Cholera is an acute intestinal infection which may cause severe, occasionally lethal, diarrhoea and now affects over 98 countries worldwide. Several pandemics have swept through the world. 01 biotype El Tor and first appeared in Indonesia, but then progressively spread through Eastern Asia, the Indian subcontinent, Russia, the Middle East, Africa and, in this decade, Latin America. The majority of individuals are asymptomatically infected with the organism, and they may act as important reservoirs of infection, excreting the bacteria for 1-2 weeks. The disease is characterized by painless diarrhoea with the production of large volumes of watery fluid which can rapidly lead to severe dehydration and death if vigorous therapy is not promptly instituted.
Vomiting is also usually present.
Cholera is spread by faecally contaminated water and food with large outbreaks usually due to sewage pollution of water supplies. Travellers to developing countries in Asia, Africa and Latin America are potentially exposed to the organism in countries where water supplies, sanitation, food safety and hygienic practices are inadequate. The most important aspect of treatment is prompt rehydra-tion and replacement of electrolytes lost through vomiting and diarrhoea. Severely dehydrated patients may require intravenous rehydration. Antibiotics may also be of help in reducing the duration of illness in patients with severe disease.