Difference between revisions of "Cholera"
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==Background== | ==Background== | ||
| − | * Endemic to Asia, Africa, and Central and South America | + | * Endemic to Asia, Africa, and Central and South America <ref>http://www.who.int/cholera/en/</ref> |
* Occasionally seen on the Gulf Coast of US, due to inadequately cooked seafood. | * Occasionally seen on the Gulf Coast of US, due to inadequately cooked seafood. | ||
==Pathophysiology== | ==Pathophysiology== | ||
| − | * Usually Vibrio cholera, which produces an enterotoxin which causes a secretory diarrhea | + | * Usually Vibrio cholera, 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> |
==Natural History== | ==Natural History== | ||
* Transmission via ingestion of contaminated food or water, usually undercooked seafood | * Transmission via ingestion of contaminated food or water, usually undercooked seafood | ||
| − | * Incubation period between hours to 5 days, depending on size of inoculum (usually 1-2 days) | + | * Incubation period between hours to 5 days, depending on size of inoculum (usually 1-2 days)<ref>Mobula LM. Community health facility preparedness for a cholera surge in Haiti. Am J Disaster Med. 2013 Autumn;8(4):235-41</ref> |
* 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 | ||
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* Acidosis from loss of bicarbonate; muscle cramps from loss of K, Ca | * Acidosis from loss of bicarbonate; muscle cramps from loss of K, Ca | ||
==Differential Diagnosis of Watery Diarrhea== | ==Differential Diagnosis of Watery Diarrhea== | ||
| − | * Enterotoxigenic E. coli (most common cause of watery diarrhea) | + | * Enterotoxigenic E. coli (most common cause of watery diarrhea)<ref>Marx et al. “Cholera and Gastroenteritis caused by Noncholera Vibrio Species”. Rosen’s Emergency Medicine 8th edition vol 1 pg 1245-1246.</ref> |
* Norovirus (often has prominent vomiting) | * Norovirus (often has prominent vomiting) | ||
* Campylobacter | * Campylobacter | ||
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* Diagnosis can be confirmed by stool cultures on TCBS medium (tell the lab cholera is suspected, so appropriate medium is used). | * Diagnosis can be confirmed by stool cultures on TCBS medium (tell the lab cholera is suspected, so appropriate medium is used). | ||
==Management== | ==Management== | ||
| − | * Aggressive volume repletion. Usually can be given orally if mild/moderate volume depletion; give rehydration solution to replete electrolyte loss. | + | * Aggressive volume repletion. Usually can be given orally if mild/moderate volume depletion; give rehydration solution to replete electrolyte loss. </ref>* Sack DA, et al. Cholera. Lancet 2004; 363:223.</ref> |
* Oral rehydration solution includes in 1L of water: 2.6g NaCl, 2.9g Trisodium citrate, 1.5 g KCl, and 13.5 g glucose. | * Oral rehydration solution includes in 1L of water: 2.6g NaCl, 2.9g Trisodium citrate, 1.5 g KCl, and 13.5 g glucose. | ||
:*If severe dehydration, bolus with 100 ml/kg over 3 hrs. LR is solution of choice. May require more than 350 ml/kg in first 24 hours. | :*If severe dehydration, bolus with 100 ml/kg over 3 hrs. LR is solution of choice. May require more than 350 ml/kg in first 24 hours. | ||
* Antibiotic treatment decreases severity and duration of disease. Antibiotic resistance patterns are changing constantly. Most recommended currently is azithromycin 20mg/kg single dose. | * Antibiotic treatment decreases severity and duration of disease. Antibiotic resistance patterns are changing constantly. Most recommended currently is azithromycin 20mg/kg single dose. | ||
| − | :*Alternatives: ciprofloxacin 1g single dose; doxycycline 300mg single dose; TMP-SMX double strength BID for 3 days; erythromycin 500 QID for 3 days. | + | :*Alternatives: ciprofloxacin 1g single dose; doxycycline 300mg single dose; TMP-SMX double strength BID for 3 days; erythromycin 500 QID for 3 days. <ref><ref>Neilson AA, Mayer CA. Cholera - recommendations for prevention in travelers. Aust Fam Physician. 2010 Apr;39(4):220-6</ref></ref> |
| − | * Give children Zinc and Vitamin A. | + | * Give children Zinc and Vitamin A. z |
==Sources== | ==Sources== | ||
<references/> | <references/> | ||
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Revision as of 12:49, 1 October 2014
Contents
Background
- Endemic to Asia, Africa, and Central and South America [1]
- Occasionally seen on the Gulf Coast of US, due to inadequately cooked seafood.
Pathophysiology
- Usually Vibrio cholera, which produces an enterotoxin which causes a secretory diarrhea[2]
Natural History
- Transmission via ingestion of contaminated food or water, usually undercooked seafood
- Incubation period between hours to 5 days, depending on size of inoculum (usually 1-2 days)[3]
- 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
Clinical Features
- 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.
- Occasionally seen: sudden watery vomiting, borborygmi, abdominal cramping.
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”)
- Acidosis from loss of bicarbonate; muscle cramps from loss of K, Ca
Differential Diagnosis of Watery Diarrhea
- Enterotoxigenic E. coli (most common cause of watery diarrhea)[4]
- Norovirus (often has prominent vomiting)
- Campylobacter
- Non-typhoidal Salmonella
- Enteroaggregative E. coli (EAEC)
- Enterotoxigenic Bacteroides fragilis
Workup
- Diagnosis largely clinical presentation + epidemiological risk factors
- Fecal smears will NOT show leukocytes or erythrocytes.
- Diagnosis can be confirmed by stool cultures on TCBS medium (tell the lab cholera is suspected, so appropriate medium is used).
Management
- Aggressive volume repletion. Usually can be given orally if mild/moderate volume depletion; give rehydration solution to replete electrolyte loss. </ref>* Sack DA, et al. Cholera. Lancet 2004; 363:223.</ref>
- Oral rehydration solution includes in 1L of water: 2.6g NaCl, 2.9g Trisodium citrate, 1.5 g KCl, and 13.5 g glucose.
- If severe dehydration, bolus with 100 ml/kg over 3 hrs. LR is solution of choice. May require more than 350 ml/kg in first 24 hours.
- Antibiotic treatment decreases severity and duration of disease. Antibiotic resistance patterns are changing constantly. Most recommended currently is azithromycin 20mg/kg single dose.
- Alternatives: ciprofloxacin 1g single dose; doxycycline 300mg single dose; TMP-SMX double strength BID for 3 days; erythromycin 500 QID for 3 days. Cite error: Closing
</ref>missing for<ref>tag</ref>
- Alternatives: ciprofloxacin 1g single dose; doxycycline 300mg single dose; TMP-SMX double strength BID for 3 days; erythromycin 500 QID for 3 days. Cite error: Closing
- Give children Zinc and Vitamin A. z
Sources
- ↑ http://www.who.int/cholera/en/
- ↑ LaRocque R and Pietroni M. “Approach to the Adult with Acute Diarrhea in Developing Countries”. UpToDate.com
- ↑ Mobula LM. Community health facility preparedness for a cholera surge in Haiti. Am J Disaster Med. 2013 Autumn;8(4):235-41
- ↑ Marx et al. “Cholera and Gastroenteritis caused by Noncholera Vibrio Species”. Rosen’s Emergency Medicine 8th edition vol 1 pg 1245-1246.