Best Cholera Treatment in Hyderabad, India | Expert Care

Vibrio cholera diagnosis is based on clinical signs and symptoms. The characteristic severe diarrhea and travel to an endemic area can be sufficient for the diagnosis of cholera. By the isolation and culture of bacterium Vibrio cholerae from stool isolates, the diagnosis can be confirmed. Culture can be improved by using selective media with a high pH, which suppresses the growth of intestinal microflora while allowing the multiplication of vibrio cholera. Rapid diagnostic tests (RDT) are used to identify the antigens (O1 or O130) in samples. Darkfield microscopy of the stool and dipsticks are used to visualize the organism rapidly. 

The general physician may consider the following before diagnosing cholera: 

Initial or Clinical evaluation

• Patient History 
• Clinical signs and symptoms 

Patient History: The patient is inquired if they have any recent travel history to endemic areas or have been exposed to contaminated water. Individuals who travelled to the endemic regions of cholera, consumed contaminated food or water increase the suspicion of cholera

Clinical signs and symptoms: Signs and symptoms of cholera range from asymptomatic to profuse diffusion. The following are the common signs and symptoms that can distinguish cholera from other diarrheal illness: 

• Diarrhea: In patients with cholera, diarrhea can be described as watery (rice watery) stools 
• Severe dehydration: High volume diarrhea causes hypovolemia, resulting in excess fluid loss. Dehydration is characterized by dry oral mucosa, cool skin, and decreased skin turgor.
  

Based on the above information, the following diagnostic tests are recommended for diagnosing cholera: 



Laboratory testing

• Stool culture 
• Polymerase chain reaction 

Rapid diagnostic tests 

Laboratory testing 

• Stool culture: Stool or rectal swab culture is the gold-standard reference method for diagnosing cholera. Specimens are placed into an enrichment broth that enhances the sensitivity of the culture, these broths are made up of alkaline peptone water. The specimens are later subcultured on ideal culture mediums like thiosulfate citrate bile salt (TCBS) agar or taurocholate tellurite gelatin agar (TTGA). For transporting the culture from field settings to the laboratory, Cary-Blair medium is commonly used as the medium. 

• Polymerase chain reaction: Diagnosis of cholera using the polymerase chain reaction (PCR) technique is highly sensitive, and this technique requires enhanced laboratory capacity. This technique can detect molecular markers of certain phenotypes with target genes such as ctxA (cholera toxin subunit A), tcpA (toxin-coregulated pilus), and ompW (outer membrane protein). The costs with PCR techniques are approximately the same as those of stool culture, but the results of polymerase chain reaction can be obtained much earlier compared to stool culture.

Rapid diagnostic tests: These diagnostic tests are performed in rural areas and in underdeveloped health care settings where culture tests and polymerase chain reactions are not employed due to scarcity of trained personnel. This diagnostic test provides an early warning to health experts when a cholera outbreak is imminent. These are available in different categories with a wide range of sensitivities and specificities.

Lipopolysaccharide (LPS) antigens of both Vibrio cholerae O1 and O139 serogroups can be detected easily by monoclonal antibodies in Crystal VC. The sensitivity of crystal VC is 97 percent, and the specificity is 76 percent.

✅Stages of Cholera

Cholera severity depends upon the rapidity and duration of fluid loss. The following are the three clinical stages of cholera:

• Stage of evacuation - In this stage, sudden onset of diarrhea, which is profuse, painless, watery (rice water) occurs, followed by episodes of vomiting. 

• Stage of collapse – In this stage, the patient collapses due to dehydration. The patient may show some classical signs such as sunken eyes, hollow cheeks, scaphoid abdomen, no pulse, blood pressure which cannot be recorded, loss of skin elasticity, and shallow and quick respiration. Death may also occur with dehydration and acidosis resulting from diarrhea. 

• Stage of recovery - The Patient will start to show symptoms of recovery when death does not occur. This is a classical form of severe cholera that occurs in only 5 ‐ 10 percent of cases. The blood pressure and the temperature will come back to normal.

✅Differential Diagnosis of Cholera

Differential diagnosis is a process of differentiating two or more diseases which share similar signs and symptoms with cholera. It includes the following: 

• Escherichia coli infection: It is a gram-negative bacillus which is a part of normal intestinal flora but can also be the cause of intestinal and extraintestinal illness in humans. There are about hundreds of identified E. coli strains, which results in a spectrum of disease from mild, self-limited gastroenteritis to renal failure and septic shock. Watery stools, low-grade fever, loss of appetite, and stomach cramps are some of the symptoms of this infection. 

• Typhoid fever: It is a life-threatening condition which is caused by the bacterium Salmonella Typhi. It usually spread through contaminated food or water, and once these bacteria are ingested, they multiply and spread into the bloodstream. Prolonged high fever, fatigue, headache, nausea, abdominal pain, and constipation or diarrhoea are some of the symptoms.

• Shigellosis: It is an acute enteric infection which is caused by shigella, a facultative gram-negative, anaerobic bacillus. It is transmitted via the fecal-oral route or by direct person-to-person contact. Mucoid bloody diarrhea, fever, and abdominal pain are some of the symptoms of shigellosis. 

• Rotavirus infection: These are the leading causes of severe, dehydrating gastroenteritis in children less than 5 years of age. It is transmitted via the oral-fecal route, directly from person to person, or indirectly through contamination.