CHOLERA

An acute water-secreting diarrhoeal infection involving the entire small bowel. It is very serious and spreads rapidly,
and usually occurs as an epidemic. Cholera is a notifiable disease.

Cause

  • Vibrio cholerae, spread by faecal-oral route

Clinical features

  • Incubation period is between 1-3 days

Sub-clinical form

  • Mild, uncomplicated diarrhoea

Acute form

  • Abrupt severe painless watery diarrhoea (rice-water stools)
  • Excessive vomiting and fever
  • Muscular cramps, weakness
  • Rapid onset severe dehydration with oliguria and collapse, decrease in consciousness

Differential diagnosis

  • Acute bacillary dysentery (shigellosis)
  • Viral enteritis
  • Acute food poisoning
  • Severe falciparum malaria (‘algid malaria’)

Investigations

  • Stool culture (fresh stools or rectal swabs)
  • Mobile vibrios under microscope

Management

Up to 90% of patients with cholera only require prompt oral rehydration. Only severely dehydrated patients
need IV fluids and antimicrobials

  • Start rehydration with ORS and isolate
  • Give oral (ORS) or IV fluids (Ringer’s lactate) according to degree of dehydration
  • Give glucose IV for hypoglycemia
  • Give maintenance fluid; at least 4-5 litres/day
  • Doxycycline 300 mg single dose (children 4 mg/ kg single dose)
    Or erythromycin 25-50 mg/kg every 6 hours for 3 days in children under 12 years
  • Or ciprofloxacin 1 g single dose or 20 mg/kg 12 hourly for 3 days
Caution
  • Ciprofloxacin, doxycycline: usually contraindicated in pregnancy and children < 8 years but single dose in
    cholera should not provoke adverse effect
  • Alternative: erythromycin 500 mg every 6 hours for 5 days

Prevention

Educate the patient/public to:

  • Rehydrate with plenty of fluids
  • Continue breastfeeding or weaning
  • Personal and food hygiene, e.g. washing hands before preparing and eating food and after using the toilet
  • Using and drinking clean safe water
  • Proper human faeces disposal
  • Prompt isolation, treatment, and reporting of cases