$Unique_ID{BRK03595} $Pretitle{} $Title{Cholera} $Subject{Cholera Asiatic Cholera Epidemic Cholera} $Volume{} $Log{} Copyright (C) 1986 National Organization for Rare Disorders, Inc. 144: Cholera ** IMPORTANT ** It is possible that the main title of the article (Cholera) is not the name you expected. Please check the SYNONYM listing to find the alternate names and disorder subdivisions covered by this article. Synonyms Asiatic Cholera Epidemic Cholera General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section. Cholera is a bacterial infection involving the entire small intestine and marked by severe diarrhea and vomiting. Symptoms are caused by a toxin released by the Cholera bacteria. There are several varieties of these bacteria, which differ somewhat in the severity of illness they cause. Cholera is rare in the United States, but is endemic in India, the tropical parts of Asia, Korea, as well as in the Middle East and parts of Africa. With appropriate treatment, or in mild cases, the prognosis is good, with recovery within about a week; without treatment, mortality can be as high as fifty percent. Symptoms Symptoms of Cholera vary in severity. The mildest infections can be asymptomatic or mild, uncomplicated diarrhea for a few days. Severe Cholera can be life threatening. The first symptoms usually consist of painless diarrhea appearing very suddenly and associated with vomiting. Serious changes in water and salt balance occur when large amounts of fluid, sodium, chloride, potassium, and bicarbonate are lost in this way. Intense thirst, decreased urination, muscle cramps, and weakness can develop. The tissues may become soft and dehydrated so that the eyes look sunken and the skin wrinkled. The blood volume may decrease, with resulting low blood pressure and changes in pulse rate. Metabolic derangements such as acidosis and electrolyte abnormalities may develop. Circulatory collapse, cyanosis (bluish discoloration due to failure of the blood to carry sufficient amounts of oxygen to the tissues), and stupor can result if the illness is not treated. If blood volume remains low for extended periods of time, kidney damage with renal failure can also result. Causes The bacterium that causes Cholera is known as Vibrio cholerae, serogroup 01, and occurs as several, variably virulent, biotypes. The bacteria produce a protein that causes the wall of the small intestine to secrete large amounts of the fluid. Ingestion of water, seafood, vegetables, and other foods contaminated with the excrement of symptomatic or asymptomatic Cholera victims spreads the disease. Affected Population Cholera is endemic in India and parts of the Middle East, Asia, and Africa. In these areas, children are affected most often, with outbreaks occurring during the warmest part of the year. Cholera occasionally spreads to Europe, Japan, Australia, etc., where epidemics can occur at any time of the year and affect persons of all ages equally. Related Disorders Cholera resembles the illness caused by enterotoxin producing strains of Escherichia coli. (E. coli normally inhabits the intestine without causing any symptoms or abnormalities whatsoever, but occasionally virulent strains appear). Some salmonella or shigella infections also produce similar clinical features. Related bacteria of the Vibrio genus that do not produce toxins can cause stomach and intestinal inflammation (gastroenteritis). Pancreatic Cholera is not a bacterial disease at all. Clinical symptoms and complications similar to those of true Cholera result from dysfunction of the pancreas, usually due to a tumor in that organ. Therapies: Standard The symptoms of mild or uncomplicated cases of Cholera resolve spontaneously within 3 to 6 days of onset, and the bacteria disappear with two weeks. Treatment of patients in shock or circulatory collapse aims to restore blood pressure and electrolyte balance to normal levels quickly. Various solutions containing salts and glucose or lactate, administered intravenously, will accomplish this. The patient should also be given as large amounts of fluids by mouth as tolerated. Plasma and related products, and drugs raising blood pressure are useless in Cholera, and should not be administered. After the initial crisis is over, patients may continue on intravenous fluid and salt replacement, or these substances may be given orally to replace stool losses. The pathogenic bacteria can be eliminated with antibiotics, and this will usually prevent severe illness if administered early. Tetracycline is the preferred antibiotic. Furazolidone is effective against resistant strains of the bacteria. To prevent Cholera outbreaks, water supplies must be purified and human excrement disposed of properly. Individuals in areas where Cholera poses a threat should boil water and avoid eating uncooked vegetables. Cholera vaccines exist, but they offer only partial protection, and require booster injections every 6 months. Tetracycline may be used prophylactically to protect against cholera if exposed to contaminated food or water. Persons living in endemic areas usually develop immunity to the Cholera bacterium. Americans travelling to susceptible areas of the world should be vaccinated against this disorder. Therapies: Investigational This disease entry is based upon medical information available through September 1989. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Cholera, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 Centers for Disease Control (CDC) 1600 Clifton Road Atlanta, GA 30333 (404) 639-3311 National Institute of Allergy and Infectious Diseases (NIAID) 9000 Rockville Pike Bethesda, MD 20892 (301) 496-5717 References THE MERCK MANUAL 15th ed: R. Berkow, et al: eds; Merck, Sharp & Dohme Research Laboratories, 1987. Pp. 91, 773, 1064. CECIL TEXTBOOK OF MEDICINE, 18th ed.: James B. Wyngaarden, and Lloyd H. Smith, Jr., Eds.: W. B. Saunders Co., 1988. Pp. 1651-3, 1388-9.