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Cholera is a diarrheal disease caused by the pathogen Vibrio cholerae. The cholera vibrios are a Gram-negative, toxigenic bacterium that infect the intestines.

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The cholera bacteria is usually passed out of the body of an infected person through the feces. These bacteria may then contaminate local food and water supplies. As a result, an individual can get cholera by drinking contaminated water and ingesting contaminated foods.

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Common symptoms may include...

• Extensive watery diarrhea
• Severe vomiting
• Nausea
• Extreme Dehydration
• Muscle cramps

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1. Motility - Vibrio cholerae have flagella, which makes them motile. This flagella allows the bacteria to swim through the lumen of the small intestine in search of nutrient rich cells.

2. Toxin Co-regulated Pilus (TCP) : A form of pili located on the polar ends of the bacteria cells and contribute to colonization due to direct adherence to epithelial cells lining the small intestine.

3. Cholera Toxin : The presence of this toxin leads to an increase in cyclic adenosine monophosphate (cAMP). cAMP is an important intracellular regulatory molecule, however large amounts of it disrupts the normal physiology of intestinal cells. The increase in cAMP causes cells to shed large amounts of water, sodium, and minerals such as potassium.

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The number one way to detect a cholera infection is through stool samples. A healthcare provider may also swab the rectum. These samples then get sent to a lab where experts use cultures of the stool to identify and locate isolation of Vibrio cholerae.

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Cholera is an easily treatable disease and most infected will have mild symptoms. The most effective way to prevent or treat dehydration, which is a major symptom of cholera, is through rehydration therapy. The goal of this treatment is to replenish lost fluids. Oral Rehydration Solution is a powdered mixture of glucose, sodium chloride, and potassium chloride and can be made with boiled or bottled water.

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If properly treated, there are rarely any long term effects of cholera. Diarrhea and vomiting from cholera makes the body lose large amounts of important substances such as electrolytes, fluids, sodium, and potassium. When the body gets depleted of those substances, you get dehydrated and may develop a fast heart rate, hypotension, and low potassium and glucose levels. Severe, untreated dehydration from cholera can result in kidney failure, shock, coma, and death within hours.

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Cholera is rare in the United States, however everyone is still susceptible to it. Ways to prevent obtaining the disease include the following:

• Wash your hands frequently with soap and water
• Drink only safe water, including bottled water
• Eat food that is completely cooked and hot and eat fruits and vegetables that you can peel
• Avoid sushi, as well as raw or undercooked seafood of any kind

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Vaxchora is a single dose, oral vaccine for people aged 2-64 who are traveling to an area of active cholera transmission. It is recommended to take the vaccine 10 days prior to travel and is effective for up to six months. The vaccine reduces extreme diarrhea in people by 90 percent at 10 days vaccination and by 80 percent at 3 months post vaccination. However, this vaccine is not available for use in the United States due to a halt in production in December of 2020. Two other oral vaccines are known as Dukoral and ShanChol and both have similar effectiveness.

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In the U.S., the occurrence of cholera is very low, with around 5 cases per year. Globally, cholera is a major disease. Cholera is especially apparent in resource-limited regions in Africa, Asia, and Latin America. Each year, there are roughly 4 million cases of cholera and between 21,000 to 143,000 die from it worldwide. The disease is most common in areas with inadequate, unsanitary water and food supplies and in developing nations.

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• People with type O blood are twice as likely to develop cholera compared to people with other blood types.

• The first cholera outbreak in the U.S. was in New York and Philadelphia.

• John Snow conducted pioneering investigations on cholera epidemics in England and made the discovery that contaminated water was the key source to outbreaks.

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Centers for Disease Control and Prevention. (2022a, November 14). Cholera - vibrio cholerae infection illness and symptoms. https://www.cdc.gov/cholera/illness.html

Centers for Disease Control and Prevention. (2022b, June 6). Cholera-vibrio cholerae infection: Diagnosis and Detection. https://www.cdc.gov/cholera/diagnosis.html

Centers for Disease Control and Prevention. (2022c, April 11). Cholera- vibrio cholerae infection: Treatment. https://www.cdc.gov/cholera/treatment/index.html

Holmgren, J. (1981, July 30). Actions of cholera toxin and the prevention and treatment of cholera. Nature 292, 413–417. https://doi.org/10.1038/292413a0

Mayo Clinic. (2022, February 26). Cholera: Symptoms and Causes. https://www.mayoclinic.org/diseases-conditions/cholera/symptoms-causes/syc-20355287