Cholera

FAQs for Health Care Providers

Cholera Risk, Diagnosis, and Treatment in Afghan Evacuees

Have there been confirmed cases in the Afghan evacuees? Yes

Epidemiology

Cholera is a major cause of epidemic diarrhea with an ongoing global pandemic in Asia, Africa, and Latin America for the past six decades. A total of 2.9 million cases and 95,000 deaths are suspected globally every year. There are no recent meaningful epidemiology reports of cholera in Afghanistan although it is considered endemic. There have been 2 confirmed cases in Afghan evacuees.

When should I consider Cholera?

Clinical Presentation

A majority of V. cholerae is asymptomatic (~9 out of 10 cases) with symptomatic cases ranging from minor symptoms (e.g. abdominal discomfort, borborygmi) to vomiting and severe watery diarrhea. Fever is uncommon. The incubation period is dependent on susceptibility and inoculum size (“dose”) ranging from hours-up to 5 days, with the average length of 1-2days. Hallmark finding is profound and rapid loss of fluid and electrolytes through profuse diarrhea, sometimes characterized by “rice-water” stools (watery diarrhea with flecks of mucous). The diarrhea odor has been described as “fishy”. Watery emesis may occur. In children, sunken eyes, dry mouth, cold clammy skin, decreased skin turgor and wrinkled hands and feet, sometimes called “washer women’s hands” occurs. Hypovolemia may occur within hours of onset of severe diarrhea. Untreated, cholera mortality may reach 50-70% and has the highest rates in infants and children, and elevated rates in pregnant women.

In individual patients it is clinically indistinguishable from other common causes of gastroenteritis. In Afghan evacuees, consider ordering tests in persons with severe, acute onset gastroenteritis.

Is Cholera contagious? No

The disease is not likely to spread directly from one person to another; therefore, casual contact with an infected person is not a risk factor for becoming ill.

Are there special infectious disease precautions for Cholera? No

Chemoprophylaxis of those exposed is not indicated. See CDC for infection control in health care settings.

How do I diagnose cholera?

When testing for a suspect or possible case, obtain a stool sample or rectal swab for a stool culture. The laboratory should be notified since a special media (Cary Blair) is ideal for transport and a selective thiosulfate-citrate-bile salts agar is ideal for isolation and identification. Cholera is reportable in in the United States.

What is the treatment/management of cholera?

• The mainstay of therapy is rehydration with appropriate electrolytes and fluid management.

• Antibiotics shorten the course and diminish the severity of the illness, but they are not as important as rehydration.

• Zinc treatment has been shown to help improve cholera symptoms in children

• For details on treatment see CDC Treatment and UpToDate Cholera Treatment.

Resources and References

• UpToDate Cholera: Clinical features, diagnosis, treatment and prevention

• CDC Cholera—Vibrio cholerae infection

Contributors

Max Stauffer

Hannah Lee, MD

William Stauffer, MD