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• Definition
– This is a form of severe gastroenteritis, characterized
by sudden onset of profuse effortless watery

Cholera diarrhea followed by vomiting and severe

dehydration.
• The most severe form of cholera is called
“cholera gravis”.

Assoc. Prof. Dr. Bilal Ahmad Rahimi

MD, DTM&H, MCTM(TP), PhD(CTM)
Faculty of Medicine
Kandahar University
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January 26, 2017

Etiology
• Vibrio cholerae

Classification of Vibrio cholerae

• V. cholerae has 139 known serotypes The action of cholera
toxin in intestinal
• There are 2 serogroups that cause most of the outbreaks: epithelial cells.
– V. cholerae O1
– V. cholerae O139
• V. cholerae O1 has two biotypes:
– Classical
– El Tor
• Each biotypes has 2 serotypes:
– Ogawa
– Inaba 3 4

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Epidemiology Clinical Features

• The disease is transmitted by the feco-oral
route, the channels of transmission being
contaminated water, contaminated foods or
drinks, or direct person-to-person contact.
• Poor environmental sanitation makes the lifeline
for spread of cholera.
• Some countries of South Asia and Africa are still
reporting outbreaks of cholera.
• Incubation period = 1–2 days, with a variation of
few hours to 5 days.
• Clinical picture shows the following three stages:
• Stage I. Stage of evacuation
– Profuse, effortless watery diarrhea with rice-water
appearance (as many as 50 motions/day) followed
by vomiting and rapidly developing dehydration
• Stage II. Stage of collapse
– Severe dehydration, eventually ending up in shock which
may prove fatal
• Stage III. Stage of recovery
– Signs of clinical improvement in subjects who have escaped
death

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Diagnosis Complications

• Clinical features • Acute kidney injury (acute renal failure)

• Diagnosis in suspected cases needs to be • Hypokalemic nephropathy
confirmed by: • Paralytic ileus
– Direct microscopy of samples of stool, vomitus, • Pulmonary edema
water or food
• Under dark field illumination, organisms appear as several • Arrhythmias
shooting stars in a dark sky.
– Culture on peptone water tellurite (PWT) medium
– Biochemical tests

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Management Management (cont.)

• Rehydration (oral and/or IV)
• Chemotherapy (to cut short the duration of
disease as also to reduce period of vibrio
excretion)
– Tetracycline (Drug of choice for children > 8 years)
– Other antibiotics are erythromycin, furazolidine,
ciprofloxacin and cotrimoxazole.
– A 3-day course is sufficient.
– V. cholerae O139 is resistant to cotrimoxaziole
– Tetracycline-resistant strains of V. cholerae O1 have
also occurred in many countries.
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• Attention must also be directed to sanitation
measures such as water control, excreta
disposal, food sanitation and disinfection.
• The innovative “cholera cot” developed by the
Diarrheal Disease Center, Dhaka, Bangladesh, is
of great utility.
• It is a portable cot with a hole in the middle,
leading to a bucket underneath

Prophylaxis

• Chemoprophylaxis (same drugs as for

treatment and for the same period) is
recommended for household contacts or for a
Cholera hospital in Dhaka,
closed community with outbreak of cholera
showing typical "cholera beds"
• Cholera vaccine (killed; 12,000 million vibrio/
ml) has a protective value of 50% for a period of
3 to 6 months

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