Cholera
Definition Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: A00.9 * Notifiable condition. DEFINITION An acute diarrhoeal disease caused by V. cholerae . DIAGNOSTIC CRITERIA Clinical Sudden onset of severe, watery diarrhoea, i.e. ‘rice water’ diarrhoea. Low-grade or no fever. Persistent vomiting not associated with nausea. Rapid fluid and electroly
Definition
Diagnostic criteria
General and supportive measures
Medicine treatment
Referral
ICD-10 code: A00.9
* Notifiable condition.
DEFINITION
An acute diarrhoeal disease caused by V. cholerae.
DIAGNOSTIC CRITERIA
Clinical
- Sudden onset of severe, watery diarrhoea, i.e. ‘rice water’ diarrhoea.
- Low-grade or no fever.
- Persistent vomiting not associated with nausea.
- Rapid fluid and electrolyte losses with dehydration, acidosis and hypovolaemic shock with/without renal failure.
- History of contact with a cholera case or the presence of cholera in the community.
Investigations
- Positive stool culture.
- Agglutinating or toxin-neutralising antibodies in the serum.
GENERAL AND SUPPORTIVE MEASURES
- Isolate patient and institute barrier nursing.
- Ensure adequate hydration and nutrition.
- Check blood glucose in patients with decreased level of consciousness.
The management of the fluid requirements is the most critical element of treating a patient with cholera.
MEDICINE TREATMENT
First treat shock.
Once shock has resolved, manage as acute diarrhoea. See: Diarrhoea, acute.
For the management of shock during recognised cholera outbreaks, there may be benefit to replace sodium chloride 0.9% with:
- Ringers–Lactate, IV.
Antibiotic treatment
Recommended antibiotics may vary according to sensitivities in epidemics. Consult the NICD for the latest recommendations.
Current recommendations for severe dehydration are:
- Ciprofloxacin, oral, 20 mg/kg as a single dose (maximum 750 mg).
OR
- Azithromycin, oral, 20 mg/kg as a single dose.
In all children who are able to take oral medication:
- Zinc (elemental), oral, 10 mg/day for 14 days:
REFERRAL
Cholera with complications, e.g. persistent shock, renal failure and severe electrolyte disturbances.
Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024
Chapter 2: Alimentary Tract, 2.2 Gastrointestinal Disorders, 2.2.1 Cholera