Imported case of cholera from India: the first recorded in Bulgaria in over a century

TL;DR

A cholera case was reported in Bulgaria, traced back to travel in India, marking the first such case in over 100 years.

Contribution

This is the first documented cholera case in Bulgaria in more than a century.

Findings

Cholera cases in non-endemic regions are often imported by travelers.

The reported case was linked to travel to India, an endemic region.

Early recognition of cholera is crucial to prevent transmission in non-endemic areas.

Abstract

Cholera is an acute bacterial infection characterized by profuse watery diarrhea, vomiting, and dehydration, potentially leading to severe complications and death. It remains endemic in regions with poor sanitation and limited access to clean water, particularly in South and Southeast Asia and parts of Africa. In Europe, only sporadic cases are reported annually, and are typically imported by travelers returning from endemic areas. Mild cases often present with non-specific gastrointestinal symptoms, making them clinically indistinguishable from other enteric infections. To initiate appropriate epidemiological measures and prevent transmission in non-endemic regions, cholera should be considered in any case of acute watery diarrhea in individuals with a recent travel history to endemic areas. We report a case of cholera in a patient returning from India—the first recorded in Bulgaria in over a century.