Cholera is an acute diarrheal disease caused by the gram-negative organism “vibrio cholerae”. It is transmitted by contaminated water or food. Humans are the only known its natural hosts. Its incubation period is very short, usually 6 hours to 5 days (average 2-3 days).

Clinical Features: Many patients infected with cholera have mild disease, with 1-2% developing severe diarrhea. Severe watery diarrhea presents with vomiting that rapidly leads to hypovolemic shock, metabolic acidosis and death. There is a sudden onset of massive, frequent, painless, watery stools, generally having a “rice-water” consistency containing some mucus but no pus cells or blood. Low grade fever occurs in some patients. Vomiting may be projectile and is not accompanied by nausea with in 2-3hours, the massive loss of fluid and electrolytes results in life-threatening dehydration with marked weakness and collapse. Fluid therapy is not initiated, renal failure with uremia will occur and death rapidly ensues. The illness lasts 1-7 days and is shortened by appropriate antibiotic therapy.

Lethargy, seizures, fever, hypoglycemia, Acute renal failure, pulmonary odema during rapid fluid correction and death are its main complications.

Diagnosis:

Diagnosis of this infectious disease is largely clinical. In endemic areas, any patient with severe, watery diarrhea should be considered a possible case of cholera until confirmed by laboratory investigations.
There may be marked acidosis, hypochloremia, and hypoglycemia on stool microscopy, the characteristic darting motility of vibrios can be recognized in freshwater preparations. Diagnosis is also confirmed by stool culture.

Treatment:

The mainstay of treatment for cholera is fluid and electrolyte replacement. Oral rehydration (ORS) given is the treatment of choice (100 ml/kg/4 hours) vomiting is not a contra-indication to oral rehydration.

ORS can be given as much a patient can take. If the child is not able to take oral fluids, has an ileus, or in shock, IV fluids (Dextrose Saline or Ringer Lactate) are given. Push 20 ml/kg of dextrose saline or ringer’s lactate IV in 10-15 minutes and repeat if shock is not corrected. All this fluid should have glucose to prevent hypoglycemia. Food should be started as soon as fluids deficits are replaced. It will minimize nutritional impact of the illness.

Antibiotics are given to shorten the duration of illness.
Chloramphenicol (75mg/kg/day in three divided doses for 3 days).
Trimethoprim-sulfamethoxazole and ciprofloxacin are also given with doctor’s advice.

Prevention:

Most important method of preventing life-threatening cholera in infants is prolonged Brest-feeding.
Hand washing, safe food and water supply and proper handling of sewage are important preventive measures.
In endemic areas, water and milk must be boiled, food protected from files, and sanitary precautions observed.
All patients with cholera should be isolated.
Cholera vaccine provides 50% efficacy upto 3-6 months after vaccination. It is given parenterally as a twice-dose.
It is not recommended for children younger than 6 months of age.