Cholera

[kayaker]

My son has had diarrhea for three days, we took him to see a doctor at reputedly the best childrens hospital in Bangkok.We were told that he probably has cholera!! Do you anyone personllay who has had cholera in Bangkok? Just trying to confirm that this is possible here, as we can't see how he could have got this. obviously we are very worried. Any advice would be greatly appreciated. He has rehydration drinks from the hospital.

[mommysboy]

My son has had diarrhea for three days, we took him to see a doctor at reputedly the best childrens hospital in Bangkok.We were told that he probably has cholera!! Do you anyone personllay who has had cholera in Bangkok? Just trying to confirm that this is possible here, as we can't see how he could have got this. obviously we are very worried. Any advice would be greatly appreciated. He has rehydration drinks from the hospital.

Never known of anyone getting Cholera !!! and am a bit surprised. Guess it can happen anywhere. The tap water is not safe to drink IMHO.

[geriatrickid]

Cholera in children requires prompt intervention. Hopefully, your child was given rehydration therapy as that is more important than antibiotics. You may have been given some packets which you were instructed to mix with water and give at regular short intervals if the case was not classified as severe. A severe case would necessitate immediate IV and antibiotic intervention. The little packets are basically sugar and salts that can work miracles and are distributed in at risk populations by case workers and they have a demonstrated history of efficacy

Is there a chance something was lost in the translation? Acute Watery Diarrhoea can sometimes be described as cholera by medical workers that don't have great language skills. While AWD can be lethal, it can have a different cause than cholera. Was there a test done to identify the culprit vibrio cholerae? Some tests look for the toxin produced, others look for the antigen. Tests can produce false results, either because the technician botched the work or the sample taken was tainted. Is it possible that someone was unable to explain shigella dysentery and said cholera because that was easier? . With shigella we'll see blood in the stool. Cholera just gives us watery stools. The expression "probably" is not acceptable. Either they suspect and need to do more tests or they don't know. It is inexcusable to use the term probably when dealing with a reportable illness. If it was cholera, it had to be reported to the MoH immediately. An investigator has to review the file. For an isolated case, the location of the patient, patient characteristics including activities and food ingested is supposed to be identified. This allows the investigator to determine if there is a risk within the area and whether or not MoH intervention is required.

Were antibiotics prescribed? The tip off will be if Erythromycin (used for cholera in children) or Ciprofloxacin (shigella) was prescribed.

Thailand does have a growing problem with cholera, but it is nothing for anyone to panic about. This illness is subject to strict reporting requirements and occurs infrequently in Thailand. In 2006, there 35 cases reported to the WHO. (For comparison sake Japan -36, CAD-6, AUS-3, USA-8 UK- 49) In 2007, the numbers worldwide were down but increased in Thailand to 1428. In comparison the UK was 32, AUS-3, CAD- 1. Japan has not reported yet. Sometimes cases are due to travellers arriving infected and not because of national conditions.

I am in no position to dispute the medical findings, so please do not let my comments interfere with any directions given by your physician. However, unless your child was hanging around where visitors from Vietnam or Laos go or was in an area previously identified as a hot spot, there is a likelihood the child did not have cholera.

The last outbreak was in Phuket and ended in late 2007. There were 110 cases recorded (with probably another 1000 or so that were not because patients did not seek medical care). I dug up this email advise from 2007;

Dr Prachit said that between 1 Jan and 31 Oct 2007, there were 600 cases of cholera spread across 36 provinces. All provinces have been put on alert to help control the severe diarrheal disease, which is

caused by ingesting contaminated food or water.

Dr Prachit said, "Khon Kaen (221 cases) and Phuket are the areas with the most reported instances of cholera, although the disease is now under control. The Ministry of Public Health has worked in each of

the provinces to raise awareness of the disease by asking people to avoid eating raw food and meat for now."

The last recorded case of cholera in Phuket was on 1 Nov 2007. In Khon Kaen, a patient suffering from cholera was hospitalized 17 Oct 2007, although there have been no cases since, added Dr Prachit.

I would not dismiss the possibility that someone was behind in his paperwork disclosures as per the discrepancy of 600 cases as stated in the above, vs. the 1462 filed with WHO. Thailand as a whole has a reliable reporting position and the health ministry doesn't screw around. However, some local reports can be filed "late" if it is during high season if you catch my drift. My point here, is that you may wish to check out the diagnosis because it might be something else. Again, I stress, do not stop the treatment until the alternative physician says otherwise.

Edited August 28, 2008 by geriatrickid