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Overview
Cholera is an infection of the small intestine by the bacterium Vibrio cholerae.[1][2]
Symptoms
Symptoms may range from none, to mild, to severe[2], but the classic symptom is large amounts of watery diarrhea, that lasts a few days.[3]
Other symptoms
Vomiting, and muscle cramps may also occur with the disease .[2]
Dehydration
Diarrhea can be so severe, that it leads to severe dehydration, and electrolyte imbalances within hours.[3]
Signs of dehydration
Severe dehydration can give the patient sunken eyes, cold skin, decreased skin elasticity, and wrinkling of the hands and feet.[4] Dehydration can cause the skin to turn bluish.[5]
Timing of symptoms
Symptoms typically start two hours, to five days after exposure.[2]
Cause
Cholera can be caused by different types of Vibrio cholerae, with some types producing more severe disease than others, which can make some outbreaks more severe than others.[3]
Spread
The main cause of Cholera is drinking unsafe water, that has been contaminated with human feces containing the bacteria, or unsafe food contaminated by infected water.[3]
Poorly cooked food
Undercooked seafood is a common source for the disease.[6], and humans are the only animal affected.[3]
Risk factors
Risk factors for the disease include poor sanitation, not enough clean drinking water, and poverty.[3]
Effect of global warming
There are concerns that rising sea levels, caused by global warming, will increase rates of disease.[3]
Diagnosis
Cholera can be diagnosed by a stool test.[3]
Prevention
Prevention methods against cholera include improved sanitation, access to clean water, and good hygiene.[4]
Vaccination
Cholera vaccines that are given by mouth, provide reasonable protection to the disease for about six months[3], and, they have the added benefit of protecting against another type of diarrhea, caused by E. coli.[3]
Treatment
The primary treatment is oral rehydration therapy—the replacement of fluids with slightly sweet and salty solutions.[3] Rice-based solutions are preferred.[3]
Zinc
Zinc supplementation is useful in children.[7]
IV fluids and antibiotics
In severe cases, intravenous fluids, such as Ringer's lactate, may be required, and antibiotics may be beneficial.[3] Testing to see which antibiotic the cholera is susceptible to, can help guide the choice.[2]
Epidemiology
Cholera affects an estimated 3–5 million people worldwide and causes 28,800–130,000 deaths a year.[3][8]
Developing nations
Although it is classified as a pandemic disease as of 2010[update], it is rare in the developed world,[3]and affects mostly the children of developing countries.[3][9]
Outbreaks vs chronic disease
Cholera occurs as both outbreaks, and chronically in certain areas.[3] Areas with an ongoing risk of disease, include Africa, and Southeast Asia.[3]
Risk of death
The risk of death among those affected is usually less than 5%, but can be as high as 50%.[3] Not having access to treatment dramatically increases the risk of death.[3]
History
Descriptions of cholera are found as early as the 5th century BC in Sanskrit.[4] The study of cholera in England by John Snow, between 1849 and 1854, led to significant advances in the field of epidemiology.[4][10] Seven large outbreaks have occurred over the last 200 years, with millions of deaths.[11]