Q: 28 year old male, who just returned from Bangladesh 2 days ago presented to ED with vomiting, painless but profuse "rice water" type diarrhea - almost 20 liter/day! which smells like fish. On examination patient skin seems turning a bluish-gray hue. Your concern?

 

Answer: Cholera

The hallmark of cholera is profuse, painless diarrhea and vomiting of clear fluid. Clinical symptoms starts from few hours upto five days after ingestion of the bacteria. The diarrhea is clasically described as "rice water" with fishy odor. Patient may produce 10 to 20 litres of diarrhea a day. Cholera has been nicknamed the "blue death" due to a patient's skin turning a bluish-gray hue from massive dehydration.

Doxycycline is the first line of agent for treatment, followed by cotrimoxazole, erythromycin, tetracycline, chloramphenicol,and furazolidone. Fluoroquinolones, such as norfloxacin, also may be used.