References:
- Global Infectious Diseases and Epidemiology Online Network: Infectious Diseases of the Philippines, 2013 eBook Edition, ISBN 978-1-61755-582-4, by Stephen Berger. Accessed here.
| Agent | BACTERIUM. Vibrio cholerae A facultative gram-negative bacillus |
| Reservoir | Human |
| Vector | None |
| Vehicle | Water Fecal-oral Seafood (oyster, ceviche) Vegetables Fly |
| Incubation Period | 1 to 5 days (as early or late as 9 hours to 6 days) |
| Diagnostic Tests | Stool culture Advise laboratory when this organism is suspected |
| Typical Adult Therapy | Stool precautions. Doxycycline 100 mg BID X 5d, or Fluoroquinolone (Levofloxacin, Trovafloxacin, Pefloxacin, Sparfloxacin or Moxifloxacin)., or Azithromycin Fluids (g/l): NaCl 3.5, NaHCO3 2.5, KCl 1.5, glucose 20 |
| Typical Pediatric Therapy | Stool precautions. Age >=8 years: Doxycycline 2 mg/kg BID X 5d. Age <8 years: Sulfamethoxazole/ trimethoprim Fluids (g/l): NaCl 3.5, NaHCO3 2.5, KCl 1.5, glucose 20 |
| Vaccine | Cholera vaccine: injectable or oral |
| Clinical Hints | Massive, painless diarrhea and dehydration; occasionally vomiting; apathy or altered consciousness common; rapid progression to acidosis, electrolyte imbalance and shock; fever is uncommon. |
| Synonyms | Colera, Kolera |
Symptoms and signs of cholera reflect the degree of fluid loss: thirst, postural hypotension, tachycardia, weakness, fatigue and dryness of the mucous membranes.
- Following an incubation period of 12 hours to 5 days, the patient experiences sudden onset of painless, watery diarrhea, which may later be accompanied by vomiting.
- Abdominal cramps may occur.
- Fever is typically absent in adults, but present in children.
- The diarrhea has a “rice water” appearance and fishy odor.
- In patients with severe disease, stool volume can exceed 250 ml per/kg during the first 24 hours (17.5 liters in a 70 kg adult).
- Severe cases exhibit sunken eyes (depressed fontanelles in infants), thready pulse, somnolence or coma.
- Without replacement of fluids and electrolytes, hypovolemic shock and death ensue.
- The clinical features of cholera due to Vibrio cholerae O139 are indistinguishable from disease due to other strains.
- Rare cases of acalculous and infectious cholecystitis have been ascribed to Vibrio cholerae.