Cholera differential diagnosis: Difference between revisions
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* [[Colonoscopy]] and [[biopsy]] are confirmatory for the diagnosis. | * [[Colonoscopy]] and [[biopsy]] are confirmatory for the diagnosis. | ||
* Chronic history of diarrhea | * Chronic history of diarrhea | ||
* Volume of stool is not as high as seen with Cholera | * Volume of stool is not as high as seen with Cholera | ||
* Negative stool examination and culture. | * Negative stool examination and culture. | ||
Revision as of 16:28, 7 October 2016
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Cholera differential diagnosis On the Web |
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Risk calculators and risk factors for Cholera differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, MBBS [2]
Overview
Patients with cholera 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, amoebic dysentry and giardiasis. It should also be differentiated from some non-infectious causes of diarrhea for e.g. 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 Diarrhea
- It may be difficult to differentiate cholera from other infectious causes of diarrhea specially 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 test to differentiate cholera from other infectious conditions. Other tests like PCR, serotyping though sensitive and specific, may not be performed because of the cost or non-availability at many centers.
Shigella
- Shigella has acute bloody diarrhea whereas cholera has watery diarrhea
- Shigella causes invasive diarrhea thus presents with symptoms of fever, abdominal cramp and rectal pain. These symptoms are lacking in cholera.
- Vomiting is usually absent in Shigella but is frequently seen in cholera.
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.
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.