Cholera - Vibrio cholerae infection

Information for Public Health & Medical Professionals

Listed below are answers to common questions for public health and medical professionals addressing cholera diagnosis, testing, treatment, patient care, and prevention in outbreak and other settings. You will also find publications and patient education materials relevant to cholera.

Public Health and Medical Professionals

What is cholera?

Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae. An estimated 3-5 million cases and over 100,000 deaths occur each year around the world. The infection is often mild or without symptoms, but can sometimes be severe. Approximately one in 10 (5-10%) infected persons will have severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In these people, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.

When should I suspect cholera?

You should suspect cholera in any patient presenting with severe watery diarrhea and vomiting with severe dehydration who may have recently traveled to a cholera-endemic area. The patient may complain of painful cramping in the legs due to electrolyte disturbances. Clinical suspicion should be increased, and milder diarrheal illnesses are more suspect, in persons returning from cholera-endemic areas, or in persons with a recent history of ingestion of raw seafood from a cholera-endemic area. The incubation period of cholera is between two hours and five days.

How do I diagnose cholera?

The diagnosis is made by culturing the organism from the stool. Notify your lab that you are considering cholera so that they will culture on TCBS agar. However, you should not wait for a positive culture before starting aggressive treatment.

How do I treat cholera?

The severe cholera patient may have lost more than 10% of body weight and needs swift volume replacement. Cholera deaths can be prevented by the aggressive administration of fluids. This will correct the dehydration, shock, and acidosis. Antibiotic treatment is less important, but will decrease the duration of illness. More...

What fluids should I give?

This depends on the patient's condition. Patients with mild to moderate dehydration can be given an appropriate oral rehydration salt solution such as Rehydralyte™ or WHO Formula Oral Rehydration Salts (ORS). Only solutions that contain the proper balance of electrolytes should be given.

Patients with severe dehydration or those with intractable vomiting need intravenous therapy with Ringer’s lactate solution. Intravenous fluid should be given quickly to restore the circulation, followed by oral fluids as soon as possible. More...

How much fluid should I give?

Fluid therapy needs to be individualized. Severely dehydrated adults may require several liters of fluid immediately to restore an adequate circulating volume. Base your therapy on the degree of dehydration. Remember that cholera patients will have significant on-going fluid losses that also need to be measured and replaced. More...

What antibiotic should I use?

Antimicrobial susceptibility testing should be conducted on strains from ongoing cholera outbreaks in order to develop appropriate antibiotic treatment guidance for patients. In Haiti, the following antimicrobial regimens were used to treat confirmed or suspected cases of cholera possibly linked to the outbreak since the strain was known to be resistant to nalidixic acid, sulfisoxazole, and furazolidone. Note that oral suspensions of most of these medications are available for young children.

Haiti 2010 Outbreak-specific Guidance for Antibiotic Treatment (Example)

Doxycycline

Adult (non-pregnant): 300 mg in a single dose
Child: 2-4 mg/kg in a single dose

Azithromycin

Adult: 1g in a single dose
Child: 20 mg/kg in a single dose

Tetracycline

Adult (non-pregnant): 500 mg, 4 times/day for 3 days
Child: 12.5 mg per kg,4 times/day for 3 days

Erythromycin

Adult: 500 mg, 4 times/day for 3 days
Child: 12 mg/kg, 4 times/day for 3 days

Clinical management guidelines including antibiotic treatment are also posted on the Cholera Treatment page.

What else should I do?

All suspected or confirmed cases of cholera should be reported to your county or state health department immediately. Do not swim or enter bodies of water like lakes or rivers while ill with diarrhea or for 2 weeks after resolution of symptoms.