Diagnosis

Laboratory diagnosis of acute untreated cholera is fairly simple and straightforward as a large number of cholera vibrios are present in the stool of such cases. The stool samples or rectal swabs transported either in Cary-Blair transport medium, alkaline peptone water, or tellurite-taurocholate peptone broth in the laboratory are plated on commonly used thiosulfate-citrate-bile salts-sucrose (TCBS) medium for isolation of V. cholerae.[21] The sucrose-fermenting V. cholerae isolates are readily detected on this medium as large, yellow, smooth colonies. Suspected colonies from TCBS are inoculated into Kligler iron agar (KIA) medium. Cultures yielding an alkaline slant over acid butt with no gas or H2S are then tested for oxidase activity and reactivity with polyvalent O1 or O139, and monospecific Ogawa or Inaba antisera using growth from the KIA slant. In case of doubtful agglutination or nonagglutination with O1 or O139 antisera, it is imperative to perform some tests such as oxidase and string test, mannitol and sucrose fermentation, lysine and ornithine decarboxylation, and arginine dihydrolation.

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