General condition and physical examination data
Assessment of the patient's physical status demonstrates a severe general condition. Despite the severity of the pathological process, the patient's consciousness remains intact, although the facial expression becomes anguished. Undernutrition is noted.
The skin and mucous membranes undergo marked changes due to fluid loss. The skin becomes dry, and its turgor is significantly reduced. The extremities are cold to the touch, and acrocyanosis (cyanosis of the distal parts) is observed. Oral cavity examination reveals a dry tongue heavily coated with a characteristic white coating.
Pathological changes are also registered in the chest organs: upon auscultation, heart sounds are muffled, and weakened vesicular breathing is heard in the lungs.
Vital signs
Profound metabolic and hemodynamic disturbances are reflected in the patient's main physiological parameters. The following clinical picture is characteristic:
- Body temperature: drops to subnormal figures (35.8°C).
- Cardiovascular system: tachycardia develops (pulse reaches 100 beats per minute), with low volume pulse. Pronounced hypotension is recorded with a drop in blood pressure to 80/50 mm Hg.
- Respiratory system: compensatory tachypnea occurs with a respiratory rate of up to 24 breaths per minute.
Gastrointestinal symptom complex and excretions
Gastrointestinal tract involvement has strictly specific features. The acute onset of the disease manifests with diarrhea, which is subsequently joined by vomiting.
On palpation, the abdomen is sunken and soft. The most important differential diagnostic sign is the complete absence of abdominal pain. Physical examination reveals rumbling throughout the abdomen and a splashing sound.
The nature of excretions is specific: both stool and vomit are watery, colorless, and contain an admixture of white flakes, acquiring the classic appearance of "rice water".
Neuromuscular and renal complications
Rapidly developing dehydration leads to systemic disorders. In the neuromuscular system, painful tonic spasms develop, predominantly localized in the lower extremities. The patient's voice becomes aphonic (aphonia develops).
The urinary system responds to hypovolemia by developing acute renal failure: oligoanuria or complete anuria (absence of urination for the last 6 hours) is recorded.
Epidemiological history and differential diagnosis
To make a provisional diagnosis, taking an epidemiological history for the past 5–6 days is critically important, which corresponds to the maximum incubation period of cholera. It is necessary to find out:
- The epidemiological situation regarding cholera in the area where the patient stayed.
- Facts of consuming substandard products or products from endemic regions.
- The patient's social status (including belonging to homeless individuals).
Case study: the patient arrived from a cholera-endemic area 3 days before the onset of the disease. Differential diagnosis for such a clinical picture is primarily performed with dysentery, salmonellosis, and typhoid fever.
Briefly: answers to topical questions
What epidemiological risk factors need to be elicited when taking a history from a patient with suspected cholera?
When taking a history from a patient with suspected cholera, the following epidemiological risk factors must be elicited:
- The epidemiological situation regarding cholera in the area where the patient was 5–6 days before the onset of the disease.
- Facts of consuming substandard food products or products imported from cholera-endemic regions.
- The patient's social status, including belonging to homeless individuals.
Which specific microorganism is the causative agent of cholera?
The causative agents of cholera are cholera vibrios (Vibrio cholerae). Specifically, the causative agents of true cholera are considered to be serovars O1 and O139. Serovar O1 biotypes include vibrio cholerae classica and El-tor.
Class and exam questions
In what sequence do dyspeptic symptoms develop?
The disease begins acutely with diarrhea, which is only subsequently joined by vomiting.
Which abdominal symptom is key for differential diagnosis?
The most important diagnostic sign is the complete absence of abdominal pain with a sunken, soft abdomen accompanied by rumbling and a splashing sound.
Over what period should the epidemiological history be collected?
The medical history is taken for the last 5–6 days, as this period corresponds to the maximum incubation period of the suspected infection.
What else to study on this topic
- Assessment of the degree of dehydration based on clinical signs (skin turgor, diuresis, hemodynamics)
- Characteristics of stool of the "rice water" type
- Pathogenesis of tonic spasms during fluid and electrolyte loss
- Differential diagnosis with dysentery and salmonellosis
- Indications for emergency hospitalization
- Pre-hospital patient management tactics
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