Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Mary D. Nettleman, MD, MS, MACP
Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
In this Article
- Cholera facts
- What is cholera?
- What are cholera symptoms and signs?
- What causes cholera, and how is cholera transmitted?
- What is the history of cholera?
- Who is at risk for cholera, and where do cholera outbreaks occur?
- How is cholera diagnosed?
- What is the treatment for cholera?
- What is the prognosis of cholera?
- Can cholera be prevented? Are cholera vaccines available?
- Where can people find more information about cholera?
How is cholera diagnosed?
Preliminary diagnosis is usually done by a caregiver who takes a history from the patient and observes the characteristic rice-water diarrhea, especially if a local outbreak of cholera has been identified. The diarrhea fluid is often teeming with motile, comma-shaped bacteria (presumptively V. cholerae) that can be seen with a microscope. The definitive diagnosis is made by isolation of the bacteria from diarrhea fluid on a selective medium thiosulfate-citrate-bile salts agar (TCBS). Reagents for serogrouping Vibrio cholerae isolates are available in all state health department laboratories in the U.S. Readers may see terms like serotypes Inaba, Ogawa, and Hikojima to describe V. cholerae; they simply indicate which O antigens (O antigens designated A, B, or C) are found on these strains of V. cholerae. PCR tests have also been developed to detect the genetic material of cholera, but currently they are not as widely used as the immunologic tests based on type-specific antiserum.
Definitive diagnosis helps to distinguish cholera from other diseases caused by other bacterial, protozoal, or viral pathogens that cause dysentery (gastrointestinal inflammation with diarrhea).
What is the treatment for cholera?
The CDC (and almost every medical agency) recommends rehydration with ORS (oral rehydration salts) fluids as the primary treatment for cholera. ORS fluids are available in prepackaged containers, commercially available worldwide, and contain glucose and electrolytes. The CDC follows the guidelines developed by the WHO (World Health Organization) as follows:
|Patient condition||Treatment||Treatment volume guidelines; age and weight|
|No dehydration||Oral rehydration salts (ORS)||Children < 2 years: 50 mL-100 mL, up to 500
Children 2-9 years: 100 mL-200 mL, up to 1,000 mL/day
Patients > 9 years: As much as wanted, to 2,000 mL/day
|Some dehydration||Oral rehydration salts (amount in first four hours)||Infants < 4 mos (< 5 kg): 200-400 mL
Infants 4 mos-11 mos (5 kg-7.9 kg): 400-600 mL
Children 1 yr-2 yrs (8 kg-10.9 kg): 600-800 mL
Children 2 yrs-4 yrs (11 kg-15.9 kg): 800-1,200 mL
Children 5 yrs-14 yrs (16 kg-29.9 kg): 1,200-2,200 mL
Patients > 14 yrs (30 kg or more): 2,200-4,000 mL
|Severe dehydration||IV drips of Ringer Lactate or, if not available, normal saline and oral rehydration salts as outlined above||Age < 12 months: 30 mL/kg within one hour*, then 70 mL/kg over
Age > 1 year: 30 mL/kg within 30 min*, then 70 mL/kg over two and a half hours
*Repeat once if radial pulse is still very weak or not detectable
- Reassess the patient every one to two hours and continue hydrating. If hydration is not improving, give the IV drip more rapidly. 200 mL/kg or more may be needed during the first 24 hours of treatment.
- After six hours (infants) or three hours (older patients), perform a full reassessment. Switch to ORS solution if hydration is improved and the patient can drink.
In general, antibiotics are reserved for more severe cholera infections; they function to reduce fluid rehydration volumes and may speed recovery. Although good microbiological principles dictate it is best to treat a patient with antibiotics that are known to be effective against the infecting bacteria, this may take too long a time to accomplish during an initial outbreak (but it still should be attempted); meanwhile, severe infections have been effectively treated with tetracycline (Sumycin), doxycycline (Vibramycin, Oracea, Adoxa, Atridox, and others), furazolidone (Furoxone), erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone), or ciprofloxacin (Cipro, Cipro XR, Proquin XR) in conjunction with IV hydration.
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