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Clinical characteristics and risk factors for Vibrio cholerae infection in children
1Pediatric Emergency, Department Univesidad Peruana Cayetano Heredia, Lima, Peru.
Insights
Epidemic cholera in Peruvian children presented with sudden watery diarrhea and dehydration. Prompt treatment led to a low case-fatality rate, with contaminated water and food as likely sources.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Cholera outbreaks pose significant public health challenges, particularly in resource-limited settings.
- Understanding the clinical characteristics and transmission dynamics of Vibrio cholerae O1 is crucial for effective outbreak response.
- Previous studies have highlighted the severity of cholera, but specific features during epidemics in pediatric populations require further elucidation.
Purpose of the Study:
- To differentiate the clinical presentation of epidemic cholera from non-cholera-associated diarrhea in children.
- To identify risk factors associated with Vibrio cholerae O1 infection during an epidemic.
- To assess the case-fatality rate and contributing factors in pediatric cholera cases.
Main Methods:
- A surveillance study was conducted in a pediatric emergency department in Lima, Peru.
- Stool specimens were collected from 626 children aged 14 years or younger presenting with diarrhea.
- Clinical data, including onset, symptoms, dehydration severity, and hospitalization, were compared between cholera and non-cholera groups.
Main Results:
- Vibrio cholerae O1 was identified in 49% of pediatric diarrhea cases, more prevalent in children over 24 months.
- Cholera cases exhibited sudden onset, watery diarrhea, abdominal pain, muscle cramps, and vomiting, leading to more severe dehydration and hospitalization.
- Nonpotable water and uncooked foods were implicated as probable sources, with evidence of intrafamily transmission.
Conclusions:
- Epidemic cholera in children is characterized by acute onset and severe dehydration, distinct from other diarrheal illnesses.
- Contaminated water and food are significant risk factors for Vibrio cholerae O1 transmission.
- Prompt and appropriate medical intervention is associated with a low case-fatality rate, emphasizing the importance of accessible healthcare during outbreaks.
Abstract:
Surveillance was conducted during February and March 1991 in the pediatric emergency department of Cayetano Heredia Hospital, Lima, Peru, to contrast the characteristics of children with epidemic cholera with those of children with noncholera-associated diarrhea. Among 626 patients 14 years of age or younger, Vibrio cholerae O1 was isolated from stool specimens of 310 patients (49%), more commonly from children older than 24 months of age (66%; p < 0.0001) than from younger children. Cholera was clinically characterized by a more sudden onset; watery diarrhea; and associated abdominal pain, muscle cramps, and vomiting, which led to more severe dehydration and hospitalization more often than in noncholera cases. Only one patient with cholera died, for a case-fatality rate of 3.2 deaths per 1000 persons. Nonpotable water and uncooked foods were identified as probable vehicles for V. cholerae. The frequency of diarrhea among relatives of patients with cholera suggested intrafamily transmission. This study of epidemic cholera describes the clinical features and the risk factors for acquisition of the infection, and points out the low case-fatality rate with prompt and appropriate treatment.