Cholera is an infection of the intestines caused by bacteria called Vibrio cholerae. It causes a watery diarrhea that can range from mild to extremely severe.
Cholera is rare in the United States but if you travel with your child to parts of the developing world, your child may contract cholera by drinking water or, less commonly, eating food such as raw or undercooked shellfish contaminated with V cholerae. Cholera has occurred in children who have visited Latin America or Asia or consumed food imported from that part of the world. Contaminated crabs, oysters, and other shellfish from the Gulf of Mexico have also caused cholera. It is probably not spread through person-to-person contact.
There are some species of Vibrio that do not cause cholera, although they can produce diarrhea and may be responsible for blood and wound infections. They are associated with preparing or eating raw or undercooked seafood, particularly oysters, shrimp, and crabs.
Signs and Symptoms
In some cases of Vibrio infection, no symptoms are present. In most cases, however, there is mild to moderate diarrhea. In a relatively small number of cases, the watery diarrhea becomes severe and dehydration occurs. Vomiting, sometimes severe, is common.
Early signs of dehydration include thirst, dry mouth, sunken eyes, and decreased urination. In the most severe cases, especially when lost fluids are not replaced, very serious complications can develop, including seizures, shock, and coma.
In noncholera Vibrio infections, the most common symptom is diarrhea, with watery stools accompanied by abdominal cramps. Other symptoms may include headaches, chills, a low-grade fever, and vomiting. Diarrhea caused by these Vibrio infections can be bloody with mucus.
Skin infections typically are very painful with redness and swelling. Fever is often present. Large blisters may form in more serious infections. When the bacteria gets into the bloodstream, the child will become very ill. There may be bleeding into the skin, low blood pressure, and sometimes shock.
How Is the Diagnosis Made?
Laboratory tests can detect the presence of Vibrio bacteria in the child’s feces, wounds, or blood.
Children with dehydration due to cholera need to be rehydrated right away. This can usually be done with oral solutions made specifically for this purpose and available over the counter. For youngsters who are moderately to severely ill, intravenous fluids may be necessary. They also may be given antibiotics such as trimethoprim sulfamethoxazole, doxycycline, or tetracycline to get rid of the bacteria and shorten the duration of the diarrhea. Antidiarrheal medicines can make the illness worse, particularly in young children, and should not be used.
Noncholera Vibrio infections causing diarrhea usually get better without treatment in 2 to 3 days, but it is important to make sure your child remains well hydrated. Antibiotics may be prescribed for severe infections.
For skin infections, your child will need antibiotics. If the infection is mild, an oral antibiotic will be given. More serious skin infections and bacteria in the blood are treated in the hospital with intravenous antibiotics. In some cases, your child may require surgery to drain pus and damaged tissues.
V cholerae can be killed by boiling, filtering, or treating water with chemicals such as chlorine or iodine. Adequately cooking food that may contain the organism will also destroy bacteria. Leftover cooked seafood should be refrigerated as soon as possible.
When traveling abroad:
- Take precautions such as making sure your food is thoroughly cooked and the water is boiled. Avoid salads, raw vegetables, fruits that have already been peeled, and food from street vendors.
- Consume safe beverages such as carbonated drinks with no ice and tea and coffee prepared with boiled water.
When taking measures like these, the risk of contracting cholera is low.
Although 2 cholera vaccines have been made, they are of only limited effectiveness and not available in the United States.