Cholera - Revision history

Elcatracho: /* See Also */

2021-02-21T02:23:31Z

ClaireLewis at 17:13, 28 August 2019

2019-08-28T17:13:59Z

← Older revision		Revision as of 17:13, 28 August 2019
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	==Clinical Features==		==Clinical Features==
	*Classic “rice water” diarrhea with fishy odor; usually painless		*Classic “rice water” [[diarrhea]] with fishy odor; usually painless
	*Fluid losses can be significant, up to 1L/hr, leading to severe fluid and electrolyte ~~depletion~~. However, most cases are mild.		*Fluid losses can be significant, up to 1L/hr, leading to severe fluid and [[electrolyte abnormalities]]. However, most cases are mild.
	*Occasionally seen: sudden watery vomiting, borborygmi, abdominal cramping.		*Occasionally seen: sudden watery [[vomiting]], borborygmi, abdominal cramping.
	Later manifestations:		Later manifestations:
	*~~Fluid loss~~ may lead to → sunken eyes, dry mouth, cold clammy skin, decreased skin turgor, or wrinkled hands and feet (also known as “washer woman’s hands”)		*[[Dehydration]]] may lead to → sunken eyes, dry mouth, cold clammy skin, decreased skin turgor, or wrinkled hands and feet (also known as “washer woman’s hands”)
	*Acidosis from loss of bicarbonate		*[[Acidosis]] from loss of bicarbonate
	*Muscle cramps from ~~loss~~ of ~~K, Ca~~		*Muscle cramps from [[hypokalemia]], [[hypocalcemia]]

			===Complications===
			*Death
			*[[Arrhythmia]] from [[electrolyte imbalance]]
			*Brain damage from prolonged [[hypoglycemia]] and failure of gluconeogenesis
			*Aspiration [[pneumonia]]
			*Paralytic [[ileus]]

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	~~===Work-up===~~		*Diagnosis largely based on clinical presentation + epidemiological risk factors
	*Fecal smears will NOT show leukocytes or erythrocytes.		*Fecal smears will NOT show leukocytes or erythrocytes.
	*Diagnosis can be confirmed by stool cultures on TCBS medium (must inform lab cholera is suspected so appropriate medium is used)		*Diagnosis can be confirmed by stool cultures on TCBS medium (must inform lab cholera is suspected so appropriate medium is used)
			*Labs; non-specific abnormalities:
	~~===Evaluation===~~		**[[hyponatremia]]
	*~~Diagnosis largely based on clinical presentation + epidemiological risk factors~~		**[[hypokalemia]]
			**[[hypoglycemia]]
	~~===~~Labs~~===~~		**hemoconcentration (increased hematocrit & plasma protein concentration) from water depletion)
	*Non-specific abnormalities: hyponatremia, hypokalemia, hypoglycemia, increased hematocrit & plasma protein concentration (from water depletion)

	==Management==		==Management==
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	*Admit if [[hypotensive]] or hemodynamically unstable, severe [[electrolyte abnormalities]]		*Admit if [[hypotensive]] or hemodynamically unstable, severe [[electrolyte abnormalities]]

	~~==Complications==~~
	*Death
	*Arrhythmia from [[electrolyte imbalance]]
	*Brain damage from prolonged [[hypoglycemia]] and failure of gluconeogenesis
	*Aspiration [[pneumonia]]
	*Paralytic ileus

	==See Also==		==See Also==

Mholtz: Text replacement - "* " to "*"

2017-07-10T13:51:44Z

Text replacement - "* " to "*"

← Older revision		Revision as of 13:51, 10 July 2017
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	===Risk Factors===		===Risk Factors===
	* Persons with blood group O are more likely to have severe disease		*Persons with blood group O are more likely to have severe disease

	{{Vibrio species}}		{{Vibrio species}}

Rossdonaldson1: /* Disposition */

2017-02-14T13:31:46Z

Disposition

← Older revision		Revision as of 13:31, 14 February 2017
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	==Disposition==		==Disposition==
	*Admit if hypotensive or hemodynamically unstable, severe electrolyte abnormalities		*Admit if [[hypotensive]] or hemodynamically unstable, severe [[electrolyte abnormalities]]


	==Complications==		==Complications==

Rossdonaldson1 at 13:31, 14 February 2017

2017-02-14T13:31:16Z

← Older revision		Revision as of 13:31, 14 February 2017
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	:^Pregnant		:^Pregnant
	:@Children		:@Children

			==Disposition==
			*Admit if hypotensive or hemodynamically unstable, severe electrolyte abnormalities


	==Complications==		==Complications==
	*Death		*Death
	*~~Dysrhythmia~~ from electrolyte imbalance		*Arrhythmia from [[electrolyte imbalance]]
	*Brain damage from prolonged hypoglycemia and failure of gluconeogenesis		*Brain damage from prolonged [[hypoglycemia]] and failure of gluconeogenesis
	*Aspiration pneumonia		*Aspiration [[pneumonia]]
	*Paralytic ileus		*Paralytic ileus

	~~==Disposition==~~
	*Admit if hypotensive or hemodynamically unstable, severe electrolyte abnormalities

	==See Also==		==See Also==

Mholtz at 17:06, 8 February 2017

2017-02-08T17:06:20Z

← Older revision		Revision as of 17:06, 8 February 2017
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	==Management==		==Management==
	#Aggressive volume repletion (primary treatment)<ref>Sack DA, et al. Cholera. Lancet 2004; 363:223.</ref>		*Aggressive volume repletion (primary treatment)<ref>Sack DA, et al. Cholera. Lancet 2004; 363:223.</ref>
	#*Mild/moderate dehydration: [[oral rehydration solution]]		**Mild/moderate dehydration: [[oral rehydration solution]]
	#*Severe dehydration: [[IV fluids]]		**Severe dehydration: [[IV fluids]] - bolus lactated ringers 100ml/kg over 3 hrs
	~~#**Bolus~~ 100ml/kg LR over 3 hrs		**May require more than 350ml/kg in first 24 hours
	#**May require more than 350ml/kg in first 24 hours		*Antibiotics (decreases severity and duration of disease)<ref>Neilson AA, Mayer CA. Cholera - recommendations for prevention in travelers. Aust Fam Physician. 2010 Apr;39(4):220-6</ref>
	#Antibiotics (decreases severity and duration of disease)<ref>Neilson AA, Mayer CA. Cholera - recommendations for prevention in travelers. Aust Fam Physician. 2010 Apr;39(4):220-6</ref>		**Use local susceptibility to choose if available
	#*Use local susceptibility to choose if available		**Option 1: [[doxycycline]] 300mg x 1 PO<ref name="Stanford">Stanford Guide to Antimicrobial Therapy 2014.</ref>
	#**Option 1: [[doxycycline]] 300mg x 1 PO<ref>Stanford Guide to Antimicrobial Therapy 2014.</ref>		**Option 2: [[azithromycin]] 1 gm (20mg/kg) x 1 PO <ref name="Stanford" />^
	#**Option 2: [[azithromycin]] 1 gm (20mg/kg) x 1 PO <ref>Stanford ~~Guide to Antimicrobial Therapy 2014.<~~/~~ref~~>^		**Option 3: [[erythromycin]] 500 QID x 3 days<ref name="Stanford" />^@
	#**Option 3: [[erythromycin]] 500 QID x 3 days<ref>Stanford ~~Guide to Antimicrobial Therapy 2014.<~~/~~ref~~>^@		**Option 4: [[ciprofloxacin]] 1g x 1 PO
	#**Option 4: [[ciprofloxacin]] 1g x 1 PO		**Option 5: [[TMP-SMX]] DS BID s 3 days
	#**Option 5: [[TMP-SMX]] DS BID s 3 days		*Give children Zinc and Vitamin A supplementation
	#Give children Zinc and Vitamin A supplementation

	:^Pregnant		:^Pregnant
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	==See Also==		==See Also==
	*[[Diarrhea]]		*[[Diarrhea]]
	*[[Travel ~~Medicine~~]]		*[[Travel medicine]]

	==References==		==References==

Alberina: /* Management */

2017-02-07T15:30:01Z

Management

← Older revision		Revision as of 15:30, 7 February 2017
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	:^Pregnant		:^Pregnant
	:@Children		:@Children

			==Complications==
			*Death
			*Dysrhythmia from electrolyte imbalance
			*Brain damage from prolonged hypoglycemia and failure of gluconeogenesis
			*Aspiration pneumonia
			*Paralytic ileus

	==Disposition==		==Disposition==

Alberina: /* Evaluation */

2017-02-07T15:24:59Z

Evaluation

← Older revision		Revision as of 15:24, 7 February 2017
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	===Evaluation===		===Evaluation===
	*Diagnosis largely based on clinical presentation + epidemiological risk factors		*Diagnosis largely based on clinical presentation + epidemiological risk factors

			===Labs===
			*Non-specific abnormalities: hyponatremia, hypokalemia, hypoglycemia, increased hematocrit & plasma protein concentration (from water depletion)

	==Management==		==Management==

Alberina: /* Pathophysiology */

2017-02-07T15:22:12Z

Pathophysiology

← Older revision		Revision as of 15:22, 7 February 2017
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	===Pathophysiology===		===Pathophysiology===
	*Usually Vibrio cholera (gram negative), which produces an enterotoxin which causes a secretory diarrhea<ref>LaRocque R and Pietroni M. “Approach to the Adult with Acute Diarrhea in Developing Countries”. UpToDate.com</ref>		*Usually Vibrio cholera (gram negative), which produces an enterotoxin which causes a secretory diarrhea<ref>LaRocque R and Pietroni M. “Approach to the Adult with Acute Diarrhea in Developing Countries”. UpToDate.com</ref>
			**Toxin causes increase in cell cAMP leading to secretion of water and electrolytes into the gut lumen

	===Natural History===		===Natural History===

Alberina: /* Background */

2017-02-07T15:19:11Z

Background

← Older revision		Revision as of 15:19, 7 February 2017
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	*Most people are asymptomatic, and simply have bacteria in their feces for 7-14 days		*Most people are asymptomatic, and simply have bacteria in their feces for 7-14 days
	*[[Diarrhea]] is most severe in days 1-2, usually resolves in 7 days		*[[Diarrhea]] is most severe in days 1-2, usually resolves in 7 days

			===Risk Factors===
			* Persons with blood group O are more likely to have severe disease

	{{Vibrio species}}		{{Vibrio species}}

← Older revision		Revision as of 02:23, 21 February 2021
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	*[[Diarrhea]]		*[[Diarrhea]]
	*[[Travel medicine]]		*[[Travel medicine]]

			==External Links==
			*[https://www.cdc.gov/cholera/index.html CDC: Cholera]

	==References==		==References==