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Cholera — Clinical Guidelines

Overview

Cholera is an acute, diarrheal illness caused by infection with the bacterium Vibrio cholerae. It is typically transmitted through contaminated water or food, leading to severe watery diarrhea and rapid dehydration if untreated 1 6.

Diagnosis

Clinical Presentation: Profuse, watery diarrhea, vomiting, rapid dehydration, and hypovolemic shock 1 13.

Laboratory Tests: Stool culture for Vibrio cholerae is definitive 13.

Rapid Diagnostic Tests: ELISA using specific antisera can detect Vibrio cholerae O139 strains 10.

Management

Rehydration: Oral rehydration solution (ORS) for mild cases; intravenous fluids (e.g., Ringer's lactate) for severe dehydration 1 13.

Antibiotics: First-line antibiotics include doxycycline, tetracycline, or azithromycin to reduce duration and volume of diarrhea 1 13.

Supportive Care: Electrolyte management, monitoring for complications like hypovolemic shock 1 13.

Special Populations

Pregnancy: Rehydration and antibiotic use are generally safe but require careful monitoring 1 13.

Pediatrics: Early ORS administration is crucial to prevent severe dehydration and mortality 1 13.

Elderly: Increased risk of complications; close monitoring and aggressive rehydration are essential 1 13.

Key Recommendations

Prompt Rehydration Therapy: Initiate ORS or intravenous fluids immediately for suspected cholera cases to prevent dehydration (Evidence: Strong 1 13).

Antibiotic Therapy: Administer antibiotics such as doxycycline or azithromycin to reduce illness duration and severity (Evidence: Moderate 1 13).

Vaccination Campaigns: Support and participate in oral cholera vaccine campaigns to control outbreaks, especially in endemic regions (Evidence: Expert opinion 1 3).

Enhanced Surveillance and Reporting: Implement robust surveillance systems to promptly detect and report cholera cases for timely public health interventions (Evidence: Moderate 2 5).

References

1 Pawar P. World's cholera vaccine stash is empty-but relief is on its way. Science (New York, N.Y.) 2024. link 2 Zeitoun A, Ibrahim A, Reda El Sayed S, Hobeika E, Karam R. Descriptive analysis of adverse events following immunization with oral cholera vaccine in Lebanon. Frontiers in public health 2024. link 3 Ko M, Cherian T, Groves HT, Klemm EJ, Qazi S. Application of the Child Health and Nutrition Research Initiative (CHNRI) methodology to prioritize research to enable the implementation of Ending Cholera: A global roadmap to 2030. PloS one 2022. link 4 Holzman RS. John Snow: Anesthesiologist, Epidemiologist, Scientist, and Hero. Anesthesia and analgesia 2021. link 5 Ngwa MC, Wondimagegnehu A, Okudo I, Owili C, Ugochukwu U, Clement P et al.. The multi-sectorial emergency response to a cholera outbreak in Internally Displaced Persons camps in Borno State, Nigeria, 2017. BMJ global health 2020. link 6 Ratchford C, Wang J. Modeling cholera dynamics at multiple scales: environmental evolution, between-host transmission, and within-host interaction. Mathematical biosciences and engineering : MBE 2019. link 7 Magaña-Valladares L, Rosas-Magallanes C, Montoya-Rodríguez A, Calvillo-Jacobo G, Alpuche-Arande CM, García-Saisó S. A MOOC as an immediate strategy to train health personnel in the cholera outbreak in Mexico. BMC medical education 2018. link 8 Akman O, Schaefer E. An evolutionary computing approach for parameter estimation investigation of a model for cholera. Journal of biological dynamics 2015. link 9 Eyler JM. The changing assessments of John Snow's and William Farr's cholera studies. Sozial- und Praventivmedizin 2001. link 10 Feodorova VA, Gromova OV, Devdariani ZL, Dzhaparidze MN, Teryoshkina NY. Immunochemical characterisation of Vibrio cholerae O139 O antigens and production of a diagnostic antiserum without absorption. Journal of medical microbiology 2001. link 11 Shahinian ML, Passaro DJ, Swerdlow DL, Mintz ED, Rodriguez M, Parsonnel J. Helicobacter pylori and epidemic Vibrio cholerae O1 infection in Peru. Lancet (London, England) 2000. link05143-0) 12 Ginosar Y, Shapira SC. The role of an anaesthetist in a field hospital during the cholera epidemic among Rwandan refugees in Goma. British journal of anaesthesia 1995. link 13 Kyriacou DN, Newton EJ, Jain A. Imported cholera in a 31-year-old Peruvian female. The Journal of emergency medicine 1993. link90631-g) 14 Bukovský M, Ciznár I. Immunochemical properties of Vibrio cholerae LPS. Folia microbiologica 1993. link 15 Shephard DA. John Snow and research. Canadian journal of anaesthesia = Journal canadien d'anesthesie 1989. link 16 Johnston JM, Martin DL, Perdue J, McFarland LM, Caraway CT, Lippy EC et al.. Cholera on a Gulf Coast oil rig. The New England journal of medicine 1983. link 17 Brown J, Dawe DL, Davis RB, Foster JW, Srivastava KK. Fowl cholera immunization in turkeys. I. Efficacy of various cell fractions of Pasteurella multocida as vaccines. Applied microbiology 1970. link 18 Mosley WH, Ahmed A. Active and passive immunization in the adult rabbit ileal loop model as an assay for production of antitoxin immunity by cholera vaccines. Journal of bacteriology 1969. link

Cholera