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
Patient 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.
Differential diagnosis
Complete Differential Diagnosis of the Causes of Cholera
Infectious Diarrhea
- Difficult to differentiate specially if the diarrhea is mild and in early stages.
- Fresh stool microscopy, stool culture, PCR and other techniques help to differentiate these conditions. Stool tests is useful and cheap way to differentiate cholera from other infectious conditions. However, other tests like PCR, serotyping may not be performed because of cost or non-availability at many centers.
Shigella, 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 |