Cholera in Modern Times: Experience From a Tertiary Care Centre in South India.

Background Cholera continues to pose significant public health challenges in regions of the world where inadequate sanitation, overcrowding, or humanitarian crises prevail (conflicts and war), manifesting in endemicity. Cholera outbreaks have also been reported, especially in low- and lower-middle-income countries, mostly during rainy seasons and natural disasters like floods, resulting in contamination of water sources and disrupted sanitation. Cholera is considered endemic in India, though it causes sporadic outbreaks and seasonal epidemics. Yet, the medical literature regarding clinical presentation and microbiologic patterns of this notifiable ancient disease in areas of rapid urbanization and globalisation in India or elsewhere is scant. This retrospective study aims to analyse the clinical and microbiological profile of patients with diagnosed cholera cases admitted to the adult ICU of a tertiary care hospital in South India, reflecting the disease's clinical behaviour and outcomes in the current healthcare era. Methodology This retrospective study included all the patients admitted to the adult ICU at a tertiary care centre, in Bengaluru with acute gastroenteritis and subsequently diagnosed with cholera either by darting motility in the stool or culture positivity or both in the past one year and the data on clinical profile including demographic parameters, clinical presentation (number of episodes and nature of diarrhoea, and vomiting), hemodynamic parameters, and need for organ supports were collected. The severity of disease was assessed based on shock at presentation, graded by the shock index (heart rate/systolic blood pressure, HR/SBP), the presence and stage of acute kidney injury (AKI), and the severity of metabolic acidosis at presentation. Results A total of 20 adult patients diagnosed with cholera (16 cases diagnosed by culture positivity, and four cases only by darting motility in the stool hanging drop preparation) were included in the study. All patients presented with watery diarrhoea, with a median stool frequency of 10 per day (mean 12.6). Vomiting was present in 16/20 patients. The mean shock index at presentation was 1 ± 0.47. 15 (75%) of patients were in the 0.6-1.0 range, two (10%) between 1.0-1.4, and three (15%) had ≥1.4 shock index. Acute kidney injury was present in 11 (55%) of patients (Stage 1: four (20%), Stage 2: four (20%), Stage 3: three (15%). Metabolic acidosis was common: four (20%) were normal, seven (35%) were mild, eight (40%) were moderate, and one (5%) were severe. Stool hanging-drop was positive in all patients, and culture positivity was recorded in 16/20 (80%). All culture-positive isolates were sensitive to tetracycline. The mean intravenous fluid requirement was 13.8 L, and the median ICU stay was 48 hours (12-72). Vasopressor support was required in four (20%) patients for short durations. All patients survived to discharge, with no hospital mortality, with a median hospital stay of three days (two to six days). Conclusion The present study reinforces that cholera, though a historic disease, remains a disease of contemporary relevance. With early suspicion, aggressive rehydration, and early and appropriate pre-emptive antibiotic use, morbidity and mortality can be substantially minimised. This study highlights that, despite cholera being an ancient disease, the isolates are still sensitive to tetracycline, yet ongoing vigilance is essential given the emergence of resistant strains.