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

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. 1.0 1.1 Sack DA, Sack RB, Nair GB, Siddique AK (2004). "Cholera". Lancet. 363 (9404): 223–33. PMID 14738797.
  2. 2.0 2.1 Krejs GJ (1987). "VIPoma syndrome". Am J Med. 82 (5B): 37–48. PMID 3035922.
  3. 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. 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.

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