Vibrio Cholera & It's Clinical Features

CLINICAL MANIFESTATION OF V.CHOLERA:
  • Diarrhea occurs as much as 20 – 30 Liters/Day fluids are lost.
  1. Incubation period 24 to 48 hrs
  2. It has been called "rice water stool" because of its resemblance to the water in which rice has been washed.
  3. The stool has a characteristic appearance a nonbilious, gray, slightly cloudy fluid with flecks of mucus, no blood and a somewhat sweet, inoffensive odour.
  4. Fever is usually absent.
  5. Sudden onset of painless watery diarrhea is followed by vomiting.
  6. Results in dehydration
  7. Shock
  8. Acidosis:Cholera is a cause of normal anion gap metabolic acidosis produced as a result of loss of bicarbonate in the faeces
  9. Can lead to death.
  • About 60% of infections are caused with classic V.cholrae and are asymptomatic, about 75% of infections are caused by El Tor biotype
  • Arsenic poisoning can be detected from hair & nails long after death and confused with cholera and clinically present with rain drop pigmentation & mees line
  • The incubation period is 1 – 4 days for person who develop symptoms, depends on the size of the inoculums ingested
  • Manifest with
  1. Nausea , vomiting,profuse diarrhea, and abdominal cramps
  2. Rice water stool characteristic of cholera
  3. Loss of fluid leads to profound dehydration, Circulatory collapse and anuria.
  • On laboratory evaluation there will be :
  1. Mild neutrophilic leukocytosis (neutrophilia)
  2. Elevated hematocrit
  3. Elevated BUN and creatinine
  4. Normal sodium, potassium and chloride levels.
  5. Markedly reduced bicorbonate level
  6. Elevated anion gap
  7. Acidosis (Low pH)
  • Dehydration. Dehydration can develop within hours after the onset of cholera symptoms.
  1. A loss of 10 percent or more of total body weight indicates severe dehydration.
  2. Signs and symptoms of cholera dehydration include irritability, lethargy, sunken eyes, a dry mouth, extreme thirst, dry and shriveled skin that's slow to bounce back when pinched into a fold, little or no urine output, low blood pressure, and an irregular heartbeat (arrhythmia).
  3. Electrolyte imbalance
  4. Muscle cramps. These result from the rapid loss of salts such as sodium, chloride and potassium.
  5. Shock. This is one of the most serious complications of dehydration. It occurs when low blood volume causes a drop in blood pressure and a drop in the amount of oxygen in your body. If untreated, severe hypovolemic shock can cause death in a matter of minutes.
PANCREATIC CHOLERA:
  • It is a Pancreatic endocrine tumor, most commonly of the Delta cells, characterized by net secretion of salt and water by gut:
  • Features of Pancreatic cholera :
  1. Severe watery diarrhea / flushing / weight loss
  2. Hypokalemia 
  3. Hypochlorhydria 
  4. Hypercalcemia 
  5. Hyperglycemia 
  6. Inordinate fecal water and electrolyte loss
  7. Achlorhydria
  8. Pancreatic cholera is synonymous with 'Verner Morrison Syndrome' or `WDHA Syndrome'
SIGNS & SYMPTOMPS OF CHOLERA IN CHILDREN: In general, children with cholera have the same signs and symptoms adults do, but they are particularly susceptible to low blood sugar (hypoglycemia) due to fluid loss, which may cause:
  • An altered state of consciousness
  • Seizures
  • Coma
Exam Question
  • V. cholera Causes secretory diarrhoea
  • In diarrhoea due to V. cholera neutrophilia is significant in stool
  • Arsenic poisoning presents with symptoms mimicking Cholera
  • Pancreatic cholera is characterized by Hypokalemia,Hypochlorhydria ,Hypercalcemia ,Hyperglycemia , Achlorhydria, Severe watery diarrhea & Inordinate fecal water and electrolyte loss Cholera is a cause of normal anion gap metabolic acidosis produced as a result of loss of bicarbonate in the faeces
  • Metabolic acidosis,Acute renal failure,Hypovolemic shock & death are the complications of cholera

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