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Cholera

Last reviewed: 12 Aug 2025
Last updated: 04 Jun 2024

Summary

Definition

History and exam

Key diagnostic factors

  • copious watery diarrhea
  • evidence of volume depletion
Full details

Other diagnostic factors

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

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 breast-feeding
Full details

Diagnostic tests

1st tests to order

  • CBC
  • serum electrolytes
  • serum BUN and creatinine
  • serum lactate
  • ABG
  • ECG
  • dark-field/phase-contrast microscopy of stool
  • rapid dipstick testing of stool
Full details

Tests to consider

  • Gram stain of stool
  • stool culture of liquid stool, fecal suspension, or rectal swab
  • serogroup confirmation using antisera
  • antibiogram (sensitivities)
  • enzyme-linked immunosorbent assay (ELISA) assay of stool
  • molecular testing of stool
  • loop-mediated isothermal amplification (LAMP) assay of stool
  • CXR and abdominal x-ray
Full details

Treatment algorithm

ACUTE

mild-moderate volume depletion: without vomiting

vomiting or severe volume depletion

Contributors

Authors

Marcus Eder, MD (Inf Diseases & Microbiology), MRCP, MRCPath, MSc, DTM&H

Scientific Collaborator

Research & Development

Swissnoso (National Center for Infection Control)

Bern

Switzerland

Disclosures

ME declares that he has no competing interests.

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

Consultant Microbiologist

Barking, Havering and Redbridge University Hospitals NHS Trust

Essex

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

Declarações

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

Declarações

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

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

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Principais artigos

Sack DA, Sack RB, Nair GB, et al. Cholera. Lancet. 2004 Jan 17;363(9404):223-33. Resumo

World Health Organization. Fact sheet: cholera. Dec 2023 [internet publication].Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Cholera images
  • Diagnósticos diferenciais

    • Other infectious diarrhea
    • Amebic dysentery
    • Strongyloides and other intestinal helminths
    Mais Diagnósticos diferenciais
  • Diretrizes

    • Laboratory testing for cholera
    • Recommendations for the use of antibiotics for the treatment of cholera
    Mais Diretrizes
  • Folhetos informativos para os pacientes

    Diarrhea in adults

    Diarrhea in children

    Mais Folhetos informativos para os pacientes
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