A patient presents in the Emergency Department, complaining of vague discomforts
ID: 3482398 • Letter: A
Question
A patient presents in the Emergency Department, complaining of vague discomforts; nausea, vomiting, stomach pain, watery diarrhea, fever, and chills. The patient reports he has not travelled outside of the U.S. since it occurs at the height of the norovirus season. The ED physician assumes it is another "run of the mill" case. When the lab reports return a quick test of cholera, the public health department is called in. Could this be a potential bioterrorism attempt? Why or why not? Provide a solid rationale for your response along with appropriate references.
Explanation / Answer
Yes this can be a potential bioterrorism attempt.
Causative Agent: Vibrio cholerae is a motile, gram negative, non-sporulating rod.
Route of Exposure: Ingestion of water or food contaminated with cholera organisms.
Transmissibility: Cholera is not easily spread from person to person; infected food handlers can
contaminate foods and drinks; in order to be an effective biological weapon, major drinking water
supplies would need to be heavily contaminated.
In the United States, cholera was prevalent in the 1800s but has been virtually eliminated by
modern sewage and water treatment systems. However, as a result of improved transportation,
more persons from the United States travel to parts of Latin America, Africa, or Asia where they are
infected by cholera. In addition, domestic foodborne outbreaks in the United States have been
caused by cholera-contaminated seafood brought back by travelers.
U.S. and international public health authorities are working to enhance surveillance for cholera,
investigate cholera outbreaks, and design and implement preventive measures. The Centers for
Disease Control is investigating epidemic cholera wherever it occurs and is training laboratory
workers in proper techniques for identification of V. cholerae.
Outbreak control: Quarantine is unnecessary. Any person who shared food or drink with a
cholera patient should be under surveillance for five days, and objects contaminated with feces or
vomitus should be disinfected prior to reuse. Feces and vomitus do not need to be disinfected if
discharged into a normal sewage disposal system.
Therapeutic treatment: oral rehydration and antibiotics for short duration.
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