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Cholera

Last reviewed: 21 Oct 2024
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

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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