Mortality, morbidity, and microbiology of endemic cholera among hospitalized patients in Dhaka, Bangladesh

Mortality and morbidity associated with cholera acquired in a modern endemi c setting have not been well defined. In Dhaka Bangladesh from 1986 to 1996 , we found that causative agents of cholera shifted over time, varying by s erogroup, biotype, and serotype. At the International Centre for Diarrhoeal Disease Research (ICDDR,B: Centre for Health and Population Research) in 1 996, 19,100 cholera patients were treat-ed, 887 (4.6%) were admitted, and 3 3 died (mortality rate = 3.7% of cholera inpatients, 0.14% of all cholera p atients). When cholera inpatients who were discharged improved were compare d with those who died, bacteremia (odds ratio [OR] = 10.5, 95% confidence i nterval [CI] = 2.9-37.9), radiographic evidence of pneumonia (OR = 3.1, 95% CI = 1.2-7.7), and acidosis as estimated by the serum bicarbonate value (O R = 0.893, 95% CI = 0.825-0.963) were independently associated with death b y multivariate analysis. Pneumonia was the leading cause of death and accou nted for two-thirds of all deaths among individuals with cholera in this st udy. Death in hospitalized patients with cholera acquired in a modern endem ic setting is, therefore, extremely rare, and most frequently due to concom itant infection, especially pneumonia.