Epidemic cholera is caused by serovars of Vibrio cholera, a comma-shaped, aerobic, gram(-), spore-forming bacteria with a characteristic darting movement.

Three types of V. cholera cause disease in humans: serogroup 0139 and two biotypes of serogrpup 01, classic and El Tor. All three elaborates a pathogenic cholera enterotoxin that cause the characteristic diarrhea. El Tor is responsible for the current seventh pandemic. Humans are the oly known natural hosts. However environmental reservoir exists in brackish water or estuaries. Transmission is via ingestion of feces or vomitus-contaminated water or food, especially shellfish or other inadequately cooked seafood. IC Usually ranges froma few hours t o 5 days and is usually 2-3 days s/sx asymptomatic infections are very common, especially wit El Tor infection. Infection often causes nondebilitating diarrhea, most commonly among children. Severe infection occurs in less than 10% of infected persons and is characterized by accumulation of diarrheal fluid in the small intestine followed by the abrup onset of profuse water diarrhea and often atke on a transluscent, sihy-smelling, rice water appearance. Brief fever occurs in a few patients as does borborygmi. Severe dehydaration, electrolyte loss, metabolic acidosis and shock may ensue, with death occurring in several days if treatment is not started. Susceptibility and resistance vary according to several factrs. Breastfeedung is protective for infants. Resistance to reinfection occurs with V. cholera 01 and 0139 but infection with one serogroup does not protect against infection with the other. Within 01 strains, infection with classical type confers resistance to both classical and El Tor cholera, but infection with El Tor confers only incomplete protection from El Tor. Achlorydia (as occurs with pernicious anemia) increases susceptibility, and persons with blood type O have increased risk of severe cholera from 01 and 0139 strains Complications Hypovolemia and hypotension lead to renal failure Hyponatremia nd hypokalemia with potassium loss cause ileus, muscle weakness and cardia arrhythmias Hypoglycemia (esp among children) sometimes causes brain damange Metabolic acidosis if left uncorreted, may cause pulmonary edema during rapid rehydration Dx: During an epidemic, diagnosis is on thebasis of acute watery diarrhea. Microscopuc exam of feces shows the characteristic darting ,movement of V. Cholera and the diagnosis may be confirmed by culture. Treatment Rapid rehydration is themainstay of treatment of severe cholera and in most cases oral hyrydration solution is effective. ORS consists of 1 L water, 3.5 g NaCl, 1.5 g KCl, 22 g glucose monohydrate and 2.9 g trisodium citrate dehydrate (ir 2.5 g Na bicarbonate). If dehydration is severe (more than 10% body weight loss, lethargy, impaired consiousness,

hypovolemuc shich and acidosis) rapid IV rehydration with ringers lactate is indicated restoration of basline body weight, acid-base balance should be achieved within 2 to 3 hours. Antibiotic treatement decreases the severity of symptoms and volumeo f diarrhea. Depending on the particular outreak vs the type of Vibrio, antibiotic threpay for adults may include doxycycline 100 mg OI bid for 1 day, then100 mg PO daily for 3 days; or doxycycline 300 mg PO in one dose; or tetracycline 500 mg PO qid for 3 days of sulfamethoxazole 800 mg/treimethrprim160 mg PO bid for 3 days or erythromycin 500 mg PO qid for 3 days, or ciprofloxacin 250 to 500 mg PO daily for 3 days. Current vaccines are effective agains lassical and el tor strains but not 0139. one vaccine Dukoral also affords procetion against travellers diarrhea caused by enterotoxigenic e. Coli.