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Patient case: Cholera

Patient case: Cholera

Discussion

A 40-year-old male presents to the emergency department with a sudden onset of profuse, watery diarrhea for the past 12 hours. He reports passing large volumes of stool that appear pale and resemble "rice water." He also complains of intense thirst, muscle cramps, and dizziness. He denies fever, nausea, or vomiting. His symptoms started after consuming seafood from a street vendor during his recent trip to a coastal region.

On examination, he appears weak and dehydrated, with sunken eyes and dry mucous membranes. His blood pressure is 90/60 mmHg, and his pulse is rapid and thready. Capillary refill is delayed, and his skin turgor is poor.

Laboratory tests reveal severe electrolyte imbalances, including low potassium and bicarbonate levels. A stool culture confirms the presence of Vibrio cholerae. He is immediately started on aggressive intravenous fluid resuscitation and oral rehydration therapy. Antibiotics are administered to reduce disease duration, and he is closely monitored for signs of shock. His condition stabilizes with treatment, and he is discharged with advice on hygiene and safe water consumption.

Questions
1. What is the most likely diagnosis in this patient?

a) Typhoid fever

b) Cholera

c) Giardiasis

d) Food poisoning

2. What is the characteristic stool appearance in cholera?

a) Bloody and mucus-filled

b) Greasy and foul-smelling

c) "Rice water" stools

d) Hard and pellet-like

3. What is the most critical initial treatment for cholera?

a) Intravenous fluids and oral rehydration therapy

b) Antibiotic therapy alone

c) Antidiarrheal medications

d) Corticosteroids

4. How does Vibrio cholerae cause severe diarrhea?

a) Direct invasion of the intestinal wall

b) Toxin-mediated secretion of chloride and water

c) Induction of inflammatory cytokines

d) Destruction of intestinal villi

Reveal answers

Answers

1. Answer: b) Cholera

The patient’s profuse, watery diarrhea, dehydration, and history of consuming contaminated seafood strongly suggest cholera, a disease caused by Vibrio cholerae. Other options, like typhoid and giardiasis, have different stool characteristics.

2. Answer: c) "Rice water" stools

Cholera is characterized by large-volume, watery stools that appear pale with flecks of mucus, resembling rice water. This distinguishes it from dysentery (bloody stool) or giardiasis (greasy stool).

3. Answer: a) Intravenous fluids and oral rehydration therapy

The most crucial treatment for cholera is aggressive fluid replacement to prevent hypovolemic shock. Antibiotics can shorten illness duration but are not the primary lifesaving intervention.

4. Answer: b) Toxin-mediated secretion of chloride and water

Vibrio cholerae produces cholera toxin, which stimulates excessive chloride and water secretion in the intestines, leading to massive fluid loss and dehydration. The bacteria do not invade the intestinal wall