Materiały źródłowe

• #1 Diagnosis, Management, and Future Control of Cholera

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9491185/

  Cholera, caused by Vibrio cholerae, persists in developing countries due to inadequate access to safe water, sanitation, and hygiene. There are approximately 4 million cases and 143,000 deaths each year due to cholera. The disease is transmitted fecally-orally via contaminated food or water. Severe dehydrating cholera can progress to hypovolemic shock due to the rapid loss of fluids and electrolytes, which requires a rapid infusion of intravenous (i.v.) fluids. The case fatality rate exceeds 50% without proper clinical management but can be less than 1% with prompt rehydration and antibiotics. […] The diagnosis of cholera is frequently based on clinical signs and symptoms in resource-limited areas of endemicity where laboratory facilities are not available. In nonendemic settings, cholera is suspected if a patient has severe dehydration or someone has died from acute watery diarrhea (AWD). But in a cholera epidemic setting, if a patient (5 years of age) has AWD more than three times with or without vomiting within 24h, cholera is indicated.

• #1 Diagnosis, Clinical Management, Prevention, and Control of Cholera; A Review Study

  https://brieflands.com/articles/iji-14679

  Cholera is an intestinal infection caused by Vibrio cholera and transmitted by the fecal-oral route. […] Here, we reviewed diagnosis, treatment, and prevention routes of cholera. […] We found many papers about the cholera, but we selected mainly those which discussed diagnosis, new treatment, and control of cholera. […] Laboratory diagnosis is necessary not only for identification of microorganism, but also for epidemiological purposes. For definitive diagnosis, direct microscopic examination of stool including dark-field examination, gram staining, culture, serotype and biotype identification are performed. Isolation of Vibrio cholera serogroup O1 or O139 by stool culture is the gold standard method for the laboratory diagnosis. […] According to the World Health Organization (WHO) standard case definition, a case of cholera is suspected when the following conditions are met: In an area where the disease is not known to be present, a patient aged five years or older with severe dehydration or dies from acute watery diarrhea; In an area with a noted cholera epidemic, a patient aged 5 years or older who develops acute watery diarrhea, with or without vomiting.

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Cholera-Diagnosis.aspx

  Cholera diagnosis involves the following: […] The culture method is the gold standard or most recommended test for diagnosis of cholera. Stool samples taken from a patient using a sterile cotton bud are placed on a plate containing TCBS (thiosulphate citrate bile salts) agar, a selective medium that isolates the bacteria from the diarrhea. On incubation, Vibrio cholerae appear as yellow clumps which are then analyzed to detect the exact strain of cholera. This definitive diagnosis allows cholera to be distinguished from other bacterial, protozoal or viral causes of dysentery. […] In areas where cholera is endemic, rapid immunochromatographic dipstick testing is often available. This involves placing a dipstick strip into a stool sample and reading the lines it then displays. Cholera is confirmed if two red lines appear on the dipstick, whereas it is ruled out if only one line appears. It takes between 2 and 15 minutes for the test to make a diagnosis. […] Diagnosis can also be made on testing blood for antibodies against Vibrio cholerae.

• #1 Laboratory Diagnosis of Cholera in: The American Journal of Tropical Medicine and Hygiene Volume s1-29 Issue 6 (1949)

  https://www.ajtmh.org/abstract/journals/tpmd/s1-29/6/article-p921.xml

  1. A simple method for the laboratory diagnosis of cholera is presented: (a) Peptone water is inoculated with fresh stool and incubated 8 hours, (b) Alkaline nutrient agar plates are streaked and incubated overnight, (c) Transparent colonies are tested for agglutination with anti-cholera O serum. (d) Agglutinable vibrio are tested for hemolysis using 5 per cent sheep or goat cells. […] 2. V. cholerae are present in the intestinal tract only in the first few days of illness, therefore sulfonamides or other bactericidal agents are effective only if given early in the course of the disease. […] 3. The value of sulfonamides in cholera carriers cannot be definitely evaluated at this time. […] 4. Of 3,000 contacts, 61 became contact carriers. Two of these developed the disease. The number of clinical cases developing from contact carriers is very small.

• #1 Cholera Clinical Detection | Cholera | CDC

  https://www.cdc.gov/cholera/php/laboratories/cholera-clinical-detection.html

  Diagnosis of cholera is confirmed in the laboratory using culture-based or molecular methods such as PCR. […] The most common way to confirm a diagnosis of cholera is to isolate Vibrio cholerae from a stool specimen and perform 01 and 0139 serotyping. […] Molecular methods such as Polymerase Chain Reaction (PCR) are gaining popularity as they are more sensitive and accurate compared to culture. […] If you suspect cholera, request that your laboratory perform a stool culture on thiosulfate-citrate-bile salts-sucrose (TCBS) agar. […] Commercially available rapid diagnostic test (RDT) kits are useful in epidemic settings. However, they don’t yield an isolate for antimicrobial susceptibility testing and subtyping. RDTs should not be used for routine diagnosis. […] Cholera is a nationally reportable disease in the United States. All isolates should be sent to CDC through state health department laboratories for cholera toxin testing and subtyping.

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3020846/

  The treatment regimen for diarrhea depends greatly on correct diagnosis of its etiology. Recent diarrhea outbreaks in Bangladesh showed Vibrio cholerae to be the predominant cause, although more than 40% of the suspected cases failed to show cholera etiology by conventional culture methods (CMs). […] Prompt and accurate diagnosis of Vibrio cholerae is a key step in cholera outbreak surveillance that can greatly influence rapid intervention and prevention to minimize disease spread and mortality. Conventional culture methods (CMs) currently used for diagnosis of V. cholerae remain the gold standard, but this procedure is not precise and requires highly skilled technicians and laboratory infrastructure. […] This study shows the practical limitations related to the precise diagnosis of cholera.

• #1 Diagnosis, Management, and Future Control of Cholera

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9491185/

  In rural or underdeveloped health care settings where there is a scarcity of culture medium/PCR and/or trained personnel, rapid diagnostic tests (RDTs) of stool samples cost only $2, and these can be performed without special training. RDTs can also provide an early warning for public health experts when a cholera outbreak is imminent. Different categories of RDTs are available on the market, with a wide range of sensitivities and specificities. Monoclonal antibodies in Crystal VC can easily detect the lipopolysaccharide (LPS) antigens of both V. cholerae O1 and O139 serogroups. Crystal VC has shown 97% sensitivity and 76% specificity.

• #1 Laboratory and Field Evaluation of the Crystal VC-O1 Cholera Rapid Diagnostic Test in: The American Journal of Tropical Medicine and Hygiene Volume 104 Issue 6 (2021)

  https://www.ajtmh.org/view/journals/tpmd/104/6/article-p2017.xml

  Cholera is a severe acute, highly transmissible diarrheal disease which affects many low- and middle-income countries. Outbreaks of cholera are confirmed using microbiological culture, and additional cases during the outbreak are generally identified based on clinical case definitions, rather than laboratory confirmation. […] A simple, reliable, and low-cost rapid diagnostic test (RDT) would improve identification of cases allowing rapid response to outbreaks. […] Here, we report an evaluation of a new commercially available cholera dipstick test which detects only serotype O1. In both laboratory and field studies in Kenya, we demonstrate high sensitivity (97.5%), specificity (100%), and positive predictive value (100%) of this new RDT targeting only serogroup O1. […] A reliable rapid diagnostic test (RDT) that could be used in low-resource settings would greatly facilitate this goal.

• #1 Development of a simple, rapid, and sensitive molecular diagnostic assay for cholera | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0011113

  Cholera continues to inflict high rates of morbidity and mortality. Prompt identification of cholera cases facilitates rapid outbreak responses in the short term while providing reliable surveillance data to guide long-term policies and interventions. Microbiological stool culture, the current recognized gold standard for diagnosing cholera, has significant limitations. Rapid diagnostic tests (RDTs) represent promising alternatives for diagnosing cholera in areas with limited laboratory infrastructure. However, studies conducted with the current cholera RDTs demonstrated wide variations in sensitivity and specificity. […] To address this gap in the diagnosis of cholera, we developed a simple, rapid, and sensitive diagnostic assay, „Rapid LAMP based Diagnostic Test (RLDT).” […] The performance specifications of the cholera RLDT assay, including analytical sensitivity and specificity, were evaluated using direct fecal samples, dried fecal samples on filter paper, and environmental water samples spiked with cholera strain.

• #1 Laboratory and Field Evaluation of the Crystal VC-O1 Cholera Rapid Diagnostic Test in: The American Journal of Tropical Medicine and Hygiene Volume 104 Issue 6 (2021)

  https://www.ajtmh.org/view/journals/tpmd/104/6/article-p2017.xml

  Theoretically, the ability to detect serotype O139 could be of benefit; however, cholera due to Vibrio cholerae serotype O139 has never been detected in Africa and is now very rarely identified in the South Asia and China during the last two decades. […] This new version tests solely for Vibrio cholerae O1 with the intention to improve the accuracy of the assay for serotype O1. […] If a cholera RDT is developed and demonstrates high sensitivity and specificity, this will greatly change the landscape of cholera detection and control as well as our understanding of true burden of disease. […] The sensitivity, specificity, positive predictive values (PPVs) and negative predictive values (NPVs) were calculated using the Stata command diagti for both laboratory evaluations and field evaluations.

• #1 Laboratory and Field Evaluation of the Crystal VC-O1 Cholera Rapid Diagnostic Test in: The American Journal of Tropical Medicine and Hygiene Volume 104 Issue 6 (2021)

  https://www.ajtmh.org/view/journals/tpmd/104/6/article-p2017.xml

  The RDT was positive for 79 of 81 samples found positive by either test, as shown in Table 4. Applying this definition to our results, the sensitivity of the RDT test was 97.5%, and specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 98.7%. […] The field evaluation corroborated the laboratory evaluation, demonstrating that Crystal VC-O1 yielded high sensitivity (%) and specificity when used to identify Vibrio cholerae O1 positive patients presenting with watery diarrhea. […] In conclusion, the new Crystal VC-O1 RDT, with a single line for serogroup O1, performed with high sensitivity and high specificity in this study. Importantly, we did not find any false-positive results.

• #1 Rethinking cholera diagnostic test performance, interpretation and evaluation: a field-based latent-class analysis in Bangladesh | medRxiv

  https://www.medrxiv.org/content/10.1101/2024.11.19.24317512v1.full-text

  Accurate and reliable diagnostics, including rapid diagnostic tests (RDTs), are critical components of cholera control programs, though their performance has varied greatly across studies. […] We enrolled all suspected cholera cases seeking care at two healthcare facilities in Sitakunda, Bangladesh over 19 months. […] For RDT, PCR and culture, we estimated a sensitivity of 93.5% (95% Credible Intervals, CrI: 91.3-95.4), 90.3% (88.4-92.1), and 73.7% (70.8-76.5), and a specificity of 97.3% (96.7-97.8), 97.2% (96.6-97.8), and 100% (culture specificity assumed perfect), respectively. […] Across various patient and sampling characteristics, Cholkit RDT had high performance in this cholera-endemic setting, supporting its use for cholera surveillance and control. […] RDT evaluation relies on two primary laboratory techniques used to confirm cholera: culture and Polymerase Chain Reaction (PCR).

• #1 Development of a cholera rapid diagnostic test that targets both Vibrio cholerae and vibriophage – Global Task Force on Cholera Control

  https://www.gtfcc.org/research/development-of-a-cholera-rapid-diagnostic-test-that-targets-both-vibrio-cholerae-and-vibriophage/

  It is likely that rapid diagnostic tests (RDTs) for cholera intermittently fail because lytic vibriophage destroy the Vibrio cholerae target. In this proposal, we are adding an antibody to the lytic vibriophage (ICP1) to the RDT. The goal is that detection of the vibriophage can serve as a proxy for Vibrio cholerae, and therefore, increase sensitivity of the RDT when vibriophage are present. […] This revised RDT will address sensitivity concerns and intermittent performance of current RDTs when lytic vibriophage are present. This new RDT will not address limitations when antibiotics are present, and therefore patient reports on antibiotic consumption need to be considered when evaluating RDT results, even with the new RDT.

• #1 Diagnosis, Management, and Future Control of Cholera

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9491185/

  Generally, in the developed laboratory setting, for the diagnosis of cholera, stool or rectal swab culture is the gold-standard reference method and costs approximately $10. The specimens are placed into an enrichment broth made of alkaline peptone water, which enhances the sensitivity of the culture, and are later subcultured on selective thiosulfate citrate bile salt (TCBS) agar or taurocholate tellurite gelatin agar (TTGA), which is the ideal culture medium. […] V. cholerae diagnosis using PCR is highly sensitive, but this technique needs an enhanced laboratory capacity, which is often lacking in most LMICs. PCR can be used to detect molecular markers of certain phenotypes with target genes such as ctxA, tcpA, and ompW. Even though PCR costs are approximately the same as those of stool culture and PCR requires a specific laboratory setup, the results can be obtained much earlier than with stool culture.

• #1 Cholera – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/451

  Cholera is usually a disease occurring in the context of poverty, war, or displacement, but is also well described in returning travelers. […] Basic laboratory tests are nonspecific. Culture of the organism is definitive, and rapid dipstick tests are available, while molecular detection methods are gaining importance as part of epidemic surveillance. […] Key diagnostic factors include copious watery diarrhea and evidence of volume depletion. […] 1st tests to order include CBC, serum electrolytes, serum BUN and creatinine, serum lactate, ABG, ECG, dark-field/phase-contrast microscopy of stool, and rapid dipstick testing of stool. […] Tests to consider include Gram stain of stool, stool culture of liquid stool, fecal suspension, or rectal swab, serogroup confirmation using antisera, antibiogram (sensitivities), enzyme-linked immunosorbent assay (ELISA) assay of stool, molecular testing of stool, and loop-mediated isothermal amplification (LAMP) assay of stool.

• #1 Cholera Differential Diagnoses

  https://emedicine.medscape.com/article/962643-differential

  Although other differential diagnosis of gastroenteritis may be considered, the clinical picture of cholera is unlikely to be confused with any other disease. This is especially true in adults, in whom no other infectious disease causes such profound dehydration so quickly. Unfortunately, in the United States, this may not trigger a diagnosis of cholera because medical personnel are not accustomed to thinking of cholera as a possibility. […] Steps in the treatment of a patient with suspected cholera are as follows: 1. Assess for dehydration (see Table 1) 2. Rehydrate the patient and monitor frequently, then reassess hydration status 3. Maintain hydration; replace ongoing fluid losses until diarrhea stops 4. Administer an oral antibiotic to the patient with severe dehydration 5. Feed the patient […] Antimicrobial therapy is an adjunct to fluid therapy of cholera and is not an essential component. However, it reduces diarrhea volume and duration by approximately 50%. The choice of antibiotics is determined by the susceptibility patterns of the local strains of V cholerae O1 or O139.

• #1 Cholera: Epidemiology, clinical features, and diagnosis – UpToDate

  https://www.uptodate.com/contents/cholera-clinical-features-diagnosis-treatment-and-prevention

  In settings where cholera is a sporadic illness, the microbiology laboratory should be notified of suspicion for cholera so that appropriate selective media can be used; these media are not used routinely for stool culture. […] Rapid tests and other tools […] Antigen detection — Several rapid antigen detection-based tests are commercially available for diagnosis of cholera. […] In one meta-analysis including 20 studies and 8 different commercial rapid tests, the combined sensitivity was 90 percent and the specificity was 86 percent, relative to bacterial culture (the diagnostic gold standard); there was variation across individual studies. […] Molecular tests — Molecular testing for V. cholerae is feasible; however, thus far practical use has been limited to epidemiologic research and surveillance. […] Darkfield microscopy — Darkfield microscopy of rice-water stools can be used to evaluate for the presence of highly motile Vibrios, whose shooting star-like motion can be inhibited by the subsequent addition of specific antibodies.

• #1 Cholera Workup: Approach Considerations, Stool Examination, Stool Culture

  https://emedicine.medscape.com/article/962643-workup

  Specific antisera can be used in immobilization tests. A positive immobilization test result is produced only if the antiserum is specific for the Vibrio type present; the second antiserum serves as a negative control. […] The major hematologic derangements in patients with cholera derive from the alterations in intravascular volume and electrolyte concentrations. […] Serum sodium is usually 130-135 mmol/L, reflecting the substantial loss of sodium in the stool. […] Patients have elevated blood urea nitrogen and creatinine levels consistent with prerenal azotemia. The extent of elevation depends on the degree and duration of dehydration. […] Antimicrobial therapy is an adjunct to fluid therapy of cholera and is not an essential component. However, it reduces diarrhea volume and duration by approximately 50%. The choice of antibiotics is determined by the susceptibility patterns of the local strains of V cholerae O1 or O139.

• #1 Global deployment of rapid diagnostic tests to boost fight against cholera

  https://www.unicef.org/press-releases/global-deployment-rapid-diagnostic-tests-boost-fight-against-cholera

  Global deployment of rapid diagnostic tests to boost fight against cholera […] The arrival of rapid diagnostic test (RDT) kits for cholera in Malawi today signals the start of a global programme that will see more than 1.2 million tests distributed to 14 countries at high risk for cholera over the next several months. […] This programme will improve the timeliness and accuracy of outbreak detection and response by boosting routine surveillance and testing capacity and helping rapidly identify probable cholera cases. […] The global cholera diagnostics programme is funded and coordinated by Gavi, the Vaccine Alliance (Gavi), with procurement and delivery to countries led by UNICEF, and undertaken in collaboration with the Global Task Force on Cholera Control (GTFCC), and WHO. […] These initial shipments signal the start of the programme, which aims to see partners deploy RDTs to additional countries that have expressed interest in the future.

• #1 Global deployment of rapid diagnostic tests to boost fight against cholera

  https://www.gavi.org/news/media-room/global-deployment-rapid-diagnostic-tests-boost-fight-against-cholera

  More than 1.2 million cholera rapid diagnostic tests will be shipped to 14 countries in largest-ever global deployment, with the first shipment landing today in Malawi. […] This first official deployment of tests through Gavi, the Vaccine Alliance, will improve timely detection and monitoring of outbreaks, effectiveness of vaccination campaigns in response to current outbreaks, and targeting of future preventive vaccination efforts. […] The global cholera rapid diagnostic test procurement programme is a collaboration between Gavi, WHO, UNICEF, FIND, and other partners. […] This programme will improve the timeliness and accuracy of outbreak detection and response by boosting routine surveillance and testing capacity and helping rapidly identify probable cholera cases. […] The global cholera diagnostics programme is funded and coordinated by Gavi, the Vaccine Alliance (Gavi), with procurement and delivery to countries led by UNICEF, and undertaken in collaboration with the Global Task Force on Cholera Control (GTFCC), and WHO.

• #1 Global deployment of rapid diagnostic tests to boost fight against cholera

  https://www.unicef.org/press-releases/global-deployment-rapid-diagnostic-tests-boost-fight-against-cholera

  Through this effort, rapid diagnostic tests from two manufacturers will now be used routinely for cholera surveillance. […] The GTFCC updated recommendations in favor of strategic, routine and systematic testing of suspected cholera cases and the expanded use of RDTs to strengthen cholera surveillance. […] Routine use of diagnostics will bolster cholera surveillance in impacted countries, and must be leveraged to better target vaccination efforts, which play a critical role in multisectoral cholera prevention and control programmes. […] Accurate and high-quality testing and surveillance measures are vital to spot the disease where it is emerging, confirm cholera cases amidst other diarrheal illnesses, and evaluate the success of preventative measures such as vaccines.

• #1 WHO Model List of

  https://edl.who-healthtechnologies.org/recommendations/2287

  Cholera outbreaks must be detected and monitored for rapid control. […] Current cholera RDTs are intended for use in primary care settings for surveillance. […] Cholera RDTs may be used for early outbreak detection, for an initial alert and for monitoring outbreaks and seasonal peaks in highly endemic areas. […] Any positive RDT result must be confirmed by culture or PCR as soon as possible before the alert is confirmed and a cholera outbreak declared. […] The SAGE IVD recommended inclusion on the EDL of the rapid antigen test for V. cholerae in the detection and monitoring of cholera epidemics at primary care level and for ruling out outbreaks. […] According to expert opinion, use of a point-of-care test for cholera can provide an initial indication of toxigenic V. cholerae transmission and thus reduce the danger of a nascent cholera epidemic. […] Cholera RDTs are not meant for individual diagnosis but rather to detect possible toxigenic cholera transmission in an endemic community and monitoring of the outbreak during its course.

• #1 Cholera (Human) | UNDRR

  https://www.undrr.org/understanding-disaster-risk/terminology/hips/bi0034

  Under the International Health Regulations, notification of all cases of cholera is no longer mandatory (WHO, 2021). However, public health events involving cholera must always be assessed against the criteria provided in the regulations to determine whether there is a need for official notification (WHO, 2014, 2019).

• #1 Enhancing national cholera surveillance using rapid diagnostic tests (RDTs): a mixed methods evaluation | medRxiv

  https://www.medrxiv.org/content/10.1101/2025.01.10.25320331v1.full-text

  Cholera rapid diagnostic tests (RDTs) can strengthen existing surveillance systems by offering a cost-effective screening method that improves understanding of cholera burden allowing for targeted prevention and control efforts. […] Implementation of cholera RDTs was evaluated following their distribution in 2023 to facilities within Nepal’s Early Warning and Reporting System (EWARS). […] Qualitative findings indicated generally positive perceptions of cholera RDTs, highlighting their speed and ease of use, and suitability for deployment in under-resourced areas by unskilled personnel. […] Quantitative findings revealed underreporting of acute gastroenteritis (AGE) and cholera in EWARS and an underutilization of the cholera RDTs, with only 2.6% of reported AGE cases screened using an RDT.

• #1 Enhancing national cholera surveillance using rapid diagnostic tests (RDTs): a mixed methods evaluation | medRxiv

  https://www.medrxiv.org/content/10.1101/2025.01.10.25320331v1.full-text

  This field evaluation demonstrated that RDTs can have an important role in cholera surveillance but highlighted significant challenges with cholera lab capacity, reporting, and training. […] Both the qualitative and quantitative findings showed gaps in surveillance reporting, which were exacerbated by the complexity of adding RDTs without strong guidance as well as beliefs about the RDTs poor validity. […] Cholera rapid diagnostic tests (RDTs) detect V. cholerae O1 and/or O139-specific antigens within 15 to 30 minutes. […] The RDTs are not recommended for use in determining treatment of patients, rather are meant for epidemiological surveillance only. […] Early field work has shown that the increasing utilization of cholera RDTs has facilitated cholera outbreak detection, particularly in endemic areas.

• #1 Enhancing national cholera surveillance using rapid diagnostic tests (RDTs): a mixed methods evaluation | medRxiv

  https://www.medrxiv.org/content/10.1101/2025.01.10.25320331v1.full-text

  Almost all interviewees expressed a desire for more training on cholera RDTs. […] Many samples need to be transported elsewhere for confirmation testing, to labs like the NPHL, causing delays in case confirmation and reporting. […] Despite the many recognized benefits of cholera RDTs, challenges and misconceptions persist.

• #1 LSHTM LSHTM Research Online

  https://researchonline.lshtm.ac.uk/id/eprint/4671262/

  Gold Standard Cholera Diagnostics Are Tarnished by Lytic Bacteriophage and Antibiotics. […] A fundamental, clinical, and scientific concern is how lytic bacteriophage, as well as antibiotics, impact diagnostic positivity. […] Diagnostic performance was assessed as a function of lytic bacteriophage detection and exposure to the first-line antibiotic azithromycin, detected in stool samples by mass spectrometry. […] The odds that an RDT or qPCR was positive was reduced by more than 99% (OR, 0.00; 95% CI, 0.00 to 0.28) and 89% (OR, 0.11; 95% CI, 0.03 to 0.44), respectively, when azithromycin was detected. […] Cholera burden estimates may improve by accommodating for the negative effects of lytic bacteriophage and antibiotic exposure on diagnostic positivity. […] These findings have relevance for other diagnostic settings where bacterial pathogens are vulnerable to lytic bacteriophage predation.

• #1 Enhancing national cholera surveillance using rapid diagnostic tests (RDTs): a mixed methods evaluation | medRxiv

  https://www.medrxiv.org/content/10.1101/2025.01.10.25320331v1.full-text

  Cholera RDTs were recognized by participants as beneficial for facilitating cholera surveillance and swift outbreak detection. […] The RDTs were viewed by some technicians as being more accurate than the commonly performed hanging drop test. […] Having the RDTs available increased screening, surprising participants when they realized cholera was still circulating in their communities. […] Negative perceptions of the sensitivity and specificity of the cholera RDTs was a recurring theme across the lab technicians, physicians, and government officials interviewed. […] Several physicians said that they would choose the cheapest diagnostic option available, and if necessary, would rather treat without laboratory testing if it saved their patient money. […] Stakeholders noted that physicians were a key barrier to uptake of cholera RDTs at the facility level given that physicians must order or prescribe the cholera RDT before a lab technician can perform it.

• #1 Why every minute counts during a cholera outbreak | MSF UK

  https://msf.org.uk/article/why-every-minute-counts-during-cholera-outbreak

  Infectious diseases specialist Dr Diyani Dewasurendra is on assignment in South Sudan when the first cholera cases arrive at the hospital. The clock has started: its time to act fast. […] Every epidemic begins with a suspicion a sudden rise in illness, recurring symptoms and the first severely ill patients. In crisis zones, infectious diseases can spread at lightning speed. Every minute counts when trying to contain them. The first 72 hours are critical: we need to act strategically to save lives and prevent a disaster. […] We knew cholera was a possibility but we had to be sure. […] As soon as the first tests came back positive for cholera, we had to act quickly. The outbreak was now officially confirmed and every minute counted. […] Cholera is a severe diarrhoeal illness and diseases like this are especially dangerous for small children. Though treatable, an infection can lead to death within just a few hours if left untreated.

• #1

  https://www.who.int/news-room/fact-sheets/detail/cholera

  Cholera is a severe diarrheal disease that can be fatal within hours if not treated. Quick access to treatment is crucial. […] Most people with cholera have no or mild symptoms and can be treated with oral rehydration solution. Severe cases need intravenous fluids, oral rehydration solution and antibiotics. […] Most people with cholera have mild or moderate diarrhoea and can be treated with oral rehydration solution (ORS). However, the disease can progress rapidly, so starting treatment quickly is vital to save lives. Patients with severe disease need intravenous fluids, ORS and antibiotics. […] Cholera can cause severe acute watery diarrhoea, which can be fatal within hours if untreated. […] Cholera is an easily treatable disease. Most people can be treated successfully with prompt ORS administration. Severely dehydrated patients are at risk of dying from dehydration and need rapid intravenous fluids. They also receive oral rehydration solution and antibiotics. […] Community access to ORS is essential during a cholera outbreak.

• #1 Diagnosis, Clinical Management, Prevention, and Control of Cholera; A Review Study

  https://brieflands.com/articles/iji-14679

  Successful prevention of infection in the community depends mainly on adequate control measures such as rapid and accurate microbiological diagnosis, prompt treatment, patient isolation and preventative education, and adequate follow-up strategies to monitor fecal shedding after treatment in at risk groups.

• #2 Development of a cholera rapid diagnostic test that targets both Vibrio cholerae and vibriophage – Global Task Force on Cholera Control

  https://www.gtfcc.org/research/development-of-a-cholera-rapid-diagnostic-test-that-targets-both-vibrio-cholerae-and-vibriophage/

  Cholera is an acute watery diarrhoeal disease that can lead to severe dehydration and death in less than 16 hours. It is an important public health problem in Asia, Africa and Latin America. Globally 1.3-4 million cases and 21,000-143,000 deaths occur annually due to cholera. Accurate diagnosis of cholera early in an epidemic is critical to reduce morbidity and mortality. Rapid diagnostic tests (RDTs) have the potential to provide immediate objective findings early in outbreaks in settings that lack conventional microbiology laboratories. […] Our primary research question is if the incorporation of antibodies that detect both V. cholerae and lytic vibriophage into a Rapid Diagnostic Test (RDT) will address limitations in the current RDTs used when cholera patients harbor lytic vibriophage. This novel RDT may represent a model for diagnostic tool development for enteric and nonenteric infectious diseases.

• #2 Cholera Workup: Approach Considerations, Stool Examination, Stool Culture

  https://emedicine.medscape.com/article/962643-workup

  Polymerase chain reaction (PCR) tests for identifying V cholerae have been developed. These have a high degree of sensitivity and specificity. At present, however, such tests are used for screening of food samples. […] Laboratory diagnosis is required not only for identification but also for epidemiological purposes. […] Unlike other Enterobacteriaceae, V cholerae is oxidase-positive; hence, in countries where selective media are not available and cholera is not endemic, V cholerae should be suspected if any motile, oxidase-positive, gram-negative rod isolated on routine differential media from the stool of a patient with diarrhea produces an acid reaction on triple sugar iron agar. […] As Vibrio has the ability to grow at a high pH or in bile salts, which inhibit many other Enterobacteriaceae, peptone water (pH 8.5-9) or selective media containing bile salts are recommended to facilitate isolation and lab diagnosis.

• #2 Diagnosis, Management, and Future Control of Cholera

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9491185/

  Generally, in the developed laboratory setting, for the diagnosis of cholera, stool or rectal swab culture is the gold-standard reference method and costs approximately $10. The specimens are placed into an enrichment broth made of alkaline peptone water, which enhances the sensitivity of the culture, and are later subcultured on selective thiosulfate citrate bile salt (TCBS) agar or taurocholate tellurite gelatin agar (TTGA), which is the ideal culture medium. […] V. cholerae diagnosis using PCR is highly sensitive, but this technique needs an enhanced laboratory capacity, which is often lacking in most LMICs. PCR can be used to detect molecular markers of certain phenotypes with target genes such as ctxA, tcpA, and ompW. Even though PCR costs are approximately the same as those of stool culture and PCR requires a specific laboratory setup, the results can be obtained much earlier than with stool culture.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Cholera-Diagnosis.aspx

  Cholera diagnosis involves the following: […] The culture method is the gold standard or most recommended test for diagnosis of cholera. Stool samples taken from a patient using a sterile cotton bud are placed on a plate containing TCBS (thiosulphate citrate bile salts) agar, a selective medium that isolates the bacteria from the diarrhea. On incubation, Vibrio cholerae appear as yellow clumps which are then analyzed to detect the exact strain of cholera. This definitive diagnosis allows cholera to be distinguished from other bacterial, protozoal or viral causes of dysentery. […] In areas where cholera is endemic, rapid immunochromatographic dipstick testing is often available. This involves placing a dipstick strip into a stool sample and reading the lines it then displays. Cholera is confirmed if two red lines appear on the dipstick, whereas it is ruled out if only one line appears. It takes between 2 and 15 minutes for the test to make a diagnosis. […] Diagnosis can also be made on testing blood for antibodies against Vibrio cholerae.

• #2 Cholera diagnosis in human stool and detection in water: A systematic review and meta-analysis | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0270860

  Cholera continues to pose a problem for low-resource, fragile and humanitarian contexts. Evidence suggests that 2.86 million cholera cases and 95,000 deaths due to cholera are reported annually. Without quick and effective diagnosis and treatment, case-fatality may be 50%. […] Diagnosis and detection in the early stages of an epidemic are essential for outbreak confirmation and control, and identification of areas for targeted interventions to control disease spread. […] Bacterial culture continues to be considered the gold standard for diagnosis of cholera from both water or stool samples, yet suffers from issues surrounding precision, sample transport, laboratory infrastructure, a time delay of two to three days, and necessity of highly trained laboratory technicians. […] The Global Task Force on Cholera Control highlights early identification as critical to cholera detection and Rapid Diagnostic Tests (RDTs) are widely viewed as a pragmatic alternative to laboratory-based detection methods.

• #2

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3020846/

  Supporting previously published data, diagnostic tests, such as the DS assay, used for rapid detection of V. cholerae antigens in stool samples were 24% more sensitive than CMs in the present study. […] Clinical cases of cholera that do not yield positive results using CMs may be influenced by factors such as changes in pH or osmolarity during passage through the lower alimentary tract or by antibiotics. […] The results of the study reported here show that about 40% of suspected cholera cases occurring during acute diarrhea outbreaks and lacking a confirmed etiology have V. cholerae as the predominant causative agent.

• #2 Enhancing national cholera surveillance using rapid diagnostic tests (RDTs): a mixed methods evaluation | medRxiv

  https://www.medrxiv.org/content/10.1101/2025.01.10.25320331v1.full-text

  This field evaluation demonstrated that RDTs can have an important role in cholera surveillance but highlighted significant challenges with cholera lab capacity, reporting, and training. […] Both the qualitative and quantitative findings showed gaps in surveillance reporting, which were exacerbated by the complexity of adding RDTs without strong guidance as well as beliefs about the RDTs poor validity. […] Cholera rapid diagnostic tests (RDTs) detect V. cholerae O1 and/or O139-specific antigens within 15 to 30 minutes. […] The RDTs are not recommended for use in determining treatment of patients, rather are meant for epidemiological surveillance only. […] Early field work has shown that the increasing utilization of cholera RDTs has facilitated cholera outbreak detection, particularly in endemic areas.

• #2

  https://journals.lww.com/armh/fulltext/2018/06010/evaluation_of_a_rapid_dipstick_test__crystal_vc__.4.aspx

  The Crystal VC RDT is a dipstick test based on the detection of the lipopolysaccharide of VC O1 and O139 by monoclonal antibodies and uses a one step, vertical-flow immunochromatography principle and colloidal gold particles-conjugated antibodies for detection of bound antigens. […] The cholera RDT Crystal VC is a useful tool for diagnosis of diarrheal disease due to VC serotypes 01 and 0139 or to identify initial cases in an outbreak situation. […] It is recommended for use as an adjunct for prompt diagnosis of diarrheal disease caused by VC in areas of limited laboratory infrastructure and outbreak situations.

• #2

  https://journals.lww.com/armh/fulltext/2018/06010/evaluation_of_a_rapid_dipstick_test__crystal_vc__.4.aspx

  Cholera is a preventable diarrheal disease associated with rapidly progressing dehydration. Early detection of the causative agent, Vibrio cholerae (VC) among symptomatic patients is a key step in cholera outbreak management to minimize disease spread and mortality. […] We prospectively evaluated the performance of Crystal VC, a commercially available test kit for rapid detection of VC serotypes 01 and 0139 directly from stool samples. […] The cholera rapid dipstick test (RDT), Crystal VC, is a useful tool for diagnosis of diarrheal disease due to VC serotypes 01 and 0139 and may provide an initial alert in an outbreak situation. […] Although it is less sensitive than conventional stool culture, it is a convenient and simple test to perform with faster turnaround time. […] Our evaluation showed a sensitivity of 95.1%, SP of 59.3%, PPV of 81.5%, and NPV of 86.5%.

• #2 Diagnosis, Management, and Future Control of Cholera

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9491185/

  In rural or underdeveloped health care settings where there is a scarcity of culture medium/PCR and/or trained personnel, rapid diagnostic tests (RDTs) of stool samples cost only $2, and these can be performed without special training. RDTs can also provide an early warning for public health experts when a cholera outbreak is imminent. Different categories of RDTs are available on the market, with a wide range of sensitivities and specificities. Monoclonal antibodies in Crystal VC can easily detect the lipopolysaccharide (LPS) antigens of both V. cholerae O1 and O139 serogroups. Crystal VC has shown 97% sensitivity and 76% specificity.

• #2 Cholera Case Definitions and Diagnosis | Cholera | CDC

  https://www.cdc.gov/cholera/hcp/case-definition/index.html

  Testing a stool sample is usually needed to confirm if a single patient with acute watery diarrhea has cholera. […] Laboratory testing of stool samples is necessary to confirm if a patient with acute watery diarrhea has cholera. […] A confirmed case is any person infected with Vibrio cholerae O1 or O139, as confirmed by culture (including seroagglutination) or PCR. […] The Crystal VC Rapid Diagnostic Test (RDT) can provide an early warning to public health officials that a cholera outbreak is occurring. However, the sensitivity and specificity of this test is not optimal. […] Fecal specimens testing positive for Vibrio cholerae O1 or O139 by RDT should be confirmed using culture-based methods or PCR. […] Cholera is a nationally reportable disease in the United States. All isolates should be sent to CDC through state health department laboratories for cholera toxin testing and subtyping.

• #2 Global deployment of rapid diagnostic tests to boost fight against cholera – FIND

  https://www.finddx.org/publications-and-statements/press-release/global-deployment-of-rapid-diagnostic-tests-to-boost-fight-against-cholera/

  The global cholera diagnostics programme is funded and coordinated by Gavi, the Vaccine Alliance (Gavi), with procurement and delivery to countries led by UNICEF, and undertaken in collaboration with the Global Task Force on Cholera Control (GTFCC), and WHO. […] These initial shipments signal the start of the programme, which aims to see partners deploy RDTs to additional countries that have expressed interest in the future. […] To be effective, these multisectoral strategies for the control of cholera must be guided by timely and reliable cholera surveillance data. […] In 2023, the GTFCC updated recommendations in favor of strategic, routine and systematic testing of suspected cholera cases and the expanded use of RDTs to strengthen cholera surveillance. […] Routine use of diagnostics will bolster cholera surveillance in impacted countries, and must be leveraged to better target vaccination efforts, which play a critical role in multisectoral cholera prevention and control programmes. […] Accurate and high-quality testing and surveillance measures are vital to spot the disease where it is emerging, confirm cholera cases amidst other diarrheal illnesses, and evaluate the success of preventative measures such as vaccines.

• #2 Diagnosis, Clinical Management, Prevention, and Control of Cholera; A Review Study

  https://brieflands.com/articles/iji-14679

  Polymerase chain reaction (PCR) has been developed to identify V. cholerae. This test has a high sensitivity and specificity. […] Oral or intravenous hydration is the most important aspect in the treatment of cholera. […] Antibiotic therapy is also recommended for all hospitalized patients. […] There are no guidelines to recommend antibiotics as prophylaxis for cholera prevention. […] Steps of treatment for a patient with cholera include: Evaluate the degree of dehydration upon arrival to the hospital, Rehydrate the patient in 2 phases; these include rehydration (for 2-4 hours) and maintenance (until diarrhea abates). […] For prevention of cholera, more attention to strategies to integrate all services in the general health system is very important. […] WHO recommends safe water supply and adequate sanitation and hygiene (WASH) as the main steps to prevent cholera.

• #2 Rethinking cholera diagnostic test performance, interpretation and evaluation: a field-based latent-class analysis in Bangladesh | medRxiv

  https://www.medrxiv.org/content/10.1101/2024.11.19.24317512v1.full-text

  Accurate and reliable diagnostics, including rapid diagnostic tests (RDTs), are critical components of cholera control programs, though their performance has varied greatly across studies. […] We enrolled all suspected cholera cases seeking care at two healthcare facilities in Sitakunda, Bangladesh over 19 months. […] For RDT, PCR and culture, we estimated a sensitivity of 93.5% (95% Credible Intervals, CrI: 91.3-95.4), 90.3% (88.4-92.1), and 73.7% (70.8-76.5), and a specificity of 97.3% (96.7-97.8), 97.2% (96.6-97.8), and 100% (culture specificity assumed perfect), respectively. […] Across various patient and sampling characteristics, Cholkit RDT had high performance in this cholera-endemic setting, supporting its use for cholera surveillance and control. […] RDT evaluation relies on two primary laboratory techniques used to confirm cholera: culture and Polymerase Chain Reaction (PCR).

• #2 Adaptive Molecular Diagnostics – Global Task Force on Cholera Control

  https://www.gtfcc.org/research/adaptive-molecular-diagnostics/

  Our project will use genomic data and a detailed understanding of pathogen evolution to deliver a robust, rapid, accurate and cost-effective pathogen detection kit for use in the field. Current methods are unsuitable for detection as they are slow, inaccurate and cannot be field deployed. […] This project will help fasten decision making in cholera outbreak control by indicating the risk associated with the type of cholera detected.

• #2 Development of a simple, rapid, and sensitive molecular diagnostic assay for cholera | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0011113

  The analytical sensitivity of cholera RLDT was determined by testing 10-fold serial dilutions of stool samples spiked with V. cholerae strain ranging in concentration from 40 to 4 x 107 CFU/gm of stool using the RLDT kit. […] The LOD for the O1rfb gene and the ctxA gene was 4 x 104 CFU/gm of stool. […] The cholera RLDT detects both the O1 and cholera toxin gene and therefore if a new cholera toxigenic strain emerges, will be able to detect immediately. […] The cholera RLDT assay is made in a dry format where all the reagents are lyophilized, which avoids maintaining a cold chain during shipment and storage. […] The RLDT kit provides all the reagents and supplies required and could mitigate the constraints in obtaining reagents, primers, and plastics at the LMICs. […] In conclusion, cholera RLDT has several advantages, including rapid results, simple operating procedures, easy readout of the results, and high analytical sensitivity, equivalent to quantitative PCR.

• #2 Cholera Workup: Approach Considerations, Stool Examination, Stool Culture

  https://emedicine.medscape.com/article/962643-workup

  Definitive diagnosis is not a prerequisite for the treatment of patients with cholera. The priority in management of any watery diarrhea is replacing the lost fluid and electrolytes and providing an antimicrobial agent when indicated. […] According to World Health Organization (WHO) standard case definition, a case of cholera is suspected when the following conditions are met: In an area where the disease is not known to be present, a patient aged 5 years or older develops severe dehydration or dies from acute watery diarrhea. In an area with a noted cholera epidemic, a patient aged 5 years or older develops acute watery diarrhea, with or without vomiting. […] In endemic areas, biochemical confirmation and characterization of the isolate are usually unnecessary. However, these tasks may be worthwhile in areas where Vibrio cholerae is an uncommon isolate. If identification of the organism is required, direct microscopic examination of stool (including dark-field examination) is indicated, along with Gram stain, culture, and serotype and biotype identification.

• #2 Diagnosis, Management, and Future Control of Cholera

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9491185/

  Cholera, caused by Vibrio cholerae, persists in developing countries due to inadequate access to safe water, sanitation, and hygiene. There are approximately 4 million cases and 143,000 deaths each year due to cholera. The disease is transmitted fecally-orally via contaminated food or water. Severe dehydrating cholera can progress to hypovolemic shock due to the rapid loss of fluids and electrolytes, which requires a rapid infusion of intravenous (i.v.) fluids. The case fatality rate exceeds 50% without proper clinical management but can be less than 1% with prompt rehydration and antibiotics. […] The diagnosis of cholera is frequently based on clinical signs and symptoms in resource-limited areas of endemicity where laboratory facilities are not available. In nonendemic settings, cholera is suspected if a patient has severe dehydration or someone has died from acute watery diarrhea (AWD). But in a cholera epidemic setting, if a patient (5 years of age) has AWD more than three times with or without vomiting within 24h, cholera is indicated.

• #2 Diagnosis of Cholera

  https://www.medindia.net/health/conditions/how-can-we-diagnose-cholera.htm

  Cholera can be diagnosed with the help of detailed patient history and stool examination. […] A patient history of watery stools especially during an epidemic should raise the suspicion of cholera. […] Stool examination- […] Stools resembles rice water and contain mucus. […] Dark field microscopic examination of stool sample shows rapidly motile V.cholerae bacteria. Epithelial cells are also present in the stool sample. […] A stool culture may be done to confirm the presence of V. cholerae. Enrichment is done in alkaline peptone water at pH 8.7 for 6-8 hours incubation. […] Typical yellow color colonies appear in thiosulfate-citrate-bile salts-sucrose (TCBS) agar after 18 hours of incubation. Organisms can be confirmed from culture by staining and examining under microscope. […] Vibrio cholerae are further identified by slide agglutination tests using anti-O group 1 antiserum and by biochemical reactions.

• #2 Cholera – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/451

  Cholera is usually a disease occurring in the context of poverty, war, or displacement, but is also well described in returning travelers. […] Basic laboratory tests are nonspecific. Culture of the organism is definitive, and rapid dipstick tests are available, while molecular detection methods are gaining importance as part of epidemic surveillance. […] Key diagnostic factors include copious watery diarrhea and evidence of volume depletion. […] 1st tests to order include CBC, serum electrolytes, serum BUN and creatinine, serum lactate, ABG, ECG, dark-field/phase-contrast microscopy of stool, and rapid dipstick testing of stool. […] Tests to consider include Gram stain of stool, stool culture of liquid stool, fecal suspension, or rectal swab, serogroup confirmation using antisera, antibiogram (sensitivities), enzyme-linked immunosorbent assay (ELISA) assay of stool, molecular testing of stool, and loop-mediated isothermal amplification (LAMP) assay of stool.

• #2 Global deployment of rapid diagnostic tests to boost fight against cholera

  https://www.gavi.org/news/media-room/global-deployment-rapid-diagnostic-tests-boost-fight-against-cholera

  More than 1.2 million cholera rapid diagnostic tests will be shipped to 14 countries in largest-ever global deployment, with the first shipment landing today in Malawi. […] This first official deployment of tests through Gavi, the Vaccine Alliance, will improve timely detection and monitoring of outbreaks, effectiveness of vaccination campaigns in response to current outbreaks, and targeting of future preventive vaccination efforts. […] The global cholera rapid diagnostic test procurement programme is a collaboration between Gavi, WHO, UNICEF, FIND, and other partners. […] This programme will improve the timeliness and accuracy of outbreak detection and response by boosting routine surveillance and testing capacity and helping rapidly identify probable cholera cases. […] The global cholera diagnostics programme is funded and coordinated by Gavi, the Vaccine Alliance (Gavi), with procurement and delivery to countries led by UNICEF, and undertaken in collaboration with the Global Task Force on Cholera Control (GTFCC), and WHO.

• #2 Global deployment of rapid diagnostic tests to boost fight against cholera

  https://www.unicef.org/press-releases/global-deployment-rapid-diagnostic-tests-boost-fight-against-cholera

  Through this effort, rapid diagnostic tests from two manufacturers will now be used routinely for cholera surveillance. […] The GTFCC updated recommendations in favor of strategic, routine and systematic testing of suspected cholera cases and the expanded use of RDTs to strengthen cholera surveillance. […] Routine use of diagnostics will bolster cholera surveillance in impacted countries, and must be leveraged to better target vaccination efforts, which play a critical role in multisectoral cholera prevention and control programmes. […] Accurate and high-quality testing and surveillance measures are vital to spot the disease where it is emerging, confirm cholera cases amidst other diarrheal illnesses, and evaluate the success of preventative measures such as vaccines.

• #2 2.4 Diagnosis confirmation | MSF Medical Guidelines

  https://medicalguidelines.msf.org/en/viewport/CHOL/english/2-4-diagnosis-confirmation-23448726.html

  The doctor or nurse of the investigation team should examine suspect cases and verify that the clinical signs are compatible with cholera: acute watery diarrhea (3 or more liquid stools in 24 hours) with no visible blood in the stool, with or without vomiting and/or dehydration. […] At this stage, laboratory investigations are carried out to confirm the causative agent and determine the sensitivity of the strain to antibiotics. […] RDTs are intended to screen suspect cases to determine if Vibrio cholerae O1 or O139 might be the causal agent. However, only culture can confirm the etiological diagnosis. […] Stool specimens are sent to a properly equipped microbiology laboratory to: Confirm cholera; Identify the strain (serogroup/biotype/serotype); Assess antibiotic sensitivity. […] Management of cases of acute watery diarrhoea should not wait for microbiologic confirmation of cholera. […] During an outbreak, cultures and antibiotic susceptibility testing on 3 to 5 patients should be repeated monthly to confirm the on-going presence of Vibrio cholerae and to determine any changes in antibiotic susceptibility patterns.

• #2

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3020846/

  The treatment regimen for diarrhea depends greatly on correct diagnosis of its etiology. Recent diarrhea outbreaks in Bangladesh showed Vibrio cholerae to be the predominant cause, although more than 40% of the suspected cases failed to show cholera etiology by conventional culture methods (CMs). […] Prompt and accurate diagnosis of Vibrio cholerae is a key step in cholera outbreak surveillance that can greatly influence rapid intervention and prevention to minimize disease spread and mortality. Conventional culture methods (CMs) currently used for diagnosis of V. cholerae remain the gold standard, but this procedure is not precise and requires highly skilled technicians and laboratory infrastructure. […] This study shows the practical limitations related to the precise diagnosis of cholera.

• #2 Rethinking cholera diagnostic test performance, interpretation and evaluation: a field-based latent-class analysis in Bangladesh | medRxiv

  https://www.medrxiv.org/content/10.1101/2024.11.19.24317512v1.full-text

  To infer the performance of the Cholkit RDT, PCR, and culture for cholera diagnosis, we developed a Bayesian modeling framework that accounted for the lack of a gold standard assay, partial testing within our sampling protocol, as well as age-specific changes in the underlying proportion of cholera cases among AWD during the study period. […] We assessed the effect of participant characteristics (age, antibiotic use prior to hospitalization) and sampling details (season, delay from sample to laboratory testing) on test performance. […] Through a direct comparison of rapid and traditional cholera diagnostics in an endemic field setting, we shed new light on test performance and the factors that can affect it. […] Our results suggest good performance of RDTs like Cholkit in an endemic setting, similar to PCR and consistent with previously published estimates for Cholkit RDT.

• #2 Enhancing national cholera surveillance using rapid diagnostic tests (RDTs): a mixed methods evaluation | medRxiv

  https://www.medrxiv.org/content/10.1101/2025.01.10.25320331v1.full-text

  Almost all interviewees expressed a desire for more training on cholera RDTs. […] Many samples need to be transported elsewhere for confirmation testing, to labs like the NPHL, causing delays in case confirmation and reporting. […] Despite the many recognized benefits of cholera RDTs, challenges and misconceptions persist.

• #2 Cholera: Causes, Symptoms, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/16636-cholera

  Cholera can be fatal if left untreated. Start drinking plenty of fluids if you have diarrhea. Go to the emergency room if you have severe diarrhea, severe vomiting or signs of dehydration. […] Healthcare providers diagnose cholera by testing a stool (poop) sample for V. cholerae. Your provider may also get blood tests done. […] Treatment for cholera includes drinking plenty of fluids or getting intravenous fluids to prevent dehydration. Healthcare providers also sometimes prescribe antibiotics like doxycycline, erythromycin or azithromycin to help you feel better. […] Drinking water thats been sanitized and washing your hands with clean water and soap are the best ways to reduce your risk of cholera. […] With treatment managing fluids to prevent dehydration the mortality (death) rate of cholera is less than 1%. Without treatment, its over 50%.

• #2 Why every minute counts during a cholera outbreak | MSF UK

  https://msf.org.uk/article/why-every-minute-counts-during-cholera-outbreak

  In addition to treating those already infected, the next major step was vaccination. Cholera can be contained with an oral vaccine a major advantage, as it allows us to quickly and efficiently vaccinate large groups of people. […] This outbreak once again showed how crucial are early diagnosis, isolation, identifying the source of infection and fast vaccination. Each of these steps is vital to saving lives. […] The disease is treatable and, in many situations, MSF teams have limited deaths to fewer than one percent.

• #2 Global deployment of rapid diagnostic tests to boost fight against cholera

  https://www.gavi.org/news/media-room/global-deployment-rapid-diagnostic-tests-boost-fight-against-cholera

  In 2023, the GTFCC updated recommendations in favor of strategic, routine and systematic testing of suspected cholera cases and the expanded use of RDTs to strengthen cholera surveillance. […] Routine use of diagnostics will bolster cholera surveillance in impacted countries, and must be leveraged to better target vaccination efforts, which play a critical role in multisectoral cholera prevention and control programmes. […] Accurate and high-quality testing and surveillance measures are vital to spot the disease where it is emerging, confirm cholera cases amidst other diarrheal illnesses, and evaluate the success of preventative measures such as vaccines.

• #2 Laboratory and Field Evaluation of the Crystal VC-O1 Cholera Rapid Diagnostic Test in: The American Journal of Tropical Medicine and Hygiene Volume 104 Issue 6 (2021)

  https://www.ajtmh.org/view/journals/tpmd/104/6/article-p2017.xml

  The RDT was positive for 79 of 81 samples found positive by either test, as shown in Table 4. Applying this definition to our results, the sensitivity of the RDT test was 97.5%, and specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 98.7%. […] The field evaluation corroborated the laboratory evaluation, demonstrating that Crystal VC-O1 yielded high sensitivity (%) and specificity when used to identify Vibrio cholerae O1 positive patients presenting with watery diarrhea. […] In conclusion, the new Crystal VC-O1 RDT, with a single line for serogroup O1, performed with high sensitivity and high specificity in this study. Importantly, we did not find any false-positive results.

• #2 Genosensor to detect cholera

  https://www.nature.com/articles/nindia.2016.2

  Researchers have fabricated an ultrasensitive genosensor for the detection of the water borne virulent bacterium Vibrio cholerae which causes cholera. The label free photoluminescence (PL) based genosensor has the potential for application in clinical diagnosis of cholera. […] Conventional cholera diagnosis tests polymerase chain reaction (PCR), biochemical reactions, immunological test, and microscopic examination of cultured bacterium take from about 2-3 days to a week. The disease may spread and become fatal during this time. […] The researchers set out to device a highly specific, rapid and sensitive diagnosis test to deal with the infection at primary stage. They developed an optical DNA biosensing device which can efficiently detect V. cholerae. This nanostructured magnesium oxide (nMgO)-based photoluminescence genosensor exhibited higher sensitivity (1.306 emi/ng) and lower detection limit of 3.133 ng/L.

• #2 Diagnosis, Clinical Management, Prevention, and Control of Cholera; A Review Study

  https://brieflands.com/articles/iji-14679.html

  For prevention of cholera, more attention to strategies to integrate all services in the general health system is very important. […] WHO recommends safe water supply and adequate sanitation and hygiene (WASH) as the main steps to prevent cholera. […] Successful prevention of infection in the community depends mainly on adequate control measures such as rapid and accurate microbiological diagnosis, prompt treatment, patient isolation and preventative education, and adequate follow-up strategies to monitor fecal shedding after treatment in at risk groups.

• #3 LSHTM LSHTM Research Online

  https://researchonline.lshtm.ac.uk/id/eprint/4671262/

  Gold Standard Cholera Diagnostics Are Tarnished by Lytic Bacteriophage and Antibiotics. […] A fundamental, clinical, and scientific concern is how lytic bacteriophage, as well as antibiotics, impact diagnostic positivity. […] Diagnostic performance was assessed as a function of lytic bacteriophage detection and exposure to the first-line antibiotic azithromycin, detected in stool samples by mass spectrometry. […] The odds that an RDT or qPCR was positive was reduced by more than 99% (OR, 0.00; 95% CI, 0.00 to 0.28) and 89% (OR, 0.11; 95% CI, 0.03 to 0.44), respectively, when azithromycin was detected. […] Cholera burden estimates may improve by accommodating for the negative effects of lytic bacteriophage and antibiotic exposure on diagnostic positivity. […] These findings have relevance for other diagnostic settings where bacterial pathogens are vulnerable to lytic bacteriophage predation.

• #3 Genosensor to detect cholera

  https://www.nature.com/articles/nindia.2016.2

  Researchers have fabricated an ultrasensitive genosensor for the detection of the water borne virulent bacterium Vibrio cholerae which causes cholera. The label free photoluminescence (PL) based genosensor has the potential for application in clinical diagnosis of cholera. […] Conventional cholera diagnosis tests polymerase chain reaction (PCR), biochemical reactions, immunological test, and microscopic examination of cultured bacterium take from about 2-3 days to a week. The disease may spread and become fatal during this time. […] The researchers set out to device a highly specific, rapid and sensitive diagnosis test to deal with the infection at primary stage. They developed an optical DNA biosensing device which can efficiently detect V. cholerae. This nanostructured magnesium oxide (nMgO)-based photoluminescence genosensor exhibited higher sensitivity (1.306 emi/ng) and lower detection limit of 3.133 ng/L.

• #3 Rethinking cholera diagnostic test performance, interpretation and evaluation: a field-based latent-class analysis in Bangladesh | medRxiv

  https://www.medrxiv.org/content/10.1101/2024.11.19.24317512v1.full-text

  Our findings add to the existing evidence that culture sensitivity is moderate to low (75%), with drastically reduced sensitivity among children under five (45%), which has not previously been documented. […] These results suggest that the timely analysis of samples, age, and antibiotic use are all key for using and interpreting culture as a confirmatory assay and particular care should be given to ruling out cholera with negative tests in many situations. […] The context in which a RDT (or other new diagnostic test) is evaluated matters, and the underlying disease prevalence is a key variable when evaluating RDT performance due to the imperfect nature of PCR and culture. […] These results, therefore, stress the importance of accounting for the setting and study population in which RDTs are evaluated, and the value of latent class models to draw inference in the absence of perfect reference assays.

• #3 A Household Yeast Biosensor for Cholera | National Agricultural Library

  https://www.nal.usda.gov/research-tools/food-safety-research-projects/household-yeast-biosensor-cholera

  Diarrheal diseases are one of the top ten causes of death in Developing Countries, with V. cholerae being one of the principal bacterial causative agents annually infecting an estimated ~4 million and killing ~120,000 people. […] Although an easily treatable Disease, Cholera continues to cause fatal epidemics because in practice clinical detection rarely occurs outside remote Hospitals and environmental detection in water supplies remains challenging. […] The state-of-the-art for Cholera diagnostics are purified Antibodies used as dipstick tests; unfortunately dipstick tests are prohibitively expensive and unstable for use directly in local communities where Cholera is endemic. […] A new transformative mode of detection will be needed to generate an extremely cheap and widely distributable system for continuous local surveillance of Cholera.

• #4 A Household Yeast Biosensor for Cholera | National Agricultural Library

  https://www.nal.usda.gov/research-tools/food-safety-research-projects/household-yeast-biosensor-cholera

  Diarrheal diseases are one of the top ten causes of death in Developing Countries, with V. cholerae being one of the principal bacterial causative agents annually infecting an estimated ~4 million and killing ~120,000 people. […] Although an easily treatable Disease, Cholera continues to cause fatal epidemics because in practice clinical detection rarely occurs outside remote Hospitals and environmental detection in water supplies remains challenging. […] The state-of-the-art for Cholera diagnostics are purified Antibodies used as dipstick tests; unfortunately dipstick tests are prohibitively expensive and unstable for use directly in local communities where Cholera is endemic. […] A new transformative mode of detection will be needed to generate an extremely cheap and widely distributable system for continuous local surveillance of Cholera.

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