Durban — Health workers have been advised to treat all diarrhoea cases as suspected cholera until proven otherwise.
The head of the Centre for Enteric Diseases at the National Institute for Communicable Diseases, Dr Juno Thomas, said the hallmark of cholera was acute watery diarrhoea.
This is after the cholera outbreak. At the time of writing, the number of laboratory-confirmed cases of cholera is 29. South Africa reported its first cholera death in February after the virus arrived in the country from Malawi.
Thomas said cholera was defined as diarrhoea which is typically watery, non-bloody liquid stools that may contain mucus, passed three or more times within 24 hours.
She said 20% of those infected with cholera – caused by the bacteria Vibrio cholerae – may vomit, while fever is mostly absent. Vibrio cholerae develop into acute watery diarrhoea.
“The classical appearance of stool in severe cases is described as ‘rice water’ in many cases with mild to moderate cholera, stool is watery but cloudy. Therefore, any acute watery stool, regardless of colour, must be regarded as suspected cholera,” said Thomas.
The latest data show that Gauteng and the Free State are the hardest hit, while another case of cholera has been detected in another province yet to be confirmed.
“Locally acquired cases are of great concern because it often means there are many infections that have not been identified. Clinicians should alert the lab before submitting a specimen from a suspected cholera case,” she advised.
Thomas said patient management must never wait for a laboratory diagnosis. The laboratory diagnosis is for public health action and not to guide individual patient management.
Meanwhile, Wits University’s infectious diseases specialist Dr Jeremy Nel said it was uncommon for adults to have severe dehydration from diarrhoea.
“So always think of cholera. If you get the fluids right in cholera, you’re almost fine. Remember that fluid hydration is 90% of the management of cholera.
“If you get this right, even if you don’t have antibiotics and forget about other components, you’re almost certain you’ll be saving lives.”
Nel emphasised that it was important for clinicians not to delay rehydrating the patient. He said the oral volume of fluid needed for moderate cases can be excessive, so intravenous administration of some or all of the fluid is often necessary.
Aneliswa Cele, from the Department of Health, said there was a high possibility of continued importation of cases to South Africa, given the reports that cholera is reported in 24 countries and 15 are in Africa.
She also urged clinicians to maintain a high index of suspicion for cholera in patients who present acute watery diarrhoea.
“Surveillance measures should be strengthened to enable early detection of cases. That is why in the Free State, for instance, we have a national team on the ground to support the provincial team,” said Cele.
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