Last reviewed: 4 Jul 2021
Last updated: 22 Jun 2021

Summary

Definition

History and exam

Key diagnostic factors

  • copious watery diarrhoea
  • evidence of volume depletion

Other diagnostic factors

  • age <5 years
  • ingestion of shellfish
  • family history of recent, severe, cholera-like illness
  • vomiting
  • fever
  • abdominal pain
  • lethargy or coma

Risk factors

  • ingestion of contaminated water
  • ingestion of contaminated food
  • inadequate sanitation
  • recent heavy rains and flooding
  • decreased gastric acid secretion
  • blood group O
  • malnutrition
  • HIV infection
  • lack of breastfeeding

Diagnostic investigations

1st investigations to order

  • FBC
  • serum electrolytes
  • serum urea and creatinine
  • serum lactate
  • ABG
  • electrocardiogram
  • darkfield/phase-contrast microscopy of stool
  • rapid dipstick testing of stool

Investigations to consider

  • Gram stain of stool
  • stool culture of liquid stool, faecal suspension, or rectal swab
  • serogroup confirmation using antisera
  • antibiogram (sensitivities)
  • chest x-ray and abdominal x-ray

Emerging tests

  • enzyme-linked immunosorbent assay (ELISA) assay of stool
  • molecular testing of stool
  • loop-mediated isothermal amplification (LAMP) assay of stool

Treatment algorithm

Contributors

Authors

Marcus Eder, MBBS, MD, MSc, MRCP, FRCPath, DTM&H

Specialist in Infectious Diseases and Clinical Microbiology (UK)

Rega (Rettungsflugwacht/Air Rescue/Guarde Aérienne)

Switzerland

Disclosures

ME declares that he has no competing interests.

Rekha Lopez, BSc, MBBS, MRCP, MSc, FRCPath

Consultant Microbiologist

Lister Hospital

East and North Hertfordshire NHS Trust

London

UK

Disclosures

RL declares that she has no competing interests.

Acknowledgements

Dr Marcus Eder and Dr Rekha Lopez would like to gratefully acknowledge Dr Justin Green, a previous contributor to this topic.

Disclosures

JG is employed by, and holds stock in, GlaxoSmithKline (GSK). GSK has had no involvement in the preparation of this document, and the views expressed are those of the author.

Peer reviewers

David Sack, MD

Professor

Department of International Health

Johns Hopkins Bloomberg School of Public Health

Baltimore

MD

Disclosures

DS is an author of some studies referenced in this topic.

Nur H. Alam, MD

Scientist

Clinical Sciences Division

International Centre for Diarrhoeal Disease Research

Dhaka

Bangladesh

Disclosures

NHA is co-author of a study referenced in this topic.

Jaya Shankar Kaushik, MD

Registrar

Department of Pediatrics

University College of Medical Sciences

New Delhi

India

Disclosures

JSK is the author of a reference cited in this topic.

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