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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.
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==
==Differential diagnosis==
===Complete Differential Diagnosis of the Causes of Cholera===
===Infectious Diarrhea===
===Infectious Diarrhea===
* Difficult to differentiate specially if the diarrhea is mild and in early stages.
* Difficult to differentiate specially if the diarrhea is mild and in early stages.

Revision as of 16:28, 4 April 2012

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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

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

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