaks.

When an adequate amount of the bacteria has passed into the stomach in food, they accumulate and begin to produce harmful substances (toxins).

And it is the toxin that causes the symptoms of the disease.

Cholera toxin has the ability to affect the cells of the gastrointestinal tract, so the affected person not only has ordinary diarrhea but also begins to lose large amounts of fluid.

It is this loss of fluid that can be serious.

Bacteria are excreted in the stool and if this stool comes into contact with drinking water, the bacteria can infect the people who drink it.

Bacteria can also spread to prepared foods if people don’t wash their hands well after using the toilet.

The disease can be transmitted through fish and shellfish obtained from contaminated water.

Shellfish filter large amounts of water and concentrate bacteria.

The cholera outbreak in Peru in 1998 was thought to be related to contaminated algae, and this appears to be an effective way for cholera to spread to the shores of Ghana in West Africa where it has suffered from cholera epidemics in recent years. years.

Direct infection from contact with another person through feces or vomit can occur, but it is very rare.

It takes a certain amount of bacteria before people with normal amounts of stomach acid get sick.

Acids in the stomach can kill small amounts of bacteria.

So the bacteria need a chance to multiply in water or food before they really pose a risk.

Haiti had an outbreak caused by infected water from water sources used by locals, from contaminated toilets.

Risk factors are associated with dietary and hygienic problems, due to nutrient deficiencies and autoimmune conditions that affect the general health of the patient.

Some of the common causes of cholera are:

  • People with type O blood groups are more likely to get a cholera infection.
  • The consumption of surface or well water that has been neglected for a long time.
  • People who live near coastal waters are more likely to have cholera infection.
  • Eating bland food is not always a great idea. The simpler the food you have, the greater the chance of cholera.
  • This infection cannot survive if the stomach acid level is adequate. It is best to take antacids only when you have severe heartburn, as the mere absence of heartburn proves to be a breeding ground for multiple problems such as cholera.
  • Consumption of cereals such as rice and millet that are grown in areas where there is contamination with cholera.
  • Consuming uncooked or undercooked fruits and vegetables, without peeling, and without proper washing is a risk factor for being infected with cholera. Fruits and vegetables that are watered with contaminated water are an excellent breeding ground for cholera.
  • Food that is prepared and stored for a long time before consumption.
  • Ingesting water contaminated with the bacteria that cause cholera.
  • Living in unsanitary conditions. Cholera can be caused and transmitted from unsanitary conditions with dirty environments.
  • In cases of humanitarian or overcrowding crises, water supply and sanitation systems are disrupted, which can increase the risk of cholera transmission.
  • Cholera is extremely contagious and is passed from person to person through infected fecal matter that has contaminated food or water and when someone else consumes it.
  • If you have someone around you who suffers from cholera, then the tendency to become contaminated may increase.

Cholera symptoms

In most cases, cholera is asymptomatic.

The first symptoms of cholera when they appear, are indicated in the form of an upset stomach.

Presence of diarrhea and nausea that cause a patient’s body to lose a large amount of electrolytes.

Dehydration occurs when the patient has this reduction in electrolyte levels.

Dehydration problems can become severe or mild depending on the toxins from the bacteria have attacked the immune system.

Vomiting occurs during the onset of cholera, and can last for a long time, therefore it becomes essential that any nausea condition should be treated as soon as possible, to avoid dehydration.

Diarrhea in cholera is often a different shade, pale and milky in color and extremely watery.

Muscle pain is very severe depending on the level of the disease.

Children can have seizures and, in severe cases, can also go into a coma.

Low blood pressure resulting from electrolyte loss and excessive dehydration also becomes a major factor in the disease.


Cholera must be distinguished from clinically similar diseases caused by enterotoxin-producing strains of bacteria such as Escherichia coli, Salmonella, and Shigella.

The diagnosis of cholera is confirmed by stool culture (the use of selective media is recommended) plus subsequent serotyping.

Tests for V. cholerae are available in most laboratories.

Polymerase chain tests are also an option.

Rapid screening tests for cholera are available for use by public health institutions in areas with limited access to laboratory tests.

Tests to measure serum electrolytes, blood urea nitrogen, and creatinine may also be ordered.

Cholera treatment

Cholera needs immediate treatment, as this disease can kill the patient in a matter of hours.

The following steps are carried out for the treatment of cholera:


The main goal of treatment in cholera is to replace lost fluids and electrolytes with the use of oral rehydration salts.

About half of cholera patients die due to lack of timely rehydration of the patient.

IV fluids

Intravenous fluids are required if the cholera patient is severely dehydrated and oral fluids are not sufficient for the patient or are not retained by the patient.

Zinc supplements

Zinc also helps decrease the duration of diarrhea in children with cholera.

The degree of this dreaded disease can be controlled through proper diet, medication, and adequate rest.

Cholera prevention

The susceptibility to cholera is quite high in most of the malnourished population or in people with immunodeficiency problems.

Hygiene should be maintained by washing your hands well and avoiding the intake of raw foods such as eating fruits and green vegetables, it is better to clean and cook them carefully, otherwise, there is a high risk of presenting severe episodes of cholera.

Drinking clean and safe water is a necessary measure to avoid this and any other water-borne disease.

Preventive measures are easy to undertake and consist of adopting a multidisciplinary approach.

Preventions include surveillance by public health agencies for endemic outbreaks, water care (chlorine treatment, water filtration, safe water tanks).

Sanitation practices and promotion of hygiene practices at home, timely treatment (oral and intravenous rehydration) and oral vaccination with drugs such as Dukoral, Shanchol and Euvichol.