Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features +++ Essentials of Diagnosis ++ Sudden onset of severe watery diarrhea Persistent vomiting without nausea or fever Extreme and rapid dehydration and electrolyte loss, with rapid development of vascular collapse Contact with a case of cholera or with shellfish, or the presence of cholera in the community Diagnosis confirmed by stool culture +++ General Considerations ++ Caused by the gram-negative organism Vibrio cholerae Transmitted by contaminated water or food, especially contaminated shellfish Epidemics are common in impoverished areas where hygiene and safe water supply are limited Typical disease is generally so dramatic that in endemic areas the diagnosis is obvious Individuals with mild illness and young children may play an important role in transmission of the infection Incubation period is short, usually 1–3 days Asymptomatic infection is far more common than clinical disease Disease is unusual in infancy Age-specific attack rate is highest in children younger than age 5 years and declines with age +++ Demographics ++ Endemic in India and southern and Southeast Asia and in parts of Africa Epidemic cholera spread in Central and South America, with a total of 1 million cases and 9500 deaths reported through 1994 A severe cholera outbreak in Haiti began in October 2010; more than 500,000 cases and 6000 deaths are estimated Infection occurs in the United States occurs after foreign travel or as a result of consumption of contaminated imported food +++ Clinical Findings ++ Many patients have mild disease Severe diarrhea Develops in 1–2% of patients Sudden onset of massive, frequent, watery stools, generally light gray in color (so-called rice-water stools) and containing some mucus but no pus Vomiting may be projectile and is not accompanied by nausea Within 2–3 hours, the tremendous loss of fluids results in life-threatening dehydration, hypochloremia, and hypokalemia, with marked weakness and collapse Illness lasts 1–7 days and is shortened by appropriate antibiotic therapy +++ Diagnosis ++ Markedly elevated hemoglobin (20 g/dL) Marked acidosis, hypochloremia, and hyponatremia Stool sodium concentration may range from 80 mEq/L to 120 mEq/L Culture confirmation requires specific media and takes 16–18 hours for a presumptive diagnosis and 36–48 hours for a definitive bacteriologic diagnosis +++ Treatment ++ Physiologic saline or lactated Ringer solution should be administered intravenously in large amounts to restore blood volume and urinary output and to prevent irreversible shock Potassium supplements are required Sodium bicarbonate, given intravenously, may be needed initially to overcome profound metabolic acidosis from bicarbonate loss in the stool Moderate dehydration and acidosis Can be corrected in 3–6 hours by oral therapy alone because the active glucose transport system of the small bowel is normally functional Optimal composition of the oral solution (mEq/L): Na+, 90; Cl-, 80; and K+, 20 (with glucose, 110 mmol/L) Tetracycline ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.