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For further information, see CMDT Part 35-20: Cholera

KEY FEATURES

Essentials of Diagnosis

  • History of travel in endemic area or contact with infected person

  • Voluminous diarrhea (up to 1 L/hour)

  • Characteristic "rice water stool"

  • Rapid development of marked dehydration

  • Positive stool cultures

General Considerations

  • An acute diarrheal illness caused by certain serotypes of Vibrio cholerae

  • The toxin activates adenylyl cyclase in intestinal epithelial cells of the small intestines, producing hypersecretion of water and chloride ion and a massive diarrhea of up to 1 L/hour

  • Occurs in epidemics under conditions of crowding, war, and famine (eg, in refugee camps) and where sanitation is inadequate

  • Infection is acquired by ingestion of contaminated food or water

Demographics

  • Rarely seen in the Western Hemisphere until an outbreak occurred in Peru in the early 1990s, resulting in more than 400,000 cholera cases and more than 3000 deaths

  • Most recent outbreak in the Western Hemisphere occurred in Haiti in 2010 after an earthquake, resulting in thousands of deaths

  • Outbreaks have recently been reported in sub-Saharan Africa; in 2021, the World Health Organization reported that Africa experienced its highest-ever reported numbers—more than 137,000 cases and 4062 deaths in 19 countries—due to water sanitation issues

CLINICAL FINDINGS

Symptoms and Signs

  • See Table 32–4

  • A sudden onset of severe, frequent watery diarrhea (up to 1 L/hour)

  • The liquid stool is gray; turbid; and without fecal odor, blood, or pus ("rice water stool")

  • Dehydration and hypotension develop rapidly

  • The disease is toxin mediated, and fever is unusual

Table 32–4.Acute bacterial diarrheas and "food poisoning" (listed in alphabetical order).

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