Cholera
Contact Precautions
Cholera, also known as Asiatic or epidemic cholera, is an acute enterotoxin-mediated GI infection caused by the gram-negative bacillus Vibrio cholerae. It produces profuse, watery diarrhea that starts suddenly and has a “fishy” odor, vomiting, massive fluid and electrolyte loss and, possibly, hypovolemic shock, metabolic acidosis, and death. infection confers only transient immunity. A similar bacterium, Vibrio parahaemolyticus, causes food poisoning. (See Vibrio parahaemolyticus food poisoning.)
Causes
Humans are the only hosts and victims of V. cholerae, a motile, aerobic organism. It is transmitted through food and water contaminated with fecal material from carriers or people with active infections. Infection also occurs after eating shellfish from recognized environmental reservoirs of cholera.
Cholera occurs during the warmer months and is most prevalent among lower socioeconomic groups. Susceptibility to cholera may be increased by a deficiency or absence of hydrochloric acid.
Vibrio Parahaemolyticus Food PoisoningVibrio parahaemolyticus is a common cause of gastroenteritis in Japan. Outbreaks also occur on cruise ships and in the eastern and southeastern coastal areas of the United States, especially during summer.
V. parahaemolyticus, which thrives in a salty environment, is transmitted by ingesting uncooked or undercooked contaminated shellfish, particularly crab and shrimp. After an incubation period of 2 to 48 hours, V. parahaemolyticus causes watery diarrhea, moderately severe cramps, nausea, vomiting, headache, weakness, chills, and fever. Food poisoning is usually self-limiting and subsides spontaneously within 2 days. Occasionally, however, it’s more severe and may even be fatal in debilitated or elderly persons.
Diagnosis requires bacteriologic examination of vomitus, blood, stool smears, or fecal specimens collected by rectal swab. Diagnosis must rule out other causes of food poisoning and other acute GI disorders.
Treatment is supportive, consisting primarily of bed rest and oral fluid replacement. I.V. replacement therapy is seldom necessary, but oral tetracycline may be prescribed. Thorough cooking of seafood prevents this infection.
Complications
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