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