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Cholera: Signs, symptoms and

treatment
by myDr | Travel Health

What is cholera?
Cholera is a highly contagious bacterial infection of the bowel caused
by eating food or drinking water contaminated with the bacterium
Vibrio cholerae.

The infection can be asymptomatic (no obvious symptoms) to severe or

life threatening. The most common symptom is severe continued
watery diarrhea. Vomiting may occur in the early stages for a few
hours. Fever is rare.

Most people reported to have cholera have had a history of traveling to

a cholera a@ected area. Symptoms may take up to 2-5 days to appear
and it’s life-saving to start re-hydrating as soon as possible and at least
within 3-4 hours.

Cholera is an ‘urgent notiIable condition’ which means doctors and

pathologists need to report a diagnosis of cholera by telephone to the
Australian government health authorities.

All cases of cholera are to be reported to The World Health

Organization (WHO) and nearby countries by the Australian
Government Department of Health and Ageing.

How is cholera caused or

transferred?
Cholera usually occurs by a person consuming food or water exposed
to faecal contamination. Higher risks include eating undercooked
seafood from coastal waters, drinking inadequately treated water or
adding contaminated ice to drinks. Places with poor sanitation are
higher risk areas.

It is rare for cholera to be transferred from one person to another.

Transfer only occurs between people from the ingestion of water or

food containing the cholera bacteria due to inadequate handwashing
and cleanliness.

Cholera bacteria can persist in an infected person’s faeces for seven to

14 days.

Who is most at risk of Cholera?

Individuals most at risk when exposed to cholera are:  

children;
elderly;
su@ers of gastric achlorhydria (low or no acid in the stomach);
breastfeeding mothers; and
individuals in regions of unsafe drinking water, unclean hygiene and
inadequate sanitation.

Complications
 The table shows the possible severity of symptoms when the condition
worsens:

Cholera symptoms and of level of severity

Low risk Moderate risk High risk

Excruciating abdominal pain

Abdominal pain – loss of appetite,
constipation, diarrhea, nausea and
vomiting
Coughing – airway pain and shortness Chest pain – pain when taking a deep breath, weakness
of breath
with breathing, wheezing and shortness of breath
Lack of concentration – fatigue,
hyperactivity, headache, sweating,
dizziness, weakness and impaired
coordination
Other problems – fever, polyuria
(excessive urination), muscle pain,
pruritis (itchy skin), ocular (eye) pain
and irritation.
(from haemorrhage or
Severe abdominal pain – diarrhea, melena(blood in
perforated gut)
faeces) and vomiting
 
Coma – paralysis and seizure
Lethal heart conditions – severe
bradycardia, severe tachycardia,
respiratory arrest and cardiac
Altered alertness – confusion, hallucination, blurred
arrest
vision, seizure, muscle rigidity, slurred speech and
fainting
Discoloured skin – bluish grey
Abnormal heart conditions – bradycardia (slow heart skin and oedema (swelling)
rate), tachycardia (fast heart rate), chest pain,
Changes in urine production –
hypertension (high blood pressure) and hypotension (low
oliguria (low urine output)  and
blood pressure)
anuria (severe reduction of
urine) 

Adapted from: TABLE: Signs and symptoms by severity category (Modelled

after Persson et. al.,1998 and includes SPIDER database elements).

Tests and diagnosis

The diagnosis of cholera requires a specialist laboratory test of faecal

specimen to identify the bacteria.

Treatment

Immediate treatment is required as cholera  can worsen within hours.

The treatments depend on the severity of the symptoms:

drinking oral rehydration solutions (ORS) containing [uid and salts;

intravenous rehydration;
antibiotics (although cholera can be antibiotic resistant); and
zinc combined with cholera vaccine (containing recombinant cholera
toxin B subunit).

 Prevention

The World Health Organization (WHO) recommends focusing on

prevention of cholera with adequate handwashing, safe water and food
precautions.

The oral killed whole cell B subunit vaccine may be appropriately

recommended for travellers if the region considered for entry is a high
risk area (oral solution).

Simple measures to avoid getting cholera include:

avoiding ice in drinks;

using bottled water for drinking, brushing teeth, washing your face
and hands;
eating foods that have been thoroughly cooked and are still hot, and
only eating meat and seafood if well cooked.

Call your General Practitioner immediately if you have been in a high

risk area and have developed diarrhea and/or some vomiting.

Last Updated: March 25, 2021

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1. A case of cholera. Australian Government - Department of Health. Updated

September 13, 1998. Accessed March 24, 2021.
https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-pubs-cdi-
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Signs and symptoms by severity category (Modelled after Persson et. al.,1998 and
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%25%20of%20people%20infected,akects%20both%20children%20and%20adults

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