Asiatic cholera is an infection that includes all of the small intestine, causing an abundant amount of watery diarrhea and vomiting.

The causative organism, Vibrio cholerae, is a short, curved, motile gram-negative rod producing a potent enterotoxin. It causes an increase in the emission of chloride, bicarbonate, and water into the small intestine. The organism is usually transmitted through water, milk, or other foods that have been contaminated with the excretions of patients or carriers.

The four stages of the condition include:

• Stage One - (Invasion) occurs at the end of the incubation period, resulting in malaise, headache, diarrhea, anorexia, and slight fever. However, there are times when this stage is missing entirely.

• Stage Two - (Evacuation) includes violent vomiting, with muscular cramps, and loose, watery stools in abundant amounts, sometimes containing mucus and blood.

• Stage Three - (Collapse) cessation of circulation. Manifestations include: deep-set eyes; indented cheeks; dry, wrinkly skin; body surface which is cool, clammy, and diaphoretic; and cool breath. In addition, the pulse is weak, systolic blood pressure is low, and urine output is either decreased or nonexistent. The diarrhea and cramps may continue.

• Stage Four - (Reaction) even in the worst cases, temperature may begin to increase, vomiting ends, diarrhea becomes less frequent and more solid, and recuperation occurs. Complete recovery takes about 1 to 2 weeks.

Diagnosis can be confirmed by identifying Vibrio cholerae in the stool.

Intravenous (IV) fluid and electrolyte replacement is indicated. The volume of fluid replacement is dependent on the patient's condition. Fluid is given swiftly until normal blood pressure returns. Antibiotics are given near the beginning of the disease to kill the organism. Low blood glucose is a life-threatening complication of cholera, but it is reversible with proper treatment.

During the collapse phase, the mind remains lucid until just prior to death, when coma develops. This stage may last from a small number of hours to 1 or 2 days. It usually ends in death. However, mortality rate is less than 1% with proper treatment.

1. May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% and/or other requirements/qualifications under 38 CFR §3.350 [Special monthly compensation ratings]. Also reference 38 CFR 3.155(d)(2).

2. This disease shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under §3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of §3.307 are also satisfied [38 CFR §3.309 [Disease subject to presumptive service connection], §3.309(a) [chronic disease].

3. This disease shall be granted service connection as a result of tropical service, although not otherwise established as incurred in service if manifested to a compensable degree within the applicable time limits under §3.307 or §3.308 following service in a period of war or following peacetime service provided the rebuttable presumption provisions of §3.307 are also satisfied [38 CFR §3.309 (b) Disease subject to presumptive service connection].

As active disease, and for 3 months convalescence evaluate as 100%, thereafter rate residuals such as renal necrosis under the appropriate system. (38 CFR §4.188b [Schedule of ratings-infectious diseases, immune disorders and nutritional deficiencies]).