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Study common diseases (Differential diagnosis of Cholera by clinical features).



Clinical feature of Cholera:

Cholera is acute watery diarrhea caused by Vibrio Cholera serotypes O1 and O139.
This disease is one of the most killer in our country and have seasonal outbreak every year causing hundred of death most of them children and infants.
Seasonal outbreaks are known to occur from the end of March through to the month July (WHO report 2011). However sporadic outbreaks occur all year round and most characterized by high fatality rates .

Symptoms of cholera:

Acute watery diarrhea is the most common features of cholera, vomiting, thirst, dry mucous, dehydration, muscle cramps, fever (sometimes) and death can occur if untreated.
These symptoms are not specific for cholera only many other diseases have like these symptoms (especially diarrhea) so you have to differentiate from these diseases.

What are diseases have diarrhea symptoms common in our country?

Bacterial diseases have diarrhea:
Enterotoxigenic E.Coli, diarrhea from food poising, bacillary dysentery, Enteroinvasive E.Coli,  Aeromonas spp, Enteric fever, Guillain Barr? Syndrome, Yersinia enterocolitica etc.

Viral diseases have diarrhea:
Infantile gastroenteritis (Rotavirus). Epidemic viral gastroenteritis in school children and adults (Norwalk virus). Sporadic gastroenteritis in infants, children, elderly and immunocompromised patients (Astroviruses).

Parasites causing diarrheal diseases:
Heterophysiasis, adult tabe worm infections, Hook worm diseases, Ascariasis, Strongyloidiasos, Trichinosis, Gardiasis, Cyclospoiasis, Isosporiasis, Visceral leishmaniasis, malignant malaria.

How can I differentiate cholera case from these diseases depend on my clinical symptoms?

Athough the cholera is serios case, first take full history from patient and then seek the following clinical features.
1. Acute watery diarrhea:   
Following an incubation period of 6 to 48 hours, cholera begins with abrupt onset of massive diarrhea.
Diarrhoea due to cholera has milky appearance (rice-water  stools), this is one of gorden role for diagnosis of cholera by clinical features.

2. Nausea and vomiting:
This occurs in both the early, and later stages of cholera and vomiting my persist for hours at time.

3. Dehydration:
As patient loss more and more body fluids, causes electrolyte imbalance and the patient may become hypovolaemic shock one of major cause of cholera death.

4. Thirst:
It is common due to dehydration as patient loss several litters of fluid within minutes.

5. Skin changes:
Loss of skin elasticity, dry mucous membrane (dry mouth).

6. Reduced urine output: 
This may leads to uraemia resulting from acute tubular necrosis.

7. Muscle cramps:
A muscle cramp is an involuntarily and forcibly contracted muscle that does not relax. These result from the rapid loss of salts such as sodium, chloride and potassium.

8. Death:
This one of most complication of untreated cholera case due to the following:
-Hypovolaemic shock.
-Metabolic acidosis.
-Uremia resulting from acute tubular necrosis.

                        By. Dr.Habiib


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