Cause:Vibrio choleraeor new non-O1 strains

Pathophys:Glucose driven Na pump inhibition by entero/exotoxin

Sewage in drinking water. Carriers (in gallbladder) = 3-5% of world population; primarily in Asia, S. America, and N. Africa; increasing number of cases/yr in US (Jama 2000;284:1541). Many asx cases

Sx:Diarrhea; sometimes fever

Si:"Rice water" diarrhea up to 15 L/d; "dishwater hands" from volume depletion

Benign if replace H₂O and salt iv or via NG tube

Mortality significant in symptomatic disease without rx; increased anion gap acidosis

Lab:

Bact:Gram-negative rod, flagellated

Chem:Stool cyclic AMP increased

Rx:

Vaccination w live attenuated oral vaccine (vBS-WC), 78% effective (Nejm 2005;352:757; Lancet 1990;335:958)

of acute disease:

• Oral rehydration solutions (Oral Rehydration Solutions (ORS)); catch up, then stool output + 100 cc q1h (Ann IM 1975;82:101) or iv Ringer's lactate
• Antibiotics: azithromycin 1 gm po × 1 (75% cure w/i 2 d—Nejm 2006;354:2452, 2500), better than doxycycline 300 mg po × 1 or 100 mg po bid × 3 d, or Tm/S 5 mg/25 mg/kg po bid × 3 d in children, or ciprofloxacin to all of which resistance now prevalent