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Cholera - Chem-Bio-Rad Suspicion
See also in: International Travel
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Cholera - Chem-Bio-Rad Suspicion

See also in: International Travel
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Contributors: Daniel B. Fagbuyi MD, Alex Garza MD, MPH
Other Resources UpToDate PubMed

Synopsis

Cholera is an acute, potentially life-threatening diarrheal illness caused by the ingestion of water or food contaminated with the bacterium Vibrio cholerae. Vibrio cholerae would make a relatively poor agent of bioterrorism because of its susceptibility to chlorination if added to the water supply. It would be more effective used in a small attack when added to food or untreated water. Any large outbreak of cholera in the United States should be highly suspect for a bioterrorism attack.

Symptoms may be mild or severe with asymptomatic cases occurring frequently. Symptoms include abdominal cramping, severe watery gray-brown (rice water) diarrhea, vomiting, malaise, and headache. Fever occurs infrequently. Fluid loss may approach 1 liter per hour, and dehydration secondary to the diarrhea can result in circulatory collapse and shock in some cases. Without treatment, the symptoms last from 1-7 days, with mortality rates as high as 50%.

Cholera's incubation period is 4 hours to 5 days, with an average of 2-3 days. Person-to-person transmission of cholera is rare. Cholera is 1 of 3 diseases with worldwide quarantine sanctions (yellow fever and plague are the others).

An oral vaccine has been shown to be effective in conferring short-term protection during outbreaks, although food and water hygiene should remain the focus of prevention.

Cholera is endemic to countries with poor sewage and water treatment systems because it spreads rapidly through contaminated fecal contact. Few cases of cholera have ever been reported in the US. Tourists to endemic areas are at higher risk for cholera.

Note:
In an outbreak, appropriate disposal of feces, frequent hand washing, and efforts to maintain clean food and water supplies are imperative. Vibrio cholerae shedding in feces continues for 1-2 weeks after infection.

Codes

ICD10CM:
A00.9 – Cholera, unspecified

SNOMEDCT:
63650001 – Cholera

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Differential Diagnosis & Pitfalls

Clinically, the onset of cholera is often indistinguishable from other acute diarrheal illnesses.
  • Domoic acid poisoning may be differentiated by its association with memory loss, confusion, and seizures.
  • Ricin poisoning, unlike cholera, frequently produces fever, hematemesis, and hematochezia.
  • Saxitoxin poisoning is associated with paresthesias of face and extremities.
  • Trichothecene mycotoxins present with respiratory symptoms and mucosal irritation.

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Last Updated: 10/13/2014
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Cholera - Chem-Bio-Rad Suspicion
See also in: International Travel
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Cholera : Vomiting, Dehydration, Leg cramp, BP decreased, Watery diarrhea
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