Cholera

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A highly infectious acute diarrhoeal disease which is endemic in many developing countries in the world.

Causes

  • Cholera is caused by Vibrio Cholerae, Serotype 01 and Serotype O139 that spreads through the faecal-oral route.

Signs and symptoms

  • Abrupt severe painless (not always) watery diarrhoea (rice-water stools) which quickly leads to profuse watery stools, vomiting, severe dehydration and muscular cramps.

Complications

  • Hypovolemic shock with multiple organ failure
  • May quickly lead to death.

Investigations

  • Darkfield microscopy revealing motile curved bacillus of fresh rice water stool specimen
  • Fresh stool or rectal swab culture

Treatment objectives

  • Rapidly restore hydration
  • Eradicate causative organism
  • Prevent spread of the disease

Pharmacological treatment

Rehydration

  • Intravenous Ringer’s lactate or Darrow’s solution
  • Oral rehydration therapy
  • Follow assessment guidelines on rehydration guidelines outlined in Diarrhoeal Diseases section

Doxycycline oral or IV

Single dose

7 mg/kg orally or intravenously and not to exceed 300 mg/dose

Multiple doses

2 mg/kg orally or intravenously twice daily on day 1

THEN

2 mg/kg on days 2 and 3

Do not exceed 100 mg/dose

OR

Ciprofloxacin oral

Single dose: 30 mg/kg orally

Multiple doses: 30 mg/kg/day orally divided every 12 hours for 3 days

OR

Azithromycin oral

1G single dose

Note: Antibiotic therapy should be used as an adjunct to appropriate fluid and electrolyte replacement

Prevention

  • Proper disposal and treatment of all materials that may have come into contact with cholera patients’ faeces (e.g., clothing, bedding, etc.)
  • Drink clean, boiled, or treated water
  • Wash hands frequently with soap and clean running water after using the toilet and before handling food or eating 
  • Ensure adequate disposal of human waste
  • Cholera vaccination

Referral

 In suspected cases of cholera, notify the District Medical Officer immediately and use the latest cholera treatment guidelines.

Note: Management of information on suspected cases should be at the highest ethical and professional standards. This is critical in ensuring that there is no public disorder, anxiety, and loss of confidence in the government and MOHS.