{"id":4334,"date":"2010-09-11T11:00:28","date_gmt":"2010-09-11T15:00:28","guid":{"rendered":"http:\/\/insidesurgery.com\/?p=4334"},"modified":"2010-09-03T20:20:10","modified_gmt":"2010-09-04T00:20:10","slug":"cholera","status":"publish","type":"post","link":"https:\/\/insidesurgery.com\/2010\/09\/cholera\/","title":{"rendered":"Cholera"},"content":{"rendered":"

Pathophysiology<\/strong><\/p>\n

1)<\/strong> cause is infection with Vibrio cholerae serogroups 01 and 0139 2)<\/strong> production of enterotoxin (exotoxin) causes prolonged hypersecretion of water and electrolytes from entire length of small bowel 3) exists in classical and El Tor biotypes, which differ in phage susceptibility and hemolysin production<\/p>\n

Signs and Symptoms<\/strong><\/p>\n

1)<\/strong> sudden onset of nausea and vomiting 2)<\/strong> profuse watery diarrhea 3)<\/strong> abdominal cramps 4)<\/strong> as condition progresses – dehydration (wrinkled skin on fingers), shock, renal failure, and death 5)<\/strong> symptoms can range from mild to severe and fulminant<\/p>\n

Characteristic Test Findings<\/strong><\/p>\n

Laboratory<\/em> – 1)<\/strong> severe metabolic acidosis 2)<\/strong> decreased serum K+ 3)<\/strong> decreased serum bicarbonate 4)<\/strong> increased anion gap 5)<\/strong> increased hematocrit owing to hemoconcentration 6)<\/strong> leukocytosis 7)<\/strong> diagnosis is by identification of organisms in stool<\/p>\n

Histology<\/strong><\/p>\n

1)<\/strong> motile, “comma-shaped,” aerobic, facultative anaerobic, gram-negative rod 2)<\/strong> strains are classified on basis of O antigent 3)<\/strong> stools contain mucus, epithelial cells, and large numbers of vibrios<\/p>\n

Associated Conditions<\/strong><\/p>\n

increased incidence in – blood group O, hypochlorhydria (normally acidic stomach partially retards growth of vibrios)<\/p>\n

Biochemistry<\/strong><\/p>\n

1)<\/strong> enterotoxin has a heat-labile protein with subunits A (which increases intracellular levels of cAMP) and B 2)<\/strong> result is a “switch on” in adenylate cyclase pathway with resulting abnormal G protein<\/p>\n

Inheritance\/Epidemiology<\/strong><\/p>\n

1)<\/strong> incubation period of 1-4 days 2)<\/strong> spread by ingestion of food or water contaminated by infected feces 3)<\/strong> infection confers partial, non-permanent protection 4)<\/strong> El Tor biotype causes milder disease than classic biotype 5)<\/strong> endemic in Middle East, Asia, Central America, and South America (outbreaks most typical in warm months in children) 6)<\/strong> mortality – in severe untreated cases, > 50%; if adequate fluid and electrolyte replacements, < 1% 7)<\/strong> most common location for vibrios in nature is in tidal bays and rivers with moderate salinity<\/p>\n

Treatment<\/strong><\/p>\n

1)<\/strong> aggressive replacement of water and electrolytes (can be orally or with Ringer’s lactate or hypertonic saline) 2)<\/strong> tetracycline, doxycycline, or ciprofloxacin 3)<\/strong> diagnosis is by positive culture of rectal swab or fresh stool specimen 4)<\/strong> IM cholera vaccine is available but has limited effectiveness<\/p>\n

Tips for USMLE<\/strong><\/p>\n

1)<\/strong> if rice-water stools is mentioned, think cholera 2)<\/strong> the diarrhea is non-bloody<\/p>\n","protected":false},"excerpt":{"rendered":"

Pathophysiology 1) cause is infection with Vibrio cholerae serogroups 01 and 0139 2) production of enterotoxin (exotoxin) causes prolonged hypersecretion of water and electrolytes from entire length of small bowel 3) exists in classical and El Tor biotypes, which differ in phage susceptibility and hemolysin production Signs and Symptoms 1) sudden onset of nausea and […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[63],"tags":[2979,2978,2976,2981,2977,2980],"yoast_head":"\nCholera - InsideSurgery Medical Information Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/insidesurgery.com\/2010\/09\/cholera\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Cholera - 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