Cholera — DTM&H MCQ

Correct answer: D — Rapid oral or intravenous rehydration

Rapid oral or intravenous rehydration (option C) is correct because this vignette describes cholera: an outbreak of sudden profuse watery diarrhoea with severe dehydration in a displaced population following contamination of the water supply. Vibrio cholerae causes massive secretory diarrhoea through cholera toxin, and death occurs from hypovolaemic shock rather than the infection itself, so the immediate priority is aggressive fluid and electrolyte replacement using oral rehydration solution or, in severe dehydration or shock, intravenous fluids such as Ringer's lactate. UKHSA guidance on cholera management confirms that fluid replacement is the mainstay of treatment, with antibiotics reserved as an adjunct in severe cases to reduce stool volume and duration once rehydration is underway. Why the other options are wrong: C. Loperamide first-line therapy: antimotility agents are avoided in suspected bacterial secretory diarrhoea because they can impair toxin clearance and are not evidence based as first line in cholera; they do not address the life threatening fluid loss. A. Immediate colonoscopy: this is an invasive diagnostic procedure with no role in an acute outbreak setting and would dangerously delay resuscitation in a haemodynamically unstable patient. E. High-dose steroids: there is no inflammatory or autoimmune process here; steroids have no evidence base in cholera and do not correct the underlying fluid and electrolyte deficit. B. Empirical praziquantel: this is an antihelminthic used for schistosomiasis and other fluke infections, which present very differently (chronic, not acute watery outbreak diarrhoea) and has no activity against Vibrio cholerae. Key point: in outbreak-pattern cholera, rehydration (oral or intravenous according to severity) is the immediate lifesaving treatment, and all other interventions are secondary or irrelevant.

Reference: UKHSA, Cholera: guidance, data and analysis, GOV.UK, https://www.gov.uk/guidance/cholera