Epidemic secretory diarrhoeal disease caused by Vibrio cholerae, which releases a toxin that stimulates adenylate cyclase in intestinal cells. Usually a disease of poverty but well described in returning travellers.
Classically, patients present passing large quantities (litres) of rice-water stools.
Basic laboratory tests are non-specific. Culture of the organism is definitive, and rapid dipstick tests are available.
Most patients will recover if the effects of the ensuing profound volume depletion are combated by oral and/or intravenous rehydration.
Antibiotics shorten duration and severity of disease, but rising rates of bacterial resistance are becoming problematic.
A secretory diarrhoeal illness caused by the gram-negative bacterium Vibrio cholerae. Secretion of the cholera enterotoxin leads to continued activity of adenylate cyclase in intestinal epithelial cells and secretion of water and accompanying salts into the gut lumen.
History and exam
Marcus Eder, MBBS, MD, MSc, MRCP, FRCPath, DTM&H
Specialist in Infectious Diseases and Clinical Microbiology (UK)
Rega (Rettungsflugwacht/Air Rescue/Guarde Aérienne)
ME declares that he has no competing interests.
Rekha Lopez, BSc, MBBS, MRCP, MSc, FRCPath
East and North Hertfordshire NHS Trust
RL declares that she has no competing interests.
Dr Marcus Eder and Dr Rekha Lopez would like to gratefully acknowledge Dr Justin Green, a previous contributor to this topic.
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.
David Sack, MD
Department of International Health
Johns Hopkins Bloomberg School of Public Health
DS is an author of some studies referenced in this topic.
Nur H. Alam, MD
Clinical Sciences Division
International Centre for Diarrhoeal Disease Research
NHA is co-author of a study referenced in this topic.
Jaya Shankar Kaushik, MD
Department of Pediatrics
University College of Medical Sciences
JSK is the author of a reference cited in this topic.
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