DIAGNOSIS AND TREATMENT OF CHOLERA IN THE UNITED-STATES - ARE WE PREPARED

Objective.-To assess cholera recognition and treatment by US health ca re workers in the largest cholera outbreak in the United States this c entury. Design.-We reviewed the medical records of passengers from a f light on which a cholera outbreak occurred. To determine the availabil ity of oral rehydration solutions, we surveyed treatment facilities an d referral pharmacies. Setting.-On February 14, 1992, more than 100 pa ssengers on a flight from South America to Los Angeles, Calif, were in fected with toxigenic Vibrio cholerae 01. Subjects.-Fifty-four of 67 p assengers who sought care in California and Nevada. Results.-We review ed the records of 54 passengers, including 39 with diarrhea and 15 wit hout symptoms. All 17 persons who sought treatment before the outbreak was widely reported by the media had diarrhea. For 12 of these person s, recent travel to South America was noted, but only those four whose records listed cholera as a possible diagnosis were immediately hospi talized. Seven sought cars again within 3 days; three were dehydrated, two of these three were hospitalized, and one of these two died. None of the 26 patients suspected to have cholera received appropriate flu ids; severely dehydrated patients did not receive Ringer's lactate sol ution and those not severely dehydrated did not receive an oral rehydr ation solution. None of the facilities and pharmacies involved stocked World Health Organization oral rehydration salts solution, the prefer red solution for treating cho!era and other diarrheal diseases. Conclu sions.-Treatment of cholera in the United States was suboptimal. Oral fluids appropriate for the treatment of cholera and other diarrheal di seases were generally unavailable. Widespread cholera in the developin g world means that US physicians should be prepared to treat ''importe d'' cases. Physicians evaluating patients with diarrhea should obtain a travel history, should consider cholera in patients returning from c ountries with endemic or epidemic cholera, and should instruct patient s in appropriate use of World Health Organization oral rehydration sal ts solution or other oral rehydration solutions containing 75 to 90 mm ol/L of sodium. Pharmacies and medical facilities should stock these s olutions.