The 2024 cholera outbreak in Mayotte. Clinical and biological factors associated with severe forms of the disease in an observational cohort of 206 patients

Abstract

Objective

In 2024, the island of Mayotte (France) was affected by a cholera outbreak. The objective of this study was to identify clinical and laboratory criteria associated with severity (defined as hypovolemic shock and/or severe acidosis) in view of improving patient triage and therapeutic management in subsequent outbreaks.

Methods

From March 18 to July 12, 2024, we screened 215 patients with cholera (positive stool PCR). We excluded five patients who died outside hospital (no data, lethality = 2.3 %) and four patients for whom no data were available. We ultimately enrolled 206 patients. Severe forms of cholera were defined as the presence of at least one of the following three objective criteria: arterial hypotension; and/or neurological impairment (GCS < 14) (hypovolemic shock); and/or venous pH < 7.20 (severe acidosis) at first medical assessment.

Findings

Median patient age was 19 years (8–32 years), and 83 patients (40 %) presented with a severe form, which often consisted in fever (n = 13/83, 13 % vs. n = 6/123, 5 %, p = 0.04), vomiting (n = 71/83, 86 % vs. n = 79/123, 64 %, p < 0.001), a higher stool output (8 (4.5–10) vs. 4 (2–6) stools on day 1, p < 0.001) and severe hemoconcentration (Ht = 54 (47–60) vs. 43 (38–50), p < 0.001). In multivariate analysis, only hemoconcentration was associated with significantly greater severity (OR 95 % CI = 1.12 [1.04–1.21], p < 0.001).

Conclusion

Cholera is a toxin-mediated infection responsible for severe, occasionally fatal acute watery diarrhea. Severity is associated with neurological impairment, metabolic acidosis, and hemoconcentration. Triage and care of these patients are absolutely essential means of preventing death.