Clinical and physiological observations during an epidemic outbreak of non-vibrio cholera-like disease in Calcutta.

During March through June 1964, an epidemic of acute non-vibrio diarrhoeal disease, closely simulating cholera, occurred in Calcutta. To clarify the etiology and pathophysiology and improve the therapy of this illness, bacteriological and metabolic studies were performed on 145 consecutive hypotensive adult male patients admitted with acute diarrhoeal disease to the Calcutta Infectious Disease Hospital. Bacteriological and serological studies clearly demonstrated that the majority of patients with acute diarrhoeal disease admitted during this period of time were not suffering from V. cholerae infection; no known pathogen could be recovered from 86% of such patients. Biochemical studies indicated that, in contrast to the findings in cholera, factors other than saline depletion contributed to hypotension in many of the patients with non-vibrio diarrhoeal disease. Although the majority of the acute diarrhoeal patients responded well to the 2: 1 saline: lactate regimen which is consistently successful in treating adult cholera patients, six of the non-cholera patients required prolonged administration of vasopressor drugs as an adjunct to fluid and electrolyte repletion therapy.