Epidemiology
Source: Clinical Case Definition Complications: Contaminated water or • Profuse, watery diarrhea food • Severe electrolyte imbalance Incubation • Colorless stools with small • Acute renal failure Anatomical source 1-3 days flecks of mucus (“rice-water” stools) • Coma Stools (Few hours-5 days) Transmission • Vomiting • Shock • Death • Ingestion of contaminated • Muscle cramps water or food, esp. raw • Loss of skin elasticity or undercooked seafood • Often asymptomatic Endemic on Gulf • Direct person-to-person coast of Louisiana transmission unlikely Very low incidence in the U.S. and Texas Infectious Dose 100 million bacteria More common in developing countries.
Diagnosis
Microbiology: Vibrio cholerae is a gram-negative, curved, motile bacillus. Serogroups O1, O139, and O141 are associated with clinical cholera. Probable: Clinically compatible case Lab Diagnosis Confirmed: Clinically compatible • Culture: Fecal specimens or vomitus cultured on thiosulfate citrate bile salts sucrose agar. case that is laboratory-confirmed - Culture for V. cholerae is not routine; must be requested for clinically suspected cases - Send to state lab for serogrouping -Serogroups O1 or O139 should be sent to CDC
Treatment, Prophylaxis
Treatment
• Oral rehydration therapy: initiate as soon as diagnosis is suspected to correct dehydration and electrolyte imbalance.
• WHO’s Oral Rehydration Solution (ORS) is standard, but rice-based ORS or amylase- resistant starch ORS is more effective Chemoprophylaxis: • Antimicrobial therapy: Moderate to severe cases Not recommended in • Oral doxycycline (single dose) U.S. unless there is a • Tetracycline (3 days): Not usually recommended for children <8 years old, but may be high probability of fecal used in severe cases exposure • Ciprofalxin, ofloxacin, trimethoprim-sulfamethoxazole: may be used if strain is tetracycline-resistant
Standard precautions Control Report immediately to OPH
Take extra precautions when Prevention: traveling to developing countries • Only drink/use safe, sanitized water • Wash hands often • Do not defecate in bodies of water No vaccine • Cook food well, especially seafood available in U.S.
http://www.infectiousdisease.dhh.louisiana.gov (800)256-2748