DIARRHEAL EPIDEMICS AMONG RWANDAN REFUGEES IN 1994 - MANAGEMENT AND OUTCOME IN A FIELD HOSPITAL

We describe the clinical course and outcome of Rwandan refugees with c holera-like illness (n = 567) and clinical dysentery (n = 1,062) treat ed at the Israeli Army field hospital in the disaster region of Goma, Zaire, during the summer of 1994. Vigorous fluid administration was th e primary therapy, complemented with antibiotics for patients with pre sumed Shigella infection. Recovery rates were 94% and 96% for patients with cholera and dysentery, respectively. Mortality was substantially affected by comorbid conditions such as pneumonia and meningitis, whi ch occurred in one-quarter of these patients. Infective, metabolic, an d surgical complications (including three cases of intussusception) ma y have contributed to the deaths. The outcome of patients during diarr heal epidemics of cholera or bacillary dysentery may be favorable, eve n in disaster settings, if patients are evacuated promptly to medical facilities and appropriate therapy is instituted. We close with genera l observations on procedures to be followed in future epidemics of dia rrheal diseases.