Rice-water diarrhea can empty twenty litres a day
Some Vibrio cholerae strains turn the small intestine into a floodgate. Untreated patients may lose ten to twenty litres of watery stool daily, racing toward shock within hours—yet simple oral rehydration salts still reverse most cases when clean water and sanitation fail.
Cholera infects the small intestine with certain Vibrio cholerae strains. Symptoms range from none to severe, classically days of massive watery diarrhea, sometimes with vomiting and cramps. Humans are the only known host. Contaminated water and food carrying fecal bacteria spread it; undercooked shellfish are a frequent vehicle. High-income countries rarely see endemic disease; children fare worst where it persists.
Prevention rests on sanitation and safe water. Oral cholera vaccines give reasonable protection for about six months and also reduce some E. coli diarrhea; in 2017 the FDA approved a single-dose oral vaccine for adults traveling to affected areas. First-line care is oral rehydration salts—slightly sweet-salty fluids, preferably rice-based—plus zinc for children. Severe cases need intravenous fluids such as Ringer's lactate, with antibiotics reserved for selected severe illness.
Estimates put annual burden at three to five million illnesses and 28,800 to 130,000 deaths. Seven pandemics are recorded; the latest began in 1961 and continues. Illness often begins abruptly anywhere from twelve hours to five days after someone swallows the bacteria. "Rice water" stool with a fishy smell is classic; fever is rare and suggests secondary infection. Sunken eyes, dry mouth, clammy skin, and wrinkled hands signal dehydration; Kussmaul breathing can follow acid loss. An untreated patient may purge ten to twenty litres daily. Developed-country cases more often track food; developing-country outbreaks more often track water.
Source: Cholera
