RISK FACTORS:Traveling or living in epidemic areas, Exposure to contaminated food or water, Person-to-person transmission (rare), Attack more severe in blood group O then AB, Individual with low gastric acid secretion/on acid-suppressing medications
GENERAL MEASURES:
โข Determination of the amount of fluid loss (may compare patientโs previous weight to current weight)
โข Rehydration therapy. Oral for mild to moderate cases. Patients with severe dehydration may require intravenous replacement.
DRUG(S) OF CHOICE:
* Oral rehydration therapy, for mild disease:
. Oral rehydration solution (ORS) commercial brands available (Pedialyte, Rehydralyte, Resol, Rice-Lyte)
OR . ORS formula from World Health Organization (WHO)
* Rehydration for severely dehydrated patients:
. IV rehydration (Ringerยfs lactate) is followed by oral or nasogastric administration of glucose or sucroseelectrolyte solution
. Antibiotics
. For older children and adults - doxycycline (Vibramycin)
- 300 mg once or 100 mg bid for 3 days or tetracycline 50 mg/kg/day for 3 days
. For young children - trimethoprim-sulfamethoxazole (SMX-TMP, Bactrim, Septra) 8 mg/kg trimethoprim plus 40 mg/kg sulfamethoxazole per day, divided q12h. This dosage is equivalent to 1 mL/kg of SMX/TMP suspension. Alternatively, furazolidone (Furoxone) 5-10 mg/kg/day divided q6h for 3 days.
. In pregnancy - furazolidone 100 mg qid x 7-10 days.
PATIENT MONITORING : Follow patient until symptoms resolved
PREVENTION/AVOIDANCE:
. Water purification
. Careful food selection, e.g., no unpeeled raw fruits or vegetables, no raw or undercooked seafood
. Enteric precautions :
. Tetracycline for contacts
. Natural infection confers long-lasting immunity
. Prophylactic vaccine :
. 50% effective for 3 to 6 months
. Not recommended unless required by destination country, and if so, a single dose is sufficient
. Concomitant administration with yellow fever vaccine may result in reduced vaccine response to yellow fever
. Invariably associated with local side effects
. Systemic side effects of fever and malaise
. A new vaccine shows promise, but still in the testing stage
POSSIBLE COMPLICATIONS
. Hypovolemic shock
. Chronic biliary infection
. Up to 50% mortality with untreated shock
. Intermittent stool shedding
EXPECTED COURSE/PROGNOSIS:
. Prompt oral or IV treatment can be lifesaving
. Appropriate disposal of human waste
. Antibiotic treatment reduces duration and infectivity of disease
. Mortality less than 1% with appropriate supportive care
. Increased mortality with untreated hypovolemic shock
AGE-RELATED FACTORS :
Pediatric:
โข Breast-feeding is protective against cholera
โข Vaccine not recommended for children less than 6 months