There is an outbreak of cholera in Haiti.
Healthcare professionals in the United States need to be on the lookout for possible cases.
What is cholera?
Cholera is an acute bacterial enteric disease with sudden onset of profuse watery diarrhea and
vomiting. If severe, it can lead to severe dehydration, shock, acidosis, and death in hours.
When should I suspect cholera?
You should suspect cholera in any patient presenting with severe watery diarrhea and vomiting
with severe dehydration, particularly after recent travel from Haiti. 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 Haiti, or in
persons with a recent history of ingestion of raw seafood. The incubation period of cholera is
between two hours and five days.
How do I diagnosis 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.
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.
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.
What antibiotic should I use?
Based on antimicrobial susceptibility testing on strains from the ongoing cholera outbreak in
Haiti, the following antimicrobial regimens may be used to treat confirmed or suspected cases of
cholera possible linked to this outbreak. Note that oral suspensions of most of these medications
are available for young children.
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 CDC’s website
at http://www.cdc.gov/haiticholera/clinicalmanagement/
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 while ill with diarrhea or for 2 weeks after resolution of
symptoms.
