A bacterium called Vibrio cholerae causes cholera infection. However, the deadly effects of the disease are the result of a potent toxin called CTX that the bacteria produce in the small intestine. CTX binds to the intestinal walls, where it interferes with the normal flow of sodium and chloride. This causes the body to secrete enormous amounts of water, leading to diarrhea and a rapid loss of fluids and salts (electrolytes).
Contaminated water supplies are the main source of cholera infection, although raw shellfish, uncooked fruits and vegetables, and other foods also can harbor V. cholerae.
Cholera bacteria have two distinct life cycles — one in the environment and one in humans.
Cholera bacteria in the environment
Cholera bacteria occur naturally in coastal waters, where they attach to tiny crustaceans called copepods. The cholera bacteria travel with their hosts, spreading worldwide as the crustaceans follow their food source — certain types of algae and plankton that grow explosively when water temperatures rise. Algae growth is further fueled by the urea found in sewage and in agricultural runoff.
Cholera bacteria in people
When humans ingest cholera bacteria, they may not become sick themselves, but they still pass the bacteria in their stool. When human feces contaminate food or water supplies, both can serve as ideal breeding grounds for the cholera bacteria.
Because more than a million cholera bacteria — approximately the amount you'd find in a glass of contaminated water — are needed to cause illness, cholera usually isn't transmitted through casual person-to-person contact.
The most common sources of cholera infection are standing water and certain types of food, including seafood, raw fruits and vegetables, and grains.
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- Surface or well water. Cholera bacteria can lie dormant in water for long periods, and contaminated public wells are frequent sources of large-scale cholera outbreaks. People living in crowded conditions without adequate sanitation are especially at risk of cholera.
- Seafood. Eating raw or undercooked seafood, especially shellfish, that originates from certain locations can expose you to cholera bacteria. Most recent cases of cholera occurring in the United States have been traced to seafood from the Gulf of Mexico.
- Raw fruits and vegetables. Raw, unpeeled fruits and vegetables are a frequent source of cholera infection in areas where cholera is endemic. In developing nations, uncomposted manure fertilizers or irrigation water containing raw sewage can contaminate produce in the field.
- Grains. In regions where cholera is widespread, grains such as rice and millet that are contaminated after cooking and allowed to remain at room temperature for several hours become a medium for the growth of cholera bacteria.
- Harris JB, et al. Cholera. The Lancet. 2012;379:2466.
- Ferri FF. Ferri's Clinical Advisor 2014: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2014. https://www.clinicalkey.com. Accessed Nov. 18, 2013.
- Cholera — Vibrio cholera infection. Centers for Disease Control and Prevention. http://www.cdc.gov/cholera/index.html. Accessed Nov. 18, 2013.
- Cholera. World Health Organization. http://www.who.int/mediacentre/factsheets/fs107/en/. Accessed Nov. 18, 2013.
- Brooks GF, et al. Jawetz, Melnick, & Adelberg's Medical Microbiology. 26th ed. New York, N.Y.: The McGraw-Hill Companies; 2013. http://www.accessmedicine.com/content.aspx?aID=57032697&searchStr=cholera. Accessed Nov. 18, 2013.
- WHO position paper on oral rehydration salts to reduce mortality from cholera. World Health Organization. http://www.who.int/cholera/technical/en/. Accessed Dec. 30, 2013.
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