Key Facts:

• Cholera is an intestinal infection caused by the bacterium Vibrio cholerae, with the most common disease-causing strain being Vibrio cholerae O1. 1
• Cholera can cause severe dehydration. Oral rehydration is the key to cholera treatment. Symptoms of dehydration include:
• Watery diarrhea, sometimes called "rice-water stools"
• Vomiting
• Thirst
• Leg Cramps
• Restlessness or irritability
Symptoms from [1]
• 1 in 10 people with cholera will experience severe symptoms 2
• Cholera spreads through contaminated drinking water. 1
• Adding solutions like chlorine or cooling the water can lower your risk of getting cholera 1. See the "Water Treatment" section for a full list of preventions and treatments.
• If you are caring for someone with cholera, you must wash your hands thoroughly after touching anything that might be in contact with the patients' feces 1.

  

• V. cholerae is transmitted through contaminated food or water. The source of contamination is usually through the feces of cholera patients. 1

  

  Table from the CDC [1].

• There is little evidence of direct person-to-person transmission. 1

The signs and symptoms of cholera are caused by the cholera toxin produced by V. cholerae.

Clinical features

• 75% of cholera patients are asymptomatic
• Of the patients that do show symptoms, they usually have a mild illness
• Around ~2% of the infected will have severe cholera (or cholera gravis)
• Symptoms of severe cholera:
• Severe dehydration
• Sunken eyes
• Dry mouth and lips
• Poor skin turgor
• Decreased blood pressure
• Poor or absent pulses

Rehydration Therapy

• Before the invention of rehydration therapy, 30-50% of patients with typical severe cholera died. Now, the mortality rate is less than 1%.
• 80-90% of patients can be treated with an oral rehydration solution

Antimicrobial Therapy

Antimicrobials can:

• Reduce fluid loss
• Shorten the duration of diarrhea
• Reduce the length of carriage of cholera in the feces

Antibiotics are recommended for:

• Moderate to severe dehydrated patients
• Patients who pass large volumes of stool while being on the rehydration treatment
• All hospitalized patients
• Asymptomatic patients should not receive antibiotics, to reduce the risk of antibiotic resistance

• Hypoglycemia (low blood sugar): is common and lethal in children with cholera
• Acute pulmonary edema: risk among elderly, young children, and anemic patients
• Renal failure (anuria): rare and occurs when shock is not rapidly corrected. Hospitalized patients should be checked for urine output before discharge.
• Hypokalemia: suspected in cases of repeated painful cramps

If available, suspected cholera patients should be tested by stool culture. For rural areas, the Crystal® VC Rapid Diagnostic Test (RDT) Procedure is recommended.

The WHO organization recommends rural areas use the following definition for cholera cases: 2

• Suspected Cholera Case
• If a cholera outbreak has not been declared, any patient 2 years or older with watery diarrhea and severe dehydration, or is dying from watery diarrhea, is a suspected cholera case.
• In areas with a declared cholera outbreak, any person presenting with or dying from watery diarrhea is a suspected cholera case.
• Confirmed Cholera Case
• Vibrio cholerase O1 confirmed by stool culture or PCR, or if the strain is confirmed to be toxigenic

Common Symptoms

Image from [4]

References

1. Haiti Cholera Training Manual: A Full Course for Healthcare Providers. (2011). Retrieved from https://www.cdc.gov/cholera/pdf/haiticholera_trainingmanual_en.pdf
2. Illness and Symptoms. (2020, October 02). Retrieved December 13, 2020, from https://www.cdc.gov/cholera/illness.html
3. Cholera: Lessons from Haiti and Beyond. Current Infectious Disease Reports. (2011). DOI: 10.1007/s11908-011-0221-9
4. CHAPTER 13: Infectious Disease (CHOLERA) (2014). Retrieved from https://www.slideshare.net/zakkuefuronfrogie/infectious-diseases-34076767