A00 Cholera
| code | description | note |
|---|---|---|
| A00.0 | Cholera due to Vibrio cholerae 01, biovar cholerae | Classical cholera |
| A00.1 | Cholera due to Vibrio cholerae 01, biovar eltor | Cholera eltor |
| A00.9 | Cholera, unspecified |
Sources
- Cholera: Clinical features, diagnosis, treatment, and prevention - Up to date
- Vibrio cholerae infection - cdc
- Vibrio cholerae - Wikipedia
- Cholera - Britannica
- Cholera: Microbiology and pathogenesis - Up to date
- Cholera vaccines: WHO position paper
- Chorela - Lancet seminar
- Identifying the Most Sensitive and Specific Sign and Symptom Combinations for Cholera: Results from an Analysis of Laboratory-Based Surveillance Data from Haiti, 2012–2013
General Despcription
Cholera is caused by the infection of toxigenic Vibrio cholerae, a gram negative rod-like bacteria. Severe cholera can be deadly.
Main symptoms are diarreah and vomiting resulting in fluid loss and electrolyte loss. Fever and abdominal pains are rare.
Main manegement is volume repletion with isotonic fluids. Antibodies and antibiotics are also useful.
Etiology
Cholera is caused by the infection of toxigenic Vibrio cholerae. After passing the upper gastro-intestinal tract, V.cholerae colonises in the small intestine. Here, toxigenic V.bacteria produces a toxin named cholera toxin.
Cholera toxin consists of 6 subunits, a single A-subunit and 5 B-subunits. Cholera toxin is endocytosed into the epithelial cell, where the disulfide bond between A-subunit and B-subunits are cleaved.
The five B-subunits cause the endocytosis of the cholera toxin. The B-subunits give cholera toxin a high affinity with monosialoganglioside GM1, a epithelial cell surface receptor.
The single A-subunit causes cAMP increase via Gs protein after it is cleaved from the B-subUnits. This increase results in chloride secretion and inhibition of sodium absorption, causing the fluid loss.
Epidemiology
The estimated number of global annual cases is 3000000 to 5000000[6] with 100000 global annual deaths.
Cholera is endemic mostly in Africa and Asia with occasional epidemic spreads1.
In Japan
Symptoms and Physical Examination
Sensitivity and specificity is based on, 8, which studied the pandemic in Haiti. Note that these values rely on local epidemiology.
| Symptom | Sensitivity (%) | Specificity (%) | Note |
|---|---|---|---|
| Diarreah | 91.3 | 43.1 | |
| Dehydration | 97.6 | 4.3 | Hypovolumeria |
| Electrolyte Loss | |||
| Vomiting | 88.7 | 29.8 | |
| Nausea | 69.2 | 45.3 | |
| Abdominal Pain |
Diarreah
Diarreah in chorela is watery diarreah with flecks of mucosa. Due to the appearance, watery diarreah is often described as “rice-water” like.
The amount of stools can be up to 1L per hour. The amount of volume loss can be roughly estimated as 10-20mL/kg of body weight for every episode of diarreah (or vomiting).
Dehydration
Severe dehydration can be lethal.
Patients with severe dehydration shows characteristic facies with sunken eyes and high cheekbones and nasal bridge.
| Symptom | Sensitivity (%) | Specificity (%) | Note |
|---|---|---|---|
| Irrtable | |||
| Less Active | |||
| Letheric | |||
| Comatose | |||
| Sunken Eye | |||
| Dry Mucosa | |||
| Thirst | |||
| Unable to Drink | |||
| Reduced Skin Turgol</span> | |||
| Wrinkled Hands and Feet</span> | Washer Woman’s Hand |
Electrolyte Loss
| Symptom | Sensitivity (%) | Specificity (%) | Note |
|---|---|---|---|
| Hypokalemia | |||
| Hyponatremia | Isonatremic dehydration is most common | ||
| Hypernatremia | Isometremic dehydration is most common | ||
| Hypocarcemia | |||
| Muscle Pain | 27.4 | 80.9 | Due to hypocarcemia |
| Lactic Acidosis | Due to lowperfusion |
Negative or Rare Symptoms
Fever is rare.
Abdominal pain may occur, but is relatively rare regarding its gastro-intestinal symptoms.