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                                                   NEHC-&Pt

               B I OLO~ I CPiL ~~RE T~T A~~NT
                    CHO~R~   (YI~IO CHOLERSE)

J8E OF ~GENT

     o   Cholera in+ection is ~pread throu~h deliberate
         contamination of food or' water with cholera bacteria
           -  Speci~ic protective eflorts munt be made to
              prevent such tabota~e
           -  Contamination 0+ food/water obtained o++ base
              from non-military sources may occur
     o   Cholera bacteria are not: effectively transmitted by
         an `~erosol route, not even as &~W a~ent
     O   £nvironm~ntal contamination not likely to be an issue
           -  Not an *++.ctive way to disseminate the organism
                -  ~acteria do not live lon~ in the environment
                -  ~nvironmental items wou~d have to be handled,
                   then hands placed in mouth; very poor
                   efficacy of transmission
           -  Clothing, etc soiled with cholera stool is potential
              source of secondary1 infection, but should be
              controllable by standard infection control practices
     o   Cholera toxin, which causes the diarrhea, has been
         synthesized
           -  Can be transmitted as an aerosol
           -  Can contaminate food/water
     o   Cholera toxin may produc~ a shorter, less severe diarrhea
           -  Toxin only active on gut wall for several hours
           -  Cholera infection continually produces toxin

Dt~(3NOStS

     o   Clinical

           o  Full blown cholera is clinically distinctive
                -  Not',a,sy;t,emi,,c disease; no fever
                   `I'niti'ally~ acute onset, several loose stools,
                   mild abdotninal cramps, may have vomitin~
                -  Later: copious classic  rice water11 stools
                     -  StooLs like clear/slightly' turbid water
                     -  Flecks 0+ mucous (rice1)
                     -  No odor or sli~htly fishy odor
           o  Initially may be confused with other types of
              secre~ory diarrhea, e.~. enterotoxigenic E. colt,
              commonest cause 0+ travelers diarrhea
                -  Management is the same for all secretory
                   diarrheas
           o  ~ltered mental status common; typical patient is
              detached, but can be aroused to ~ive lucid,
              accurate information

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