Snapshot A 25-year-old man was brought to the emergency health clinic after a recent earthquake in Haiti. He presents with acute onset of severe watery diarrhea for the past twelve hours, averaging one episode per hour. He reports that the stools are liquid with flecks of mucus. Physical exam reveals sunken eyes, dry mucus membranes and decreased skin turgor. Patient is afebrile. Blood pressure is 90/60 mmHg. Intravenous rehydration with 0.9% normal saline is administered. Introduction Classification bacteria gram-negative bacilli facultative anaerobes Vibrionaceae Vibrio V. cholera Presentation Asymptomatic Mild cholera cannot be distinguished from gastroenteritis from other causes Severe disease "rice water" diarrhea watery with flecks of mucus mild fishy odor vomiting abdominal cramping massive volume and electrolyte losses metabolic acidosis hypokalemia Bacteria is non-invasive 50 - 70% mortality in untreated patients usually within days although may be as quickly as hours Evaluation Culture and Gram stain of stools Treatment Rehydration oral rehydration solution (electrolyte balanced, glucose-containing solution) IV rehydration if cannot tolerate PO Antibiotics after rehydration tetracyclines most commonly used single high dose oral doxycycline shown to be effective antibiotics shorten the duration of symptoms