Ebola virus disease or cholera, central Democratic Republic of Congo 2018?

Submitted by Katharina Kopp on Wed, 07/04/2018 - 14:48

Has the recent Ebola epidemic moved from western to central Democratic Republic of Congo, is it a new outbreak of Ebola, or is it "just" an ongoing cholera epidemic in the central region?

Lusambo, Democratic Republic of Congo (DRC):  30 cases of diarrhea recorded.


While the source (https://www.mediacongo.net/article-actualite-39783_sankuru_trois_deces_dus_a_une_diarrhee_d_origine_inconnue_a_lusambo.html)

cited in http://www.promedmail.org/post/5886426 (EBOLA (48): DEMOCRATIC REPUBLIC OF CONGO, MEDECINS SANS FRONTIERES, SUSPECTED DEATHS, REQUEST FOR INFORMATION, Archive Number: 20180703.5886426)

indicates a possible Ebola virus disease outbreak, the following report rather suggests an outbreak of Cholera.


Translated from original French text by Radio Okapi published on 02/07/2018 - 10:48 (https://www.radiookapi.net/2018/07/02/actualite/en-bref/lusambo-30-cas-suspects-de-cholera-enregistres):

"Suspected cases of cholera have been detected in the Lusambo health zone in Sankuru province for two weeks. As of Saturday 30 June, thirty cases have been reported, including seven deaths.

Lusambo Chief Medical Officer of Health, Willy Kidinda, said it would be cholera because of trade between the locality of Bena Dibele and the city of Mbuji-Mayi, two countries where the disease is already rife.

We are in thirty cases, until last night. We are in full preparations for sending the samples to the INRB, because the sampling materials are en route coming, "said the doctor."


Contrary to this, there are two statements in the first source


, published on 02/07/2018, translated from original French text)

which are ambiguous (1.) or false (2.).

1. "Samples of this bloody and deadly diarrhea, it has been reported, are already being sent to the National Institute for Biochemical Research, INRB, in Kinshasa for analysis."

2. "Sankuru province shares borders with the former(?) province of Equator, where the Ebola epidemic had recently erupted."

Regarding 1.: It is not clear, if the description of the samples as "bloody and deadly diarrhea" either

a) refers to actual clinical symptoms observed in patients of Lusambo health zone or

b) is one of the commonly used phrases in media when characterizing Ebola virus disease, which is actually misleading. Since the huge number of cases recorded during the epidemic in West Africa 2014-16 it is common consensus among Ebola clinicians that "bleeding" is much rarer in patients than described before.

However, one of the typical signs of cholera is non-bloody watery diarrhea, which distinguishes it from differential diagnoses for other also bacterial but bloody diarrhea caused by e.g. Shigella, Salmonella, Campylobacter, Yersinia species.

Of course, this is all speculative, while the definitive laboratory diagnosis of the samples sent to the National Institute for Biochemical Research, INRB, in Kinshasa is still pending.


Regarding 2.: The provinces of Sankuru and Equator are rather distant and do not share a border, as displayed in the following map:


Here we share a map visualizing the geographic clustering of Ebola virus disease cases in the western province of Equator and the confirmed or suspected cases of cholera in the cities Mbuji-Mayi and Bena Dibele as well as the location of the undiagnosed diarrhea outbreak Lusambo in the central region of DRC.



Media coverage of the ongoing cholera epidemic in Mbuji-Mayi can be found here (in French):