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__NOTOC__
{{Cholera}}
{{Cholera}}
{{CMG}}
{{CMG}}; '''Associate Editors-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, MBBS]] [mailto:psingh13579@gmail.com], {{AA}}


==Overview==
==Overview==
Choleria is a severe bacterial gastrointestinal, diarrheal disease. In its most severe forms, cholera is one of the most rapidly fatal illnesses known. A healthy person may become [[hypotension|hypotensive]] within an hour of the onset of symptoms and may die within 2-3 hours if no treatment is provided. More commonly, the disease progresses from the first liquid stool to shock in 4-12 hours, with death following in 18 hours to several days without [[rehydration]] treatment.<ref name=McLeod_2000>{{cite journal |author=McLeod K |title=Our sense of Snow: John Snow in medical geography |journal=Soc Sci Med |volume=50 |issue=7-8 |pages=923-35 |year=2000 |pmid = 10714917}}</ref><ref> WHO Cholera [http://www.who.int/topics/cholera/control/en/index.html]</ref>
Laboratory tests are not mandatory for diagnosis and treatment of [[cholera]]. In [[endemic]] areas when suspected, treatment should be started as early as possible with fluid replacement and antibiotics. In areas where cholera is uncommon, performing lab tests are worthwhile.Tests used for identification of organisms are: Direct microscopic examination of organism, dark field examination, gram staining, culture, antigen, [[polymerase chain reaction]], and serotype tests.<ref name=CDCcholera>http://www.cdc.gov/cholera/laboratory.html Accessed on October 7, 2016</ref><ref name="pmid20739485">{{cite journal| author=Alam M, Hasan NA, Sultana M, Nair GB, Sadique A, Faruque AS et al.| title=Diagnostic limitations to accurate diagnosis of cholera. | journal=J Clin Microbiol | year= 2010 | volume= 48 | issue= 11 | pages= 3918-22 | pmid=20739485 | doi=10.1128/JCM.00616-10 | pmc=3020846 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20739485  }} </ref><ref name="pmid22666350">{{cite journal| author=Page AL, Alberti KP, Mondonge V, Rauzier J, Quilici ML, Guerin PJ| title=Evaluation of a rapid test for the diagnosis of cholera in the absence of a gold standard. | journal=PLoS One | year= 2012 | volume= 7 | issue= 5 | pages= e37360 | pmid=22666350 | doi=10.1371/journal.pone.0037360 | pmc=3364251 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22666350  }} </ref><ref name="pmid3693549">{{cite journal| author=Rahman M, Sack DA, Mahmood S, Hossain A| title=Rapid diagnosis of cholera by coagglutination test using 4-h fecal enrichment cultures. | journal=J Clin Microbiol | year= 1987 | volume= 25 | issue= 11 | pages= 2204-6 | pmid=3693549 | doi= | pmc=269441 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3693549  }} </ref><ref name="pmid14215188">{{cite journal| author=BENENSON AS, ISLAM MR, GREENOUGH WB| title=RAPID IDENTIFICATION OF VIBRIO CHOLERAE BY DARKFIELD MICROSCOPY. | journal=Bull World Health Organ | year= 1964 | volume= 30 | issue=  | pages= 827-31 | pmid=14215188 | doi= | pmc=2555074 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14215188  }} </ref><ref name="pmid11571173">{{cite journal| author=Lyon WJ| title=TaqMan PCR for detection of Vibrio cholerae O1, O139, non-O1, and non-O139 in pure cultures, raw oysters, and synthetic seawater. | journal=Appl Environ Microbiol | year= 2001 | volume= 67 | issue= 10 | pages= 4685-93 | pmid=11571173 | doi= | pmc=93220 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11571173  }} </ref><ref name="pmid22748592">{{cite journal| author=Harris JB, LaRocque RC, Qadri F, Ryan ET, Calderwood SB| title=Cholera. | journal=Lancet | year= 2012 | volume= 379 | issue= 9835 | pages= 2466-76 | pmid=22748592 | doi=10.1016/S0140-6736(12)60436-X | pmc=3761070 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22748592  }} </ref>
==Lab tests==
[[Stool]] and swab collected in the acute stage of the disease are useful specimens for laboratory diagnosis. A number of special media have been employed for the cultivation for Cholera vibrios. They are classified as follows:


==== Holding or transport media ====
==Laboratory Findings==
Laboratory tests that may be helpful in diagnosing cholera infection include:<ref name=CDCcholera>http://www.cdc.gov/cholera/laboratory.html Accessed on October 7, 2016</ref><ref name="pmid20739485">{{cite journal| author=Alam M, Hasan NA, Sultana M, Nair GB, Sadique A, Faruque AS et al.| title=Diagnostic limitations to accurate diagnosis of cholera. | journal=J Clin Microbiol | year= 2010 | volume= 48 | issue= 11 | pages= 3918-22 | pmid=20739485 | doi=10.1128/JCM.00616-10 | pmc=3020846 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20739485  }} </ref><ref name="pmid22666350">{{cite journal| author=Page AL, Alberti KP, Mondonge V, Rauzier J, Quilici ML, Guerin PJ| title=Evaluation of a rapid test for the diagnosis of cholera in the absence of a gold standard. | journal=PLoS One | year= 2012 | volume= 7 | issue= 5 | pages= e37360 | pmid=22666350 | doi=10.1371/journal.pone.0037360 | pmc=3364251 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22666350  }} </ref><ref name="pmid3693549">{{cite journal| author=Rahman M, Sack DA, Mahmood S, Hossain A| title=Rapid diagnosis of cholera by coagglutination test using 4-h fecal enrichment cultures. | journal=J Clin Microbiol | year= 1987 | volume= 25 | issue= 11 | pages= 2204-6 | pmid=3693549 | doi= | pmc=269441 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3693549  }} </ref><ref name="pmid14215188">{{cite journal| author=BENENSON AS, ISLAM MR, GREENOUGH WB| title=RAPID IDENTIFICATION OF VIBRIO CHOLERAE BY DARKFIELD MICROSCOPY. | journal=Bull World Health Organ | year= 1964 | volume= 30 | issue=  | pages= 827-31 | pmid=14215188 | doi= | pmc=2555074 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14215188  }} </ref><ref name="pmid11571173">{{cite journal| author=Lyon WJ| title=TaqMan PCR for detection of Vibrio cholerae O1, O139, non-O1, and non-O139 in pure cultures, raw oysters, and synthetic seawater. | journal=Appl Environ Microbiol | year= 2001 | volume= 67 | issue= 10 | pages= 4685-93 | pmid=11571173 | doi= | pmc=93220 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11571173  }} </ref><ref name="pmid22748592">{{cite journal| author=Harris JB, LaRocque RC, Qadri F, Ryan ET, Calderwood SB| title=Cholera. | journal=Lancet | year= 2012 | volume= 379 | issue= 9835 | pages= 2466-76 | pmid=22748592 | doi=10.1016/S0140-6736(12)60436-X | pmc=3761070 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22748592  }} </ref><ref name="pmid1774258">{{cite journal| author=Shirai H, Nishibuchi M, Ramamurthy T, Bhattacharya SK, Pal SC, Takeda Y| title=Polymerase chain reaction for detection of the cholera enterotoxin operon of Vibrio cholerae. | journal=J Clin Microbiol | year= 1991 | volume= 29 | issue= 11 | pages= 2517-21 | pmid=1774258 | doi= | pmc=270365 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1774258  }} </ref>
===Stool Examination===
* Direct microscopic examination of organism (wet film)
* Dark field examination (helps visualize the [[motility]] of the organism)
* [[Gram staining]]
 
===Stool Cultue===
* Stool culture is the gold standard for ''[[Vibrio cholerae]]'' serotypes O1 and O139. A number of special media have been employed for the cultivation for Cholera vibrios. They are classified as follows:
==== Holding or Transport Media ====
#''Cary-Blair medium'': This the most popular carrying media. This is a buffered solution of [[sodium chloride]], sodium thioglycollate, disodium phosphate and [[calcium chloride]] at pH 8.4.
#''Venkataraman-ramakrishnan (VR) medium''
#''Venkataraman-ramakrishnan (VR) medium''
#''Cary-Blair medium'': This the most popularly carrying media. This is a buffered solution of [[sodium chloride]], sodium thioglycollate, disodium phosphate and [[calcium chloride]] at pH 8.4.


==== Enrichment media ====
==== Enrichment Media ====
#''Alkaline peptone water'' at pH 8.6
#''Alkaline peptone water'' at pH 8.6
#''Monsur's taurocholate tellurite peptone water'' at pH 9.2
#''Monsur's taurocholate tellurite peptone water'' at pH 9.2
 
====Plating Media ====
==== Plating media ====
#''Alkaline bile salt agar'': The colonies are very similar to those on Nutrient Agar.
#''Alkaline bile salt agar'': The colonies are very similar to those on Nutrient Agar.
#''Monsur's gelatin Tauro cholate trypticase tellurite agar (GTTA) medium'': Cholera vibrios produce small translucent colonies with a greyish black centre.
#''Monsur's gelatin Tauro cholate trypticase tellurite agar (GTTA) medium'': Cholera vibrios produce small translucent colonies with a greyish black centre.
#''TCBS medium'': This the mostly widely used medium. This medium contains thiosulphate, citrate, [[bile salts]] and [[sucrose]]. Also in oysters and lobster in some cases. Cholera vibrios produce flat 2-3 mm in diameter, yellow nucleated colonies.
#''TCBS medium'': This the mostly widely used medium. This medium contains thiosulphate, citrate, [[bile salts]] and [[sucrose]]. Also in oysters and lobster in some cases. Cholera vibrios produce flat 2-3 mm in diameter, yellow nucleated colonies.


== References ==
===Rapid tests===
{{Reflist|2}}
*Rapid tests which may help diagnose ''V. cholera'' infection in [[endemic]] areas with limited resources include Crystal VC® dipstick rapid test.<ref name=CDCcholera>http://www.cdc.gov/cholera/laboratory.html Accessed on October 7, 2016</ref>
*Used for screening patients with suspected infection.
*Low sensitivity and specificity.
*Confirmation by culture required.
 
===Antigen and Antibody Tests===
* Antigen, [[polymerase chain reaction]]
* Serotype tests
**  Quick method
** Useful in epidemiological studies
** Classic and El Tor both can be identified by using same method
===Hemogram===
Elevated serum specific gravity, protein, and [[hematocrit]] occurs due to [[dehydration]] caused by excessive [[fluid loss]].
 
===Serum Electrolytes===
* Decreased sodium levels due to sodium loss in the stool.
* [[Serum potassium]] may remain normal for longer periods, which is a manifestation of the body's compensatory mechanism to deal with [[acidosis]].
* Elevated [[blood urea nitrogen]] and [[creatinine]] (prerenal [[azotemia]]).
* Decreased pH, decreased bicarbonate ([[acidosis]]).
 
==Gallery==
 
<gallery>
 
Image: Cholera15.jpeg| Agglutination test was used for the isolation and identification of Vibrio cholerae, the causal agent of cholera. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Cholera14.jpeg| Heiberg Fermentation lab test used during the isolation and identification of Vibrio cholerae. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Cholera13.jpeg| Hemolysis test tubes used for the purpose of isolation and identification of Vibrio cholerae. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Cholera12.jpeg| Sensitivity test for Vibrio cholerae involving Group IV bacteriophage and Polymyxin B. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Cholera11.jpeg| Typical "rice-water" stool from a cholera patient shows flecks of mucus that have settled to the bottom. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
 
 
 
 
 
 


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Latest revision as of 20:55, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, MBBS [2], Aysha Anwar, M.B.B.S[3]

Overview

Laboratory tests are not mandatory for diagnosis and treatment of cholera. In endemic areas when suspected, treatment should be started as early as possible with fluid replacement and antibiotics. In areas where cholera is uncommon, performing lab tests are worthwhile.Tests used for identification of organisms are: Direct microscopic examination of organism, dark field examination, gram staining, culture, antigen, polymerase chain reaction, and serotype tests.[1][2][3][4][5][6][7]

Laboratory Findings

Laboratory tests that may be helpful in diagnosing cholera infection include:[1][2][3][4][5][6][7][8]

Stool Examination

  • Direct microscopic examination of organism (wet film)
  • Dark field examination (helps visualize the motility of the organism)
  • Gram staining

Stool Cultue

  • Stool culture is the gold standard for Vibrio cholerae serotypes O1 and O139. A number of special media have been employed for the cultivation for Cholera vibrios. They are classified as follows:

Holding or Transport Media

  1. Cary-Blair medium: This the most popular carrying media. This is a buffered solution of sodium chloride, sodium thioglycollate, disodium phosphate and calcium chloride at pH 8.4.
  2. Venkataraman-ramakrishnan (VR) medium

Enrichment Media

  1. Alkaline peptone water at pH 8.6
  2. Monsur's taurocholate tellurite peptone water at pH 9.2

Plating Media

  1. Alkaline bile salt agar: The colonies are very similar to those on Nutrient Agar.
  2. Monsur's gelatin Tauro cholate trypticase tellurite agar (GTTA) medium: Cholera vibrios produce small translucent colonies with a greyish black centre.
  3. TCBS medium: This the mostly widely used medium. This medium contains thiosulphate, citrate, bile salts and sucrose. Also in oysters and lobster in some cases. Cholera vibrios produce flat 2-3 mm in diameter, yellow nucleated colonies.

Rapid tests

  • Rapid tests which may help diagnose V. cholera infection in endemic areas with limited resources include Crystal VC® dipstick rapid test.[1]
  • Used for screening patients with suspected infection.
  • Low sensitivity and specificity.
  • Confirmation by culture required.

Antigen and Antibody Tests

  • Antigen, polymerase chain reaction
  • Serotype tests
    • Quick method
    • Useful in epidemiological studies
    • Classic and El Tor both can be identified by using same method

Hemogram

Elevated serum specific gravity, protein, and hematocrit occurs due to dehydration caused by excessive fluid loss.

Serum Electrolytes

Gallery

References

  1. ↑ 1.0 1.1 1.2 http://www.cdc.gov/cholera/laboratory.html Accessed on October 7, 2016
  2. ↑ 2.0 2.1 Alam M, Hasan NA, Sultana M, Nair GB, Sadique A, Faruque AS; et al. (2010). "Diagnostic limitations to accurate diagnosis of cholera". J Clin Microbiol. 48 (11): 3918–22. doi:10.1128/JCM.00616-10. PMC 3020846. PMID 20739485.
  3. ↑ 3.0 3.1 Page AL, Alberti KP, Mondonge V, Rauzier J, Quilici ML, Guerin PJ (2012). "Evaluation of a rapid test for the diagnosis of cholera in the absence of a gold standard". PLoS One. 7 (5): e37360. doi:10.1371/journal.pone.0037360. PMC 3364251. PMID 22666350.
  4. ↑ 4.0 4.1 Rahman M, Sack DA, Mahmood S, Hossain A (1987). "Rapid diagnosis of cholera by coagglutination test using 4-h fecal enrichment cultures". J Clin Microbiol. 25 (11): 2204–6. PMC 269441. PMID 3693549.
  5. ↑ 5.0 5.1 BENENSON AS, ISLAM MR, GREENOUGH WB (1964). "RAPID IDENTIFICATION OF VIBRIO CHOLERAE BY DARKFIELD MICROSCOPY". Bull World Health Organ. 30: 827–31. PMC 2555074. PMID 14215188.
  6. ↑ 6.0 6.1 Lyon WJ (2001). "TaqMan PCR for detection of Vibrio cholerae O1, O139, non-O1, and non-O139 in pure cultures, raw oysters, and synthetic seawater". Appl Environ Microbiol. 67 (10): 4685–93. PMC 93220. PMID 11571173.
  7. ↑ 7.0 7.1 Harris JB, LaRocque RC, Qadri F, Ryan ET, Calderwood SB (2012). "Cholera". Lancet. 379 (9835): 2466–76. doi:10.1016/S0140-6736(12)60436-X. PMC 3761070. PMID 22748592.
  8. ↑ Shirai H, Nishibuchi M, Ramamurthy T, Bhattacharya SK, Pal SC, Takeda Y (1991). "Polymerase chain reaction for detection of the cholera enterotoxin operon of Vibrio cholerae". J Clin Microbiol. 29 (11): 2517–21. PMC 270365. PMID 1774258.
  9. ↑ 9.0 9.1 9.2 9.3 9.4 "Public Health Image Library (PHIL)".

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