Sign In


Read in Hindi

Dr. Santosh Palve


Cholera is the most dramatic form of acute diarrheal disease caused by Vibrio cholerae bacteria. Cholera continues to be endemic in the Indian subcontinent, particularly in the southern and eastern parts, the Indonesian islands, the Philippines, and Latin America; it may also afflict travellers to these countries. The disease is transmitted through contaminated water and food. When a patient’s stool containing the bacteria is not properly disposed of, it leads to contamination of common water bodies. Due to open defecation, various sources of water get contaminated.

Toxins produced by Vibrio cholerae bacteria lead to painless, watery diarrhoea, also called ‘rice water stools’ because of its appearance. The disease may also be associated with vomiting. Rapid loss of fluids from the body cause symptoms of mild fever, body ache, abdominal pain and cramps, lethargy and fatigue, excessive thirst, headaches, loss of elasticity of the skin, etc. The disease can ultimately cause death if not treated rapidly.

Globally, there are four million cases with over 140,000 deaths due to cholera. Around 1.8 million individuals receive water that is contaminated from human faeces. Human faeces may contain the bacteria causing cholera infection. This disease is endemic in about 50 countries, mainly through Asia and Africa.

Also Read


The symptoms of cholera can range from no symptoms to severe diarrhoea. One in 10 infected individuals can show severe symptoms. In some cases, patients might also have vomiting associated with the disease, apart from painless watery diarrhoea. An individual starts showing cholera symptoms within hours or five days after being exposed to cholera-causing bacteria. The most significant risk in cholera is the possibility of the patient getting dehydrated.

Other symptoms that are closely related to the rapid loss of fluids from the body are:

  • Mild fever

  • Body ache

  • Abdominal pain and cramps

  • Lethargy and fatigue

  • Excessive thirst

  • Headaches

  • Loss of elasticity of the skin

  • Dry mouth

  • Dry skin

  • Glassy eyes

  • No tears

  • Dehydration

  • Low urine

  • Rapid heartbeat

  • Sleepiness or tiredness

  • Vomiting

Causes And Risk Factors


Cholera is an acute infectious disease. It is caused by the Vibrio cholerae bacterium. It can produce toxins within the human body leading to painless, watery diarrhoea, also called ‘rice water stools’ because of its appearance.

The disease is transmitted through contaminated water and food. During the monsoons, this problem is further compounded by the overflowing of sewers and waterlogging. Vibrio cholera is present in a patient’s stools, and when this stool is not properly disposed of, it leads to contamination of common water bodies. This infection is commonly seen in countries like Africa, India, Bangladesh, Mexico, South America, and Central America.

Risk Factors

People develop cholera infection in places that lack water or sewage treatment facilities. The following are more at risk of getting infected with this bacterium:

  1. Doctors and nurses who treat cholera patients; 

  2. Cholera response workers; 

  3. Travellers to cholera-infested places;  

  4. Individuals who don’t use safe food and water and lack personal hygiene.. 

  5. Patients with type O blood or H pylori infection are also susceptible to cholera infection.


Although there is a vaccine available in the countries like the United States, India still does not have a vaccination program in place. That being said, the vaccine is not very effective in preventing the disease during an outbreak. 

Tips to keep cholera at bay:

  • Keep your surroundings clean.

  • Drink only boiled and filtered water; the best way to stay safe is to wash your utensils in boiled water as well. Avoid drinking tap water.

  • Avoid ice cubes made from tap water.

  • Avoid eating food from roadside stalls.

  • Avoid eating raw or undercooked meats or unpeeled fruits and vegetables.

  • Always wash your hands well with water and soap after you have visited the bathroom and before eating. People can use an alcohol-based sanitiser that contains at least 60% alcohol if soap and water are not available.

  • Use boiled water to wash utensils.

  • Avoid open defecation.

  • Dispose of the waste far from drinking water sources, especially if an individual has had cholera.


A patient recently travelled to an endemic area and has watery stools are sufficient signs for diagnosis to the doctor. As such, laboratory tests are not required to begin the treatment. A doctor usually diagnoses cholera through either a blood or stool sample, along with the patient’s symptoms. 

In places where cholera is widespread but lacks access to laboratories, a rapid “dipstick’ test is used to check the stool sample. This test is also found to be accurate.

A doctor should suspect a cholera infection if patients above five years of age develop severe diarrhoea, even if there is no cholera endemic.


Apart from prescribing antibiotics, a doctor will advise the patient to replace the fluid lost using oral rehydration solutions constantly. If a patient loses five to 10 per cent of body weight, they are given an oral rehydration solution. Patients can be given an emergency homemade oral rehydration solution using one litre of water, six teaspoons of sugar, and half a teaspoon of salt. Depending on the severity of the condition, a patient might need to be rehydrated intravenously. Proper treatment of severe cholera infection using fluids can reduce the death rate from 10% to less than 0.5%. After the patient’s body volume is restored, the doctor prescribes antibiotics. 

Antibiotics are part of the balancing treatment. They do not prevent death if the patient is not rehydrated. Treatment with antibiotics like doxycycline or tetracycline for days can reduce the infection. Doxycycline is recommended as a first choice for the treatment in adults as well as pregnant women and children. Other antibiotics such as ciprofloxacin, erythromycin, azithromycin, and fluoroquinolones are used as alternative therapies, if the patients develop resistance to doxycycline and tetracycline. Erythromycin is also an effective therapy for cholera in pregnant women and children. Patients below 12 years of age are given low doses of antibiotics. Antibiotics should not be given to patients who have little or no diarrhoea and dehydration.

Zinc can be a complementary treatment for cholera in children under five years of age. Zinc reduces the duration of watery diarrhoea and can also prevent watery diarrhoea in future.

A cholera vaccine prevents severe watery diarrhoea and vomiting. Most individuals do not require this vaccine; however, doctors recommend taking the vaccine to people between 18 to 64 years of age, who are travelling to an area with cholera endemic. The vaccine should not be administered to those who have had severe allergies, used antibiotics recently, took anti-malarial drugs, or have a weak immune system. Vaccines can cause side effects, such as stomach pain, tiredness, headache, loss of appetite, upset stomach, and diarrhoea. However, these side effects are rare and can go away in a few days.


Patients and their family should maintain personal hygiene, use boiling water, and improve sanitation. Breastfeeding should be continued in infected babies as it will provide vital nutrition to them. Once the patient is rehydrated, they should eat a high energy diet to prevent further complications like malnutrition, hypokalaemia, and hypoglycaemia.

Prognosis And Complications


Cholera causes severe dehydration and shock in the patient, which may lead to death. The rate of individuals dying from this disease is higher in pregnant women, children, and the elderly. However, most patients recover entirely after receiving enough fluids. The death rate decreases because of increased accessibility to health care and improved sanitation.



Cholera is a self-limiting condition, and the most significant risk that a patient faces is severe dehydration. Severe dehydration results in loss of electrolytes and leads to a drop in total blood in a patient’s body. This is called hypovolemic shock, which leads to low blood pressure and decreased oxygen level. Dehydration can lead to multi-organ failure, coma and even death.

Alternative Treatments

  • Probiotics: Vibrio Cholerae leads to severe disruption of the gut bacteria. For the restoration of these bacteria, probiotics can be administered to the patients. Probiotics are taken along with antibiotic drugs, but they may lead to side effects in patients. 

  • Unani treatment for cholera starts with evacuation of the stomach, strengthening of body heat and heart, dietary control, and control of vomiting and diarrhoea. In Unani treatment, first, the patient is administered warm water mixed with salt to induce vomiting.

  • Unani home remedies for cholera include:

  • Drinking lots of water is effective in getting rid of cholera.

  • Adding a few pieces of clove to the boiling water

  • Drinking water and basil leaves mixture.

  • Consumption of buttermilk is one of the best home remedies.

  • Drinks like orange juice, lemon juice (sweet or salted), and coconut water with cucumber leaves.

  • Herbal tea made with black pepper, ginger, basil, and mint.

It is always better to consult a doctor before starting any treatment.


  1. Cholera. NCBI. Available at: 

  2. Harris JB, et al. Cholera. Lancet. 2012 Jun 30;379(9835):2466-2476. 

  3. Cholera. CDC. Available at: 

  4. Sources of infection & risk factors. CDC. Available at: 

  5. Cholera. Cleveland Clinic. Available at:,-What%20are%20the&text=Cholera%20infection%20can%20be%20mild%2C%20and%20some%20people%20have%20no,leading%20to%20dehydration%20and%20shock.

  6. Haiza (Cholera). NHP. Available at: 

  7. Cholera. MedlinePlus. Available at: 

  8. Recommendations for the Use of Antibiotics for the Treatment of Cholera. CDC. Available at: 

  9. Cholera. WHO. Available at: 

  10. Cholera. HHS. Available at: 

  11. Hsueh BY, et al. Combating Cholera. F1000Res. 2019 Apr 30;8:F1000 Faculty Rev-589.


Health Calculator

Photo Gallery