Overview
Cholera is an acute diarrhoeal infection caused by Vibrio cholerae, characterised by large amounts of watery diarrhoea which can quickly lead to severe dehydration within hours if untreated. It is associated with poverty, however, can be found in returning travellers.
Pathophysiology
Most bacteria are killed by stomach acid when ingested, however, some Vibrio cholerae bacteria can survive and attach to epithelial cells in the small intestine. They produce toxins causing epithelial cells to pump chloride ions into the small intestine, creating a water potential gradient, resulting in water following and severe diarrhoea.
Epidemiology
- Cholera is more common in areas with poor sanitation and water hygiene
- It is endemic to South Asia, along with parts of Africa, the Middle East, and south America
- Around 10 cases of cholera are imported into the UK annually
Risk Factors
- Drinking untreated water
- Eating poorly cooked food
- Living in unsanitary conditions
Presentation
Features include:
- Profuse diarrhoea – litres of fluid can be lost, often described as ‘rice water’ stools (greyish, cloudy, with mucus)
- Dehydration
- Vomiting
Investigations
- Stool microscopy and culture:
- Confirms organism presence
Management
Overview
The mainstay of management includes oral rehydration therapy, intravenous fluids and antibiotics such as doxycycline.
