Cholera differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, MBBS [2]

Patients with cholera may have a history of consumption of contaminated food or water and/or travel to an endemic area. Symptoms of cholera usually develop within 24-48 hour of infection. Patient presents with sudden-onset, painless, odorless, rice-watery, large-volume stool; abdominal cramps; vomiting; and fever. Cholera should be differentiated from other infectious causes of diarrhea such as rotavirus, E. coli, amoebic dysentry, and giardiasis. Cholera should also be differentiated from some non-infectious causes of diarrhea such as VIPoma, tubulovillous adenoma, and food poisoning.^[1][2][3][4]

Cholera must be differentiated from other conditions associated with acute onset diarrhea, including:^[1][2][3][4]

• It may be difficult to differentiate cholera from other infectious causes of diarrhea, especially if it is mild and in early stages.
• Fresh stool microscopy, stool culture, PCR, and other techniques help to differentiate these conditions. Stool tests are useful, cheap, and frequently used to differentiate cholera from other infectious conditions. Other tests (e.g., PCR, serotyping), though sensitive and specific, may not be performed due to prohibitive cost or lack of availability at many healthcare centers.

• Shigella patients present with acute, bloody diarrhea, whereas cholera patients have watery diarrhea.
• Shigella causes invasive diarrhea and thus presents with symptoms of fever, abdominal cramps, and rectal pain, which are not observed in patients with cholera.
• Vomiting is usually absent in shigella but is frequently seen in cholera.

• Bloody diarrhea, which is not seen in cholera, guides clinicians toward a diagnosis of dysentery.
• The volume of stool is not as high as seen in cases of cholera.

• The volume of stool is not as high as in cases of cholera.
• Stool microscopy is used to detect eggs and parasites.
• The stool of giardiasis patients produces a strong odor, whereas cholera patients usually have odorless stools.

• The volume of stool is not as high as in cases of cholera.
• Stool microscopy is used to detect eggs and parasites.

• The volume of stool is not as high as in cases of cholera.

• Patients present with a chronic history of diarrhea
• Volume of stool is not as high as in cases of cholera
• Negative stool examination and culture
• Fasting gut hormones confirm the diagnosis

• Colonoscopy and biopsy confirm the diagnosis
• Patients present with a chronic history of diarrhea
• Volume of stool is not as high as in cases of cholera
• Negative stool examination and culture

The table below summarizes the findings that differentiate watery causes of chronic diarrhea^[5][6][7][8]

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