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Appendices

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Section 3. Summaries of Infectious Diseases

VIBRIO Infections

Cholera

(Vibrio cholerae)

Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures

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CLINICAL MANIFESTATIONS: Cholera is characterized by painless voluminous diarrhea without abdominal cramps or fever. Dehydration, hypokalemia, metabolic acidosis, and occasionally, hypovolemic shock can occur in 4 to 12 hours if fluid losses are not replaced. Coma, seizures, hypoglycemia, and death also can occur, particularly in children. Stools are colorless, with small flecks of mucus ("rice-water"), and contain high concentrations of sodium, potassium, chloride, and bicarbonate. Most infected people with toxigenic Vibrio cholerae O1 have no symptoms, and some have only mild to moderate diarrhea lasting 3 to 7 days; fewer than 5% have severe watery diarrhea, vomiting, and dehydration (cholera gravis).


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ETIOLOGY: Vibrio cholerae is a gram-negative, curved, motile bacillus with many serogroups. Only serogroups O1, O139, and O141 cause clinical cholera associated with enterotoxin. There are 3 serotypes of V cholerae O1: Inaba, Ogawa, and Hikojima. The 2 biotypes of V cholerae are classical and El Tor. El Tor is more commonly observed. Since 1992, toxigenic V cholerae serogroup O139 has been recognized as a cause of cholera. Nontoxigenic strains of V cholerae O1 and serogroups other than O1 and O139 can cause sporadic diarrheal illness, but they do not cause epidemics.


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EPIDEMIOLOGY: During the last 5 decades, V cholerae O1 biotype El Tor has spread from India and Southeast Asia to Africa, the Middle East, Southern Europe, and the Western Pacific Islands (Oceania). In 1991, epidemic cholera caused by toxigenic V cholerae O1, serotype Inaba, biotype El Tor, appeared in Peru and spread to most countries in South and North America. In the United States, cases resulting from travel to or ingestion of contaminated food transported from Latin America or Asia have . . . [Go to Full Text]


Related text in Red Book:

Introduction

Red Book 2006: 735. [Extract] [Full Version]