Bacterial Infection

0

population

Global

percentage

Variable, higher in regions with poor sanitation

evidence

reference	supports	snippet	explanation
PMID:22461716	SUPPORT	The percentages of the population in each country that lacked access to improved sanitation were used to compute the populations at risk for cholera.	The study links the risk of cholera to the lack of improved sanitation, supporting the statement that cholera prevalence is higher in regions with poor sanitation.
PMID:33350917	SUPPORT	Overcrowding, poverty, insufficient water and sanitation facilities increase the risk for cholera outbreaks.	The reference discusses how poor sanitation is one of the critical factors increasing the risk of cholera, supporting the statement.
PMID:36639850	SUPPORT	Cholera transmission is associated with several socio-economic and environmental factors, each associated variable is suggested to have at least one mediating mechanism.	The review highlights the influence of socio-economic factors like sanitation on cholera transmission, supporting the statement.

1

population

South Asia (particularly Bangladesh and India)

percentage

Endemic

evidence

reference	supports	snippet	explanation
PMID:34550374	SUPPORT	in many developing nations such as India, cholera disease is endemic.	The reference clearly indicates that cholera is endemic in India, a part of South Asia.
PMID:34633491	SUPPORT	Cholera has been endemic to the Ganges Delta for centuries. Although the causative agent, Vibrio cholerae, is autochthonous to coastal and brackish water, cholera occurs continually in Dhaka, the inland capital city of Bangladesh which is surrounded by fresh water.	The reference indicates that cholera is endemic in the Ganges Delta, which is part of South Asia, and it specifically mentions Dhaka, Bangladesh.
PMID:31326255	SUPPORT	India reported the most number of confirmed cases with a mean of 5964 cases annually... Bangladesh, Malaysia, Nepal, Pakistan, Philippines, Thailand, and Vietnam. Surveillance for cholera exists in most countries, but cases are not always reported.	The reference provides statistical data confirming high prevalence of cholera in India and Bangladesh, supporting the statement about endemic prevalence.
PMID:34453539	SUPPORT	In 2014, Bangladesh established a nationwide, facility-based cholera surveillance system for Vibrio cholerae infection... The cholera surveillance system in Bangladesh has the ability to monitor progress towards cholera elimination goals.	The reference mentions the ongoing surveillance and control measures in Bangladesh, implicitly supporting the idea of cholera being endemic and prevalent in the region.
PMID:20562706	SUPPORT	The mechanisms underlying the seasonality of cholera are still not fully understood, despite long-standing recognition of clear bimodal seasonality in Bangladesh.	This reference supports the statement by acknowledging the long-standing endemicity and seasonal patterns of cholera in Bangladesh.

2

population

Parts of Africa

percentage

Endemic

evidence

reference	supports	snippet	explanation
PMID:24827501	PARTIAL	More than 40 years after its resurgence in Africa in 1970, cholera remains a grave public health problem, characterized by large disease burden, frequent outbreaks, persistent endemicity, and high CFRs, particularly in the region of the central African Great Lakes which might act as reservoirs for cholera. [...] Excluding the Haitian epidemic, sub-Saharan Africa accounted for 86 % of reported cases and 99 % of deaths worldwide in 2011.	The reference supports that cholera is a persistent endemic problem in parts of Africa (e.g., Central African Great Lakes) and accounts for a significant portion of global cases and deaths. However, it does not specify the exact percentage of the population in Africa that is affected.
PMID:22461716	PARTIAL	To estimate the global burden of cholera using population-based incidence data and reports. [...] About 1.4 billion people are at risk for cholera in endemic countries. [...] The incidence is estimated to be greatest in children less than 5 years of age.	This reference provides information on the global burden of cholera and mentions endemic countries without specifically quantifying the percentage of the African population that is affected.

3

population

Haiti

percentage

Endemic

evidence

reference	supports	snippet	explanation
PMID:37610182	SUPPORT	In Haiti in 2017, the prevalence of serum vibriocidal antibody titers against Vibrio cholerae serogroup O1 among adults was 12.4% in Cerca-la-Source and 9.54% in Mirebalais.	The data indicates a high prevalence of recent infection, suggesting cholera is prevalent among the endemic population in Haiti.
PMID:23301694	SUPPORT	Within days after detection, the Ministry of Public Health and Population established a National Cholera Surveillance System (NCSS)... Through October 20, 2012, the public health ministry reported 604,634 cases of infection, 329,697 hospitalizations, and 7436 deaths from cholera.	The large number of reported cases indicates a significant prevalence of cholera in Haiti.
PMID:33350917	SUPPORT	Centre Department, Haiti, was the origin of a major cholera epidemic during 2010-2019.	The outbreak in Haiti's Centre Department signifies a high prevalence of cholera within the endemic population over a considerable period.
PMID:35259956	SUPPORT	We also show that, in our model, effective reproduction numbers and epidemicity indices are explicitly related. Therefore, providing an upper bound to the effective reproduction number (significantly lower than the unit threshold) warrants negative epidemicity and, in turn, a rapidly fading outbreak preventing coalescence of sparse local sub-threshold flare-ups.	The discussion on controlling the cholera spread through negative epidemicity indicates efforts to manage the disease prevalence.
PMID:37735743	SUPPORT	The 2010 cholera epidemic in Haiti was thought to have ended in 2019, and the Prime Minister of Haiti declared the country cholera-free in February 2022. On September 25, 2022, cholera cases were again identified in Port-au-Prince.	Re-emergence of cases suggests ongoing cholera prevalence even after being declared cholera-free.

0

phase

Incubation

evidence

reference	supports	snippet	explanation
PMID:23201968	PARTIAL	We estimate the median incubation period of toxigenic cholera to be 1.4 days (95% CI, 1.3-1.6). Five percent of cholera cases will develop symptoms by 0.5 days (95% CI 0.4-0.5), and 95% by 4.4 days (95% CI 3.9-5.0) after infection.	The literature describes an incubation period median of 1.4 days and a window from 0.5 days to 4.4 days for symptom onset, which is consistent with a portion of the stated range but does not completely align.

notes

Period between infection and onset of symptoms. Individuals are typically not infectious during this phase.

duration

2 hours to 5 days

1

phase

Prodromal

evidence

reference	supports	snippet	explanation
PMID:1465231	NO_EVIDENCE	Cholera is a diarrheal disease that results from colonization of the small intestine by the Vibrio cholerae organism. The disease is spread primarily by means of fecal contamination of drinking water and may begin with the sudden onset of profuse, watery diarrhea. Vomiting, rapid dehydration, acidosis, muscular cramps and circulatory collapse are other prominent features of severe cholera.	The reference discusses the symptoms and features of cholera but does not provide information specific to the progression phase or the duration of the prodromal phase.
PMID:37769103	NO_EVIDENCE	No abstract available.	Without an abstract or detailed information, this reference cannot provide evidence regarding the progression or duration of cholera's prodromal phase.
PMID:23201968	NO_EVIDENCE	We estimate the median incubation period of toxigenic cholera to be 1.4 days (95% CI, 1.3-1.6). Five percent of cholera cases will develop symptoms by 0.5 days (95% CI 0.4-0.5), and 95% by 4.4 days (95% CI 3.9-5.0) after infection.	This reference provides data on the incubation period of cholera but does not detail the duration of the prodromal phase or early symptoms specific to hours.
PMID:38702080	NO_EVIDENCE	The study found results consistent with previous AWD outbreaks in developing countries like Yemen, Nigeria and Lebanon.	The reference is focused on acute watery diarrhea during cholera outbreaks but does not offer details on the prodromal phase duration or specific early symptoms.
PMID:37580033	NO_EVIDENCE	From May 4, 2014 through November 30, 2021, we enrolled 51,414 suspected cases from our sentinel surveillance sites.	The study is about national cholera surveillance and does not address the specific progression or the prodromal phase duration in hours.
PMID:18704085	NO_EVIDENCE	This is true for cholera, a pandemic bacterial disease, where estimates of the ratio of asymptomatic to symptomatic infections have ranged from 3 to 100 (refs 1-5).	This study discusses asymptomatic infections and their implications but does not provide detailed information on early symptoms duration in hours.
PMID:29165706	NO_EVIDENCE	We investigated singular Danish cholera epidemics (in 1853) to elucidate epidemiological parameters and modes of spread.	The reference concerns historical cholera epidemics and their transmission but does not address the duration of the prodromal phase or early symptoms.
PMID:21150867	NO_EVIDENCE	As of December 3, MSPP reported 91,770 cases of cholera from all 10 departments and the capital city of Port-au-Prince.	This study details the cholera outbreak in Haiti but does not provide specific information on the early symptoms duration in hours.
PMID:8548982	NO_EVIDENCE	The clinical manifestations of cholera and the pathophysiology of the toxin-induced diarrhea are reviewed.	This review on cholera's clinical manifestations does not offer specifics on the duration of the prodromal phase or early symptoms in hours.
PMID:23622872	NO_EVIDENCE	We identified 281 Vibrio cholerae non-O1, non-O139 strains from patients with diarrhea in Kolkata, India. Cholera-like diarrhea was the major symptom (66.0%); some patients (20.3%) had severe dehydration.	The focus is on non-O1, non-O139 Vibrio cholerae strains and does not provide information on the prodromal phase duration or early symptoms in hours.

notes

Early symptoms may include mild diarrhea, abdominal discomfort, and nausea. Often overlooked or misdiagnosed.

duration

Hours

2

phase

Acute

evidence

reference	supports	snippet	explanation
PMID:28952662	SUPPORT	The incubation period can be very short and it takes between several hours and 5 days.	This reference supports the statement that cholera has a rapid progression with symptoms developing within hours to a few days.
PMID:23201968	SUPPORT	We estimate the median incubation period of toxigenic cholera to be 1.4 days (95% CI, 1.3-1.6). Five percent of cholera cases will develop symptoms by 0.5 days (95% CI 0.4-0.5), and 95% by 4.4 days (95% CI 3.9-5.0) after infection.	This reference supports the rapid progression of cholera, stating that symptoms can develop within half a day to around 4-5 days after infection.

notes

Rapid onset of severe symptoms, can be life-threatening if not treated promptly. Peak infectiousness.

duration

Hours to Days

3

phase

Early Acute

evidence

reference	supports	snippet	explanation
PMID:28952662	PARTIAL	The incubation period can be very short and it takes between several hours and 5 days.	The literature mentions that cholera can have a very short incubation period starting from several hours up to 5 days. However, it does not specify that the rapid onset and highest risk of severe dehydration are specifically within the first 24-48 hours.
PMID:37769103	NO_EVIDENCE		The abstract does not provide specific information about the progression of cholera within the first 24-48 hours.
PMID:8548982	NO_EVIDENCE		The abstract covers the epidemiology and general clinical manifestations but does not detail the progression specific to the first 24–48 hours.
PMID:31668817	NO_EVIDENCE		The abstract reviews case management of cholera but does not provide information specifically regarding the initial 24-48 hours.
PMID:20135270	NO_EVIDENCE		The abstract estimates the prevalence of cholera in pediatric patients with acute dehydrating diarrhea but does not specify the time frame within the first 24-48 hours.

notes

Rapid onset of profuse, watery diarrhea and vomiting. Highest risk of severe dehydration.

duration

First 24-48 hours

4

phase

Late Acute

evidence

reference	supports	snippet	explanation
PMID:23201968	NO_EVIDENCE	We estimate the median incubation period of toxigenic cholera to be 1.4 days (95% CI, 1.3-1.6). Five percent of cholera cases will develop symptoms by 0.5 days (95% CI 0.4-0.5), and 95% by 4.4 days (95% CI 3.9-5.0) after infection.	While this paper provides information on the incubation period of cholera rather than the duration of symptoms, it indirectly suggests that the symptom onset and duration can vary significantly.
PMID:28952662	PARTIAL	The incubation period can be very short and it takes between several hours and 5 days. The most common symptoms of the illness are diarrhoea, dehydration, vomiting, and abdominal cramps. Case-fatality rate is lower than 1%, if rehydration treatment is prescribed rapidly, but it can exceed 70% in patients not treated properly.	This reference mentions that symptoms can appear within a range of hours to 5 days from ingestion but does not directly address the duration of these symptoms and the progression phase.
PMID:31668817	NO_EVIDENCE	Cholera can be effectively managed in the majority of cases with oral rehydration solution alone. Up to one third of patients present with severe dehydration, which can be diagnosed clinically, and will require rapid intravenous rehydration...	This reference focuses more on the treatment and management of cholera rather than the progression and duration of symptoms.

notes

Continued symptoms but may begin to improve with proper treatment.

duration

3-5 days

5

phase

Recovery

evidence

reference	supports	snippet	explanation
PMID:23201968	PARTIAL	Five percent of cholera cases will develop symptoms by 0.5 days (95% CI 0.4-0.5), and 95% by 4.4 days (95% CI 3.9-5.0) after infection.	The reference provides information on the incubation period but not on the overall progression of the disease or the recovery phase.
PMID:10414380	PARTIAL	Nine (69.2%) of the convalescents had positive faecal cultures for periods ranging from two weeks to more than seven months.	This literature supports that bacteria can be shed in stool during the convalescent period but does not provide a comprehensive view of the full disease progression or typical duration of symptoms.

notes

Symptoms resolve, but individuals may still shed bacteria in stool for 1-2 weeks.

duration

Days to Weeks

6

phase

Asymptomatic Carriage

evidence

reference	supports	snippet	explanation
PMID:5300876	SUPPORT	The duration of the carrier state among 19 household carriers isolated for examination varied from 5 to 19 days.	This literature provides data on the duration of the carrier state, indicating that some individuals can carry and shed the bacteria for several days, which supports the statement regarding the duration of asymptomatic carriage.
PMID:8373550	SUPPORT	There are also cases of cholera where victims do not show any symptoms of it, that is asymptomatic carriers.	The statement about asymptomatic carriage is supported, as the literature confirms the existence of asymptomatic carriers who can harbor the bacteria for varying periods.
PMID:32529415	PARTIAL	They indicate the existence of bacteria and asymptomatic individuals in the population of Senegal at any single time for the duration of collection of the data.	The statement is partially supported as the literature indicates the presence of asymptomatic carriers in the population, although it does not specify the exact duration of carriage.
PMID:28483382	NO_EVIDENCE	Information on human settlements and host mobility on waterways along which pathogens and hosts disperse, and relevant hydroclimatological processes, can be acquired remotely and included in spatially explicit mathematical models of disease transmission.	This study focuses on drivers of cholera transmission using spatially explicit models and does not provide information on the duration of asymptomatic carriage.
PMID:29274002	PARTIAL	We obtain the global attractivity of the disease-free state when [Formula: see text] and discuss the disease persistence when [Formula: see text]. We also explore the coexistence of endemic state in the nonautonomous system and prove the uniqueness with constants coefficients.	The paper discusses the role of asymptomatic carriers in disease persistence but does not provide specific details on the duration of asymptomatic carriage.
PMID:34670655	NO_EVIDENCE	This study describes the apparent discontinuation of cholera transmission in Haiti since February 2019.	This study discusses cholera transmission cessation in Haiti and does not address the duration of asymptomatic carriage.
PMID:23201968	NO_EVIDENCE	The incubation period did not differ by a clinically significant margin between strains (except O1 El Tor Ogawa).	This review focuses on the incubation period of cholera and does not discuss the duration of asymptomatic carriage.
PMID:22461716	NO_EVIDENCE	About 1.4 billion people are at risk for cholera in endemic countries.	This study estimates the global burden of cholera and does not provide information on the duration of asymptomatic carriage.

notes

Some individuals can carry and shed the bacteria without showing symptoms. Important for disease transmission modeling.

duration

Days to Months

0

name

Cholera Toxin

description

Vibrio cholerae produces a toxin that activates adenylate cyclase in intestinal epithelial cells, leading to increased cyclic AMP (cAMP) levels.

cell_types

• Intestinal Epithelial Cell

evidence

reference	supports	snippet	explanation
PMID:8783505	SUPPORT	Vibrio cholerae produce a variety of extracellular products that have deleterious effects on eukaryotic cells... CT acts by activation of adenylate cyclase-cAMP system located at the basolateral membrane of intestinal epithelial cells.	The statement is supported by the information that cholera toxin (CT) from Vibrio cholerae activates the adenylate cyclase-cAMP system in intestinal epithelial cells.
PMID:30624615	SUPPORT	Cholera toxin (CT)-induced diarrhea is mediated by cyclic adenosine monophosphate (cAMP)-mediated active Cl- secretion via the cystic fibrosis transmembrane conductance regulator (CFTR).	The statement is supported as it describes CT inducing diarrhea through cAMP-mediated mechanisms.
PMID:4364505	SUPPORT	Comparable results were also obtained when cholera toxin was used. The degree of enzyme stimulation was proportional to the concentration of enterotoxin.	This further confirms that cholera toxin stimulates adenylate cyclase activity in cells.
PMID:8817767	SUPPORT	V cholerae, the representative noninvasive pathogen, has fimbrial adhesins that mediate attachment and colonization... organisms secrete cholera toxin (CT), a potent enterotoxin that induces a voluminous diarrhea via adenylate cyclase-dependent chloride secretion.	This literature confirms that cholera toxin induces diarrhea by acting on the adenylate cyclase system in the intestinal epithelial cells, resulting in elevated cAMP levels.

downstream

Increased cAMP

1

name

Increased cAMP

description

Elevated cAMP levels cause cells to secrete large amounts of chloride ions into the intestinal lumen, followed by water and other electrolytes.

evidence

reference	supports	snippet	explanation
PMID:23651092	SUPPORT	Increased intracellular cAMP in human intestinal epithelial cells accounts for the pathogenesis of profuse diarrhea and severe fluid loss in cholera.	This reference directly supports the statement by confirming that elevated cAMP levels in intestinal epithelial cells lead to the secretion of fluid, resulting in profuse diarrhea, which aligns with the described pathophysiology.
PMID:30624615	SUPPORT	Cholera toxin (CT)-induced diarrhea is mediated by cyclic adenosine monophosphate (cAMP)-mediated active Cl- secretion via the cystic fibrosis transmembrane conductance regulator (CFTR).	This reference supports the statement by explaining that CT-induced diarrhea involves cAMP-mediated chloride secretion, leading to diarrhea.
PMID:80378	PARTIAL	Cholera toxin causes net secretion of fluid into the small intestine of weanling pigs, and secretory rates are dependent on the dose of the toxin placed in intestinal loops.	While this study supports that cholera toxin leads to fluid secretion, it notes that net fluid fluxes did not always correlate with total mucosal cAMP concentrations in pigs. Therefore, it provides partial evidence for the described pathophysiology.
PMID:659596	SUPPORT	The effects of vasoactive intestinal polypeptide (VIP) on intestinal water and electrolyte transport were investigated ... the effect of cholera toxin was qualitatively similar to VIP.	This reference supports the statement by drawing a parallel between the effects of VIP and cholera toxin, both leading to secretion of water and electrolytes in the intestine, which implies a similar underlying mechanism involving increased cAMP and chloride secretion.

downstream

Profuse Watery Diarrhea

2

name

Profuse Watery Diarrhea

description

Rapid loss of fluids and electrolytes through diarrhea, which can lead to severe dehydration and hypovolemic shock.

evidence

reference	supports	snippet	explanation
PMID:14738797	SUPPORT	Intestinal infection with Vibrio cholerae results in the loss of large volumes of watery stool, leading to severe and rapidly progressing dehydration and shock.	The statement describes the loss of large volumes of fluids and electrolytes through diarrhea, leading to severe dehydration and hypovolemic shock, which aligns with the literature.
PMID:15367740	SUPPORT	A patient presented with cholera and a severe degree of ECF volume contraction. Despite large losses of bicarbonate (HCO3-)-containing diarrhoeal fluid, laboratory acid-base values were remarkably close to normal.	The literature describes large fluid losses and severe dehydration due to cholera, supporting the statement's explanation of pathophysiology.
PMID:28448489	SUPPORT	To take advantage of emerging opportunities to reduce morbidity and mortality from diarrheal disease, we need to better understand the determinants of life-threatening severe dehydration (SD) in resource-poor settings.	The text mentions severe dehydration as a key issue in the pathophysiology of cholera.
PMID:34523840	SUPPORT	A 28-year-old female presented with severe dehydration due to acute diarrhea and vomiting... which is typical for cholera and can amount to 1000 cc/hour.	This literature supports the rapid loss of fluids through profuse watery diarrhea leading to severe dehydration, consistent with the pathophysiology described.
PMID:38702080	SUPPORT	The most common complications reported at admission and during hospitalisation included electrolyte imbalance (28.2%), followed by severe dehydration (16.3%).	This literature mentions severe dehydration and electrolyte imbalance as common complications, supporting the statement regarding the pathophysiology of cholera.

0

category

Gastrointestinal

name

Profuse Watery Diarrhea

frequency

VERY_FREQUENT

diagnostic

True

sequelae

Severe Dehydration Shock

evidence

reference	supports	snippet	explanation
PMID:14738797	SUPPORT	Intestinal infection with Vibrio cholerae results in the loss of large volumes of watery stool, leading to severe and rapidly progressing dehydration and shock.	The provided excerpt supports the statement that profuse watery diarrhea is a very frequent diagnostic phenotype of cholera and that it leads to severe dehydration and shock.
PMID:34523840	SUPPORT	Her stool was watery, with flecks of mucous, also referred to as 'rice-water' stool, which is typical for cholera and can amount to 1000 cc/hour.	This case study supports the characterization of profuse watery diarrhea as a very frequent diagnostic phenotype of cholera.
PMID:29488455	SUPPORT	Adding dehydration, vomiting, or rice water stools to the case definition could increase the specificity without a substantial decrease in sensitivity.	This study supports that rice-water stools (a form of profuse watery diarrhea) are indicative of cholera and frequently used in its diagnosis.
PMID:820813	SUPPORT	The severity of diarrhea and nutritional status were measured in a prospective study of 97 patients hospitalized with cholera in Dacca, Bangladesh... The increased stool loss was unrelated to antibiotic usage, to presence of intestinal parasites, or to the refeeding diet given.	The study supports that profuse watery diarrhea is a very frequent diagnostic phenotype of cholera.
PMID:27412979	SUPPORT	Choleriform diarrhea and vomiting were the main signs, found respectively in 100% and 95% of the women; dehydration was mild for 16%, moderate for 45%, and severe for 39%.	This study supports that profuse watery diarrhea (choleriform diarrhea) is a very frequent diagnostic phenotype of cholera.
PMID:38702080	SUPPORT	The most common complications reported at admission and during hospitalisation included electrolyte imbalance (28.2%), followed by severe dehydration (16.3%).	This study supports that watery diarrhea leading to severe dehydration is a frequent phenotype of cholera.

1

category

Systemic

name

Dehydration

frequency

VERY_FREQUENT

diagnostic

True

sequelae

Sunken Eyes Low Blood Pressure Tachycardia

evidence

reference	supports	snippet	explanation
PMID:28448489	SUPPORT	Vibrio cholerae was the most common pathogen isolated (12,405 patients; 22%), and had the strongest association with SD (AOR 4.77; 95% CI: 4.41-5.51).	The article notes that Vibrio cholerae was the most common pathogen with a strong association with severe dehydration, which aligns with the statement.
PMID:19678971	SUPPORT	During epidemics of cholera in two rural sites (Bakerganj and Mathbaria), a much higher proportion of patients came for treatment with severe dehydration than was seen in previous years.	The article confirms that severe dehydration is a common and significant symptom during cholera outbreaks.
PMID:15367740	PARTIAL	A patient presented with cholera and a severe degree of ECF volume contraction. Despite large losses of bicarbonate (HCO3-)-containing diarrhoeal fluid, laboratory acid-base values were remarkably close to normal.	The study discusses severe dehydration, but also mentions metabolic and respiratory complications without specifically noting frequency.
PMID:33252133	PARTIAL	It was later confirmed that he was suffering from cholera. On presentation, he was hyperkalemic with ECG changes and soon went into a hypovolemic shock.	This article discusses a specific case of cholera leading to severe dehydration and hypovolemic shock, but does not provide frequency data.
PMID:9269227	SUPPORT	Cholera can cause severe dehydration, leading to various secondary symptoms such as sunken eyes, low blood pressure, and tachycardia.	This reference clearly supports the statement regarding dehydration and its associated sequelae.

2

category

Systemic

name

Hypovolemic Shock

frequency

OCCASIONAL

evidence

reference	supports	snippet	explanation
PMID:33252133	SUPPORT	The morbidity and mortality of cholera is resultant from large-volume diarrhea, hypovolemia, and electrolyte derangement. In the following case... he was suffering from cholera. On presentation, he was hyperkalemic with ECG changes and soon went into a hypovolemic shock.	This case description demonstrates that hypovolemic shock is an occasional systemic consequence of cholera due to excessive fluid loss.
PMID:14738797	SUPPORT	Intestinal infection with Vibrio cholerae results in the loss of large volumes of watery stool, leading to severe and rapidly progressing dehydration and shock.	This abstract highlights that severe dehydration caused by cholera often leads to shock, supporting the claim.

notes

Caused by severe dehydration due to fluid loss

name	presence	evidence	context
Electrolytes	Low Sodium, Potassium, and Bicarbonate Levels	TRUNCATED	Due to excessive loss in diarrhea

0

name

Contaminated Water

evidence

reference	supports	snippet	explanation
PMID:29949592	SUPPORT	We concluded that this cholera outbreak was caused by drinking lake water collected from inside the lakeshore water-collection site X.	This study explicitly identifies contaminated water as the source of a cholera outbreak.
PMID:33844507	SUPPORT	Cholera is transmitted primarily by the ingestion of drinking water contaminated with fecal matter...	This review supports the statement that contaminated water is a major environmental source of cholera infection.
PMID:37930488	SUPPORT	...acute diarrheal disease (ADD), typhoid, cholera, hepatitis, and shigellosis are common waterborne diseases in India.	The abstract indicates that cholera is one of the primary diseases transmitted through contaminated water in India.
PMID:36573678	SUPPORT	Cholera is a diarrheal infection caused by ingested water or food contaminated with the bacterium Vibrio cholerae.	This study confirms that cholera is caused by ingesting contaminated water, which aligns with the statement.
PMID:31319654	SUPPORT	This suggests that aquatic environs do harbor the pathogenic O1 strain, though the isolation of culturable V. cholerae O1 is a rare event in the presence of relatively abundant non-O1 non-O139 isolates.	This study provides evidence that water environments can be reservoirs for Vibrio cholerae, supporting the role of contaminated water in cholera transmission.

notes

Major source of infection

1

name

Poor Sanitation

evidence

reference	supports	snippet	explanation
PMID:30512613	SUPPORT	Prevention is based on universal access to water, sanitation and hand hygiene.	The snippet suggests that poor sanitation is linked to cholera and can help prevent its spread with proper sanitation.
PMID:20074356	SUPPORT	In both pre- and post-monsoon seasons, SES significantly influences these patterns, likely because it is a proxy for poor water quality and sanitation in poorer households.	The snippet implies that poor sanitation is a significant factor influencing cholera patterns.
PMID:31319654	SUPPORT	The spread of cholera is chiefly caused by the presence of contaminated water, in environments with inadequate hygiene and sanitation.	The snippet directly links poor sanitation with the spread of cholera.
PMID:34961483	SUPPORT	Drinking contaminated water from an unprotected well was associated with this cholera outbreak.	The outbreak was associated with poor sanitation practices involving unprotected water sources.
PMID:29903037	SUPPORT	ranked among the world''s dirtiest countries, Ghana has poor environmental sanitation and hygiene, and a lack of potable water, all of which combined have been largely blamed as the underscoring reasons for cholera outbreaks.	The snippet explicitly states that poor sanitation and hygiene are key factors in cholera outbreaks.
PMID:34695790	SUPPORT	A water pipeline was damaged in the vicinity of a stream flowing from a site of open defecation.	This incident of poor sanitation led to a cholera outbreak.

notes

Facilitates the spread of the bacteria

0

name

Oral Rehydration Solution (ORS)

description

Mixture of clean water, salt, and sugar to replace lost fluids and electrolytes.

evidence

reference	supports	snippet	explanation
PMID:8783513	SUPPORT	For more than two decades, WHO and UNICEF have recommended a single formulation of oral rehydration salts (ORS) solution based on glucose and three salts. This product has proven safe and highly effective in treating and preventing dehydration from diarrhoea of all causes and in all age groups in worldwide use and has substantially contributed to the saving of lives in developing countries.	The use of Oral Rehydration Solution (ORS) is supported as a treatment for cholera, as it involves a mixture of water, salts, and glucose to replace lost fluids and electrolytes.
PMID:49561	SUPPORT	The data contrast with the rarity of treatment failures of oral glucose-electrolyte solutions. Glucose, therefore, is preferable to sucrose for oral therapy of diarrhoeal diseases.	This study emphasizes the effectiveness of glucose-based ORS over sucrose, supporting the use of ORS with clean water, salt, and glucose as a treatment for cholera and related diarrheal diseases.
PMID:12562304	SUPPORT	The mainstay of therapy of cholera patients is rehydration with oral rehydration salt solution or intravenous Ringer's lactate depending upon the degree of dehydration.	This reference affirms that ORS is a primary treatment method for cholera, consistent with the use of clean water, salt, and sugar to replace lost fluids and electrolytes.

1

name

Intravenous Rehydration

description

Used for severe dehydration when rapid fluid replacement is necessary.

evidence

reference	supports	snippet	explanation
PMID:8736618	SUPPORT	Patients with severe dehydration should be treated intravenously, as should those patients who do not tolerate oral rehydration solution (ORS).	The literature clearly states that intravenous rehydration is used for severe dehydration in cholera patients.
PMID:3171790	SUPPORT	We compared the efficacy and safety of a single polyelectrolyte solution, Dhaka solution (DS), containing 133 mmol/L sodium, 13 mmol/L potassium, 98 mmol/L chloride, and 48 mmol/L acetate with and without 139 mmol/L (25 gm/L) dextrose in the rapid (4 hours) rehydration of 67 patients with diarrhea and moderate or severe dehydration requiring parenteral fluid therapy.	The study supports the use of intravenous rehydration for moderate or severe dehydration, which includes severe dehydration caused by cholera.
PMID:4885250	NO_EVIDENCE	N/A	This study focuses on the measurement of dehydration in cholera and does not provide evidence specifically on the treatment involving intravenous rehydration.
PMID:35465904	PARTIAL	Fluid therapy is the most important therapeutic measure in patients suffering from dehydration or hypovolemia owing to gastrointestinal diseases. The therapy should be tailored based on the patient's condition, physical examination, and diagnostic findings.	The literature discusses the importance of fluid therapy for dehydration but does not explicitly focus on intravenous rehydration for severe dehydration in cholera patients.
PMID:19174284	NO_EVIDENCE	Severely dehydrated calves that are unable to suckle need intravenous fluids for effective resuscitation.	The article discusses intravenous fluid therapy in calves, which is not directly relevant to cholera treatment in humans.

2

name

Antibiotics

description

Shorten the course of the illness and reduce the severity, examples include doxycycline, azithromycin.

evidence

reference	supports	snippet	explanation
PMID:24944120	SUPPORT	Overall, antimicrobial therapy shortened the mean duration of diarrhoea by about a day and a half compared to placebo or no treatment (MD -36.77 hours, 95% CI -43.51 to -30.03, 19 trials, 1013 participants, moderate quality evidence). Antimicrobial therapy also reduced the total stool volume by 50% (ROM 0.5, 95% CI 0.45 to 0.56, 18 trials, 1042 participants, moderate quality evidence) and reduced the amount of rehydration fluids required by 40% (ROM 0.60, 95% CI 0.53 to 0.68, 11 trials, 1201 participants, moderate quality evidence).	The reference indicates that antimicrobial treatment, including antibiotics like doxycycline and azithromycin, significantly shortens the duration of diarrhea and reduces stool volume, thereby supporting the statement.
PMID:11378428	SUPPORT	Antibiotics such as tetracycline and doxycycline shorten the duration of illness but do not significantly affect overall mortality.	This reference supports the statement as it specifies that antibiotics such as doxycycline shorten the illness duration, aligning with the value description.

3

name

Zinc Supplementation

description

Recommended for children to reduce the duration and severity of diarrhea.

evidence

reference	supports	snippet	explanation
PMID:18184631	SUPPORT	Zinc supplementation significantly reduced the duration of diarrhoea and stool output in children with cholera. Children with cholera should be supplemented with zinc to reduce its duration and severity.	This study found that zinc supplementation reduced both the duration and severity of diarrhoea in children with cholera.
PMID:17582575	SUPPORT	Short-course daily zinc supplementation shortens the duration (a 15%-24% reduction) and severity of the episode and is now recommended for the treatment of all episodes of diarrhea occurring among children <5 years of age.	This reference supports the statement by recommending zinc supplementation to reduce the duration and severity of diarrhea in children under 5 years of age.
PMID:30269306	SUPPORT	Zinc supplements are recommended in children with acute infectious diarrhea.	This guideline recommends zinc supplementation specifically for children with acute infectious diarrhea.
PMID:37842003	SUPPORT	Zinc supplementation has previously been shown to improve resolution of symptoms from infectious diarrhea.	This literature shows that zinc supplementation improves symptom resolution in children with infectious diarrhea, including those caused by rotavirus.

4

name

Vaccination

description

Oral cholera vaccines can provide protection in endemic areas or during outbreaks.

evidence

reference	supports	snippet	explanation
PMID:22634452	SUPPORT	This vaccine should be used in areas where cholera is endemic, particularly in those at risk of outbreaks, in conjunction with other prevention and control strategies.	This supports that oral cholera vaccines can provide protection in endemic areas or during outbreaks.
PMID:15193408	SUPPORT	Retrospective analysis suggests that mass vaccination with oral cholera vaccines can be a useful adjunct tool for controlling outbreaks, particularly if implemented early in association with other standard control measures.	This indicates that oral cholera vaccines can be a valuable tool during outbreaks.
PMID:36255170	PARTIAL	Efficacies of the currently licensed cholera vaccines are not optimal in endemic settings and low in children below the age of five, a section of the population most susceptible to the disease.	While oral cholera vaccines can provide protection, their efficacy is not optimal in endemic settings, especially for children under five.
PMID:26494426	PARTIAL	Oral cholera vaccination could be deployed in a diverse range of situations from cholera-endemic areas and locations of humanitarian crises, but no clear consensus exists.	The deployment of oral cholera vaccines is suggested for endemic areas and crises, but a clear consensus on their use is lacking.

name	evidence	description	has_subtypes
Vibrio cholerae	TRUNCATED	A bacterium that causes severe diarrhea by producing a toxin that triggers excess water and electrolyte loss in the intestines.	TRUNCATED

name	description	evidence
Fecal-Oral Transmission	Spread through ingestion of contaminated water or food.	TRUNCATED
Direct Contact	Can spread through direct contact with infected individuals or their bodily fluids.	TRUNCATED
Environmental Reservoirs	Vibrio cholerae can survive in aquatic environments, potentially leading to outbreaks.	TRUNCATED

name	description
Environmental Dynamics	Include water contamination levels and seasonal variations
Population Mobility	Consider movement patterns that can spread the disease
Intervention Impacts	Model effects of vaccination, improved sanitation, and treatment access
Asymptomatic Carriers	Account for their role in disease transmission
Super-spreading Events	Consider potential for rapid spread in gatherings or contaminated water sources
Stochastic vs Deterministic Models	Choose appropriate modeling approach based on population size and heterogeneity
Spatial Considerations	Incorporate geographical factors affecting disease spread and control measures
Vaccination Dynamics	Model the impact of vaccination campaigns, including coverage rates and vaccine efficacy

name	description	minimum_value	maximum_value	mean_range	notes	factors	unit
Basic Reproduction Number (R0)	The average number of secondary infections caused by one infected individual in a completely susceptible population.	1	20	None	Highly variable depending on environmental and population factors. Higher in areas with poor sanitation and during initial outbreak phases.	Population density Sanitation conditions Water quality Hygiene practices	None
Effective Reproduction Number (R or Rt)	The average number of secondary cases per infectious case in a population made up of both susceptible and non-susceptible individuals.	None	None	None	Changes over time as control measures are implemented and population immunity increases. Rt < 1 indicates declining epidemic.	Proportion of susceptible individuals Control measures (e.g., improved sanitation, vaccination) Changes in behavior (e.g., increased hygiene practices)	None
Serial Interval	The time between the onset of symptoms in a primary case and the onset of symptoms in secondary cases.	1	10	3-5	Important for estimating R and modeling the speed of epidemic spread.	None	days
Generation Time	The time between the infection of a primary case and the infection of secondary cases.	1	9	2-4	Often shorter than the serial interval due to potential pre-symptomatic transmission.	None	days
Case Fatality Rate (CFR), untreated	None	25	50	None	Varies significantly based on access to treatment and quality of care.	None	percentage
Case Fatality Rate (CFR), treated	None	None	1	None	Varies significantly based on access to treatment and quality of care.	None	percentage
Infectivity Period	None	1	10	None	Can be longer in asymptomatic carriers. Important for determining isolation periods and contact tracing windows.	None	days
Peak Infectivity post symptom onset	None	3	5	None	None	None	days
Incubation Period	None	0	5	2-3	Affects the timing of symptom onset and the implementation of control measures.	None	days
Attack Rate, typical	The proportion of susceptible individuals who become ill during a specified time interval.	0.1	2	None	Varies widely depending on environmental conditions and population susceptibility.	None	percentage
Attack Rate, severe	The proportion of susceptible individuals who become ill during a specified time interval.	5	10	None	Varies widely depending on environmental conditions and population susceptibility.	None	percentage
Asymptomatic Ratio	The proportion of infected individuals who do not display symptoms.	10	80	None	Highly variable and challenging to measure accurately. Critical for understanding true disease spread and implementing control measures.	None	percentage

0

name

Stool Culture

presence

Positive for Vibrio cholerae

evidence

reference	supports	snippet	explanation
PMID:32319946	SUPPORT	The appearance of her stools and clinical findings were not suggestive of a typical case of cholera, but Vibrio cholerae was nevertheless isolated from her stools in the laboratory. The National reference center (NRC) for vibrios and cholera identified a Vibrio cholerae serogroup O1 (serotype Inaba) strain.	This reference supports the statement that Cholera can be diagnosed by a stool culture positive for Vibrio cholerae.
PMID:36376441	SUPPORT	We examined the stools of 23 patients in Kolkata, who were diagnosed as cholera patients because Vibrio cholerae O1 was detected from their stools by culturing methods...	This reference also supports the statement by indicating that stool cultures detecting V. cholerae O1 were used for diagnosis.
PMID:6680124	SUPPORT	A rapid test for the identification of Vibrio cholerae in stools.	This reference supports the idea of using stool culture for diagnosing Cholera by identifying V. cholerae.
PMID:13356145	SUPPORT	The first portion of this study describes in detail the different aspects of stool examinations, including the collection, preservation, and pooling of specimens, macroscopic and bacterioscopic examination, enrichment methods, and cultivation on a variety of solid media.	This reference discusses stool examinations and cultivation on solid media as methods of identifying V. cholerae, thereby supporting the statement.
PMID:35130995	SUPPORT	A bacterial pathogen was isolated from the diseased bullfrog intestines. The bacterium was identified as Vibrio cholerae using morphological, biochemical and 16S rRNA phylogenetic analysis.	This reference talks about isolating and identifying V. cholerae from intestines using culture methods, supporting the statement.

1

name

Rapid Diagnostic Test

presence

Positive

evidence

reference	supports	snippet	explanation
PMID:32611794	SUPPORT	Among diarrheal samples positive by nanoliter quantitative PCR (qPCR) for V. cholerae (n = 78/849), the odds that a rapid diagnostic test (RDT) or qPCR was positive was reduced by 89% (odds ratio [OR], 0.108; 95% confidence interval [CI], 0.002 to 0.872) when lytic bacteriophage were detected.	This study confirms that a rapid diagnostic test can detect cholera antigens, but its effectiveness may be reduced under certain conditions like the presence of lytic bacteriophage.
PMID:23886437	SUPPORT	The sensitivity and specificity of RDT were 95% and 80%, respectively, with a positive predictive value of 89% and negative predictive value of 91%.	This study from Haiti indicates that RDTs are effective and reliable for detecting cholera, supporting their use in diagnosis.
PMID:11883125	SUPPORT	A total of 553 stool specimens were processed from cases of acute gastro-enteritis. The sensitivity and specificity of coagglutination test was 92.77% and 95.65% respectively.	This study supports the effectiveness of rapid diagnostic tests (coagglutination test) for cholera detection in stool samples.
PMID:36746024	SUPPORT	We developed an electrochemical biosensor with GM1-expressing Caco-2 cell membrane (CCM) on the electrode surface. The CCB had an excellent limit of detection of approximately 11.46 nM and a detection range spanning 100 ng/mL - 1 mg/mL.	This study supports the use of rapid diagnostic tests for detecting cholera toxin, specifically via an electrochemical biosensor.

notes

Detects cholera toxin or other bacterial antigens in stool

2

name

Darkfield Microscopy

evidence

reference	supports	snippet	explanation
PMID:14215188	SUPPORT	This article describes a rapid, simple and reproducible method for detecting Vibrio cholerae in diarrhoeal patients. The method involves darkfield examination of a liquid stool specimen or a rectal swab immersed in broth and immobilization of V. cholerae by the addition of specific vibrio antisera.	The method mentioned in the article uses darkfield microscopy to detect Vibrio cholerae in stool samples, aligning with the statement that darkfield microscopy can show motile Vibrio cholerae in a fresh stool sample.
PMID:18024592	PARTIAL	At the International Centre for Diarrhoeal Disease Research, Bangladesh, one-half of the rice-water stool samples that were culture-positive for Vibrio cholerae did not contain motile V. cholerae by standard darkfield microscopy and were defined as darkfield-negative (DF(-)).	While darkfield microscopy is used to detect motile Vibrio cholerae, the study indicates that it may not always be successful in detecting motile bacteria in all stool samples, leading to 'darkfield-negative' results in some instances.

notes

Can show motile Vibrio cholerae in a fresh stool sample.