Cholera differential diagnosis

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

Overview

Patients with cholera may give a history of consumption of contaminated food or water, and travel to an endemic area. The symptoms usually develop within 24-48 hour of consumption of contaminated food. Patient presents with sudden onset, painless, odorless, rice watery large volume stool, abdominal cramps, vomiting and fever. It should be differentiated from other infectious causes of diarrhea for e.g. rotavirus, E.coli, amebic dysentry and giardiasis. It should also be differentiated from some non-infectious causes of diarrhea for e.g. VIPoma, tubulovillous adenoma and food poisoning.

Differentiating Cholera from other Diseases

Infectious Diarrhea

• It may be difficult to differentiate cholera from other infectious causes of diarrhea specially if it is mild and in early stages.
• Fresh stool microscopy, stool culture, PCR and other techniques help to differentiate these conditions. Stool tests are useful, cheap and frequently used test to differentiate cholera from other infectious conditions. Other tests like PCR, serotyping though sensitive and specific, may not be performed because of the cost or non-availability at many centers.

Shigella

• Shigella has acute bloody diarrhea whereas cholera has watery diarrhea
• Shigella causes invasive diarrhea thus presents with symptoms of fever, abdominal cramp and rectal pain. These symptoms are lacking in cholera.
• Vomiting is usually absent in Shigella but is frequently seen in cholera.

Amoebic, hemorrhagic E.coli dysentery

• Bloody diarrhea is not found in cholera and guides to a diagnosis of dysentery
• The volume of stool is not as high as seen with Cholera.

Giardiasis

• The volume of stool is not as high as seen with Cholera.
• Stool microscopy is used to detect eggs and parasite.
• Stool in giardiasis produce strong odour whereas cholera usually has odourless stools.

Strongyloides

• The volume of stool is not as high as seen with Cholera.
• Stool microscopy is used to detect eggs and parasite.

Food poisoning

• The volume of stool is not as high as seen with Cholera.

Non-infectious causes

VIPoma

• Chronic history of diarrhea
• Volume of stool is not as high as seen with Cholera.
• Negative stool examination and culture.
• Fasting gut hormones are confirmatory for the diagnosis.

Tubulovillous adenoma

• Colonoscopy and biopsy are confirmatory for the diagnosis.
• Chronic history of diarrhea
• Volume of stool is not as high as seen with Cholera.
• Negative stool examination and culture.

(By organ system)

Cardiovascular	No underlying causes
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	VIPoma, Tubulovillous adenoma, Food poisoning
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	Giardiasis, Amoebic dysentry, E.coli, Strongyloides,
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	No underlying causes

References

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