**3. Clinical features of cholera**

The infection may be mild or asymptomatic in most of the cases, but sometimes it can be severe. Approximately 5–10% of persons suffer from severe cholera. In severe cases, the clinical features include profuse watery diarrhea, vomiting, increased heart rate, loss of skin elasticity, dry mucous membranes, low blood pressure, feeling of thirst, muscle cramps, metabolic acidosis, and restlessness or irritability. These patients can develop acute renal failure, severe electrolyte imbalances, and coma, leading to hypovolemic shock and death [3, 15]. If untreated, 50% of severe cases are fatal, while proper treatment and fluid replacement reduce mortality to less than 1% [3, 12].

#### **3.1. Diagnosis**

The confirmatory test for cholera is done by culture of a stool specimen or rectal swab. For transport of specimen, Cary Blair media is the most appropriate, and for isolation and identification of the organism, the selective thiosulfate–citrate–bile salts agar (TCBS) is the medium of choice. Commercially available rapid test kits should not be used for routine diagnosis as they cannot determine the subtypes and are not able to isolate the antimicrobial susceptibility. However, they are useful during epidemics [16].

#### **3.2. Treatment**

Rehydration by oral rehydration salts and, if required, intravenous fluids and electrolytes, is the cornerstone of cholera treatment. In addition, antibiotics may be needed for severe cases. Commonly used antibiotics include tetracycline, doxycycline, furazolidone, erythromycin, or ciprofloxacin [17].
