Diagnosing Cholera in The Young: A Review of W.H.O. Criteria

This study was undertaken to study the occurrence of cholera in young children with a view to define the clinical criteria of diagnosis and endemicity of cholera in Delhi and to compare its clinical profile with rotavirus diarrhea. Hundred children below 3 years of age admitted with acute watery diarrhea were recruited. The severity of diarrhea and degree of dehydration were noted. Stool specimens collected from all cases were subjected to bacterial culture for identification of Vibrio cholerae and rotavirus detection by ELISA and PAGE techniques. Both Vibrio cholerae and rotavirus were detected in 5, Vibrio cholerae alone in 13 and rotavirus alone in 18 cases. Sixty-one percent cases of cholera occurred in children below two years. Rice watery stools were seen only in 28% (5/18) cases of cholera. Three (3/13) cases with cholera alone and 6/18 with rotavirus alone had mild diarrhea. Moderate diarrhea occurred in 3/5 cases with both pathogens, 6/13 with cholera alone and 7/18 with rotavirus alone. Severe diarrhea occurred in 3/5 cases with both pathogens, 4/13 with cholera alone, and 5/18 cases with rotavirus alone. Mild dehydration occurred in 3/5 and severe dehydration in 2/5 children with both pathogens. Only 3/13 children with cholera alone and one child with rotavirus alone were severely dehydrated. It is concluded that considering the diagnosis of cholera solely on clinical grounds and overlap between the clinical spectrum of cholera and rotavirus diarrhea would result in missing many cholera cases in a non-endemic area like Delhi.