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 have a history of consumption of contaminated food or water and/or travel to an endemic area. Symptoms of cholera usually develop within 24-48 hour of infection. Patient presents with sudden-onset, painless, odorless, rice-watery, large-volume stool; abdominal cramps; vomiting; and fever. Cholera should be differentiated from other infectious causes of diarrhea such as rotavirus, E. coli, amoebic dysentry, and giardiasis. Cholera should also be differentiated from some non-infectious causes of diarrhea such as VIPoma, tubulovillous adenoma, and food poisoning.[1][2][3][4]
Differentiating Cholera from other Diseases
Cholera must be differentiated from other conditions associated with acute onset diarrhea, including:[1][2][3][4]
Infectious causes of diarrhea
- It may be difficult to differentiate cholera from other infectious causes of diarrhea, especially 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 to differentiate cholera from other infectious conditions. Other tests like PCR, serotyping though sensitive and specific, may not be performed due to prohibitive cost or lack of availability at many centers.
Shigella
- Shigella patients present with acute bloody diarrhea whereas cholera patients have watery diarrhea
- Shigella causes invasive diarrhea and thus presents with symptoms of fever, abdominal cramps, and rectal pain, which are not observed in cholera
- Vomiting is usually absent in shigella but is frequently seen in cholera
Amoebic Hemorrhagic E. coli Dysentery
- Bloody diarrhea, which is not seen in cholera, guides one toward a diagnosis of dysentery
- The volume of stool is not as high as seen in cases of cholera
Giardiasis
- The volume of stool is not as high as in cases of cholera
- Stool microscopy is used to detect eggs and parasites
- Stool of giardiasis patients produces a strong odor, whereas cholera patients usually have odorless stools
Strongyloides
- The volume of stool is not as high as in cases of cholera
- Stool microscopy is used to detect eggs and parasites
Food poisoning
- The volume of stool is not as high as in cases of cholera
Non-infectious causes of diarrhea
VIPoma
- Patients present with a chronic history of diarrhea
- Volume of stool is not as high as in cases of cholera
- Negative stool examination and culture
- Fasting gut hormones confirm the diagnosis
Tubulovillous adenoma
- Colonoscopy and biopsy confirm the diagnosis
- Patients present with a chronic history of diarrhea
- Volume of stool is not as high as in cases of cholera
- Negative stool examination and culture
Differential Diagnosis 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
- ↑ 1.0 1.1 Sack DA, Sack RB, Nair GB, Siddique AK (2004). "Cholera". Lancet. 363 (9404): 223–33. PMID 14738797.
- ↑ 2.0 2.1 Krejs GJ (1987). "VIPoma syndrome". Am J Med. 82 (5B): 37–48. PMID 3035922.
- ↑ 3.0 3.1 Guerrant RL, Van Gilder T, Steiner TS, et al.; Infectious Diseases Society of America. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis. 2001;32(3):331–351.
- ↑ 4.0 4.1 Scallan, Elaine, et al. "Foodborne illness acquired in the United States—unspecified agents." Emerg Infect Dis 17.1 (2011): 16-22.