Cholera - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Infectious Diseases

Cholera - a particularly dangerous anthroponotic acute infectious disease of bacterial origin characterized by epidemiological prevalence and causes massive fluid loss with rapid dehydration and a high risk of mortality in the absence of adequate treatment.It refers to highly, lightly managed quarantine infections.

The name "cholera" refers to "launder" and "zhelchetechenie", these concepts come from more ancient doctors, because they considered the cause of this disease is "an excessive outflow of bile, as a result of which the water flows out of the body like the chute."Cradle of infection is considered to be India.Epidemic situation became a little better after the decoding of the genome of Vibrio cholerae and eliminate out of dangerous areas of genetic information - in this way the vaccine was created in 2000.


causative agent of cholera - Vibrio cholerae Vibrio cholerae, or Vibrio El-Tor (the latter species causes the disease more often).The causative agent of cholera is slightly curved

in the form of a comma.It has the following structure, which determines the features of his life and the symptoms caused by them:

• He has a 1 on the surface of the flagellum (which is why it is called monotrihom), which determines its mobility;
• chemotaxis (purposeful movement to nutrients) is one of the factors that determines its movement;
• exotoxin holirogen - the leading determinants of symptoms.It consists of 2 subunits - A and B. "B" - it recognizes the intestinal cell (enterocyte) and establishes a connection with him, through the formation of the binding channel for passage subёdinitsy A;"A" - this part causes the output of salts and water from the cells and the intercellular substances in the intestinal lumen by activation of the cascade of chemical reactions occurs resulting in strong sharp dehydration diarrhea.
• Enzymes (mucinases, protease, neuraminidase, Lecithinase) - destroying the intestinal mucosa, facilitate the penetration of the pathogen into the deeper layers of the intestinal mucosa;
• To help exotoxin enzymes come and drink - formation on the surface of the pathogen, resembling suction cups that make fixing it to the enterocytes even more durable, it gives a chance to the pathogen to multiply and colonize (fill) the intestines;
• There is also an endotoxin, but it has more scientific value than practical.

Vibrio cholerae

capsules and spores cholera pathogen does not form, but despite this, it is quite stable in the environment: high survival rate at low temperatures (ice and river water - 1 month, sea water -1.5 months) in the soil for up to 3 months in the faeces up to 3 days, in raw fruits and vegetables - up to 5 days.But the pathogen is less resistant to low temperatures (under 100 ° - instant death), and dryness, UV radiation and disinfectant action.

Concerning prevalence, it was believed that this figure is high in endemic areas (natural foci): India, Bangladesh, Pakistan, Indonesia.But the sad experience of 2010 led to suspect pervasive, both in geographical terms, so bypassing the age and gender restrictions.For outbreaks characterized by the summer-autumn season, because it is formed favorable conditions for the fecal-oral mechanism of transmission.

Causes of cholera infection

source - the sick person or carrier.Way - water, food, contact-household.Predisposing factors - overcrowding and assotsializatsiya population and low acidity in the stomach.

Symptoms of cholera

There are a number of symptoms, presence and severity of which depends on the degree of severity of dehydration.

1 degree - seen light or obliterated clinic.With this degree of fluid loss = 1.3% of total body weight, due to vomiting and diarrhea up to 10 times per day, this leads to fluid loss dry mouth and thirst.Symptoms last up to 2 days.

2 degree - the average degree, with a loss of 4-6% of total body weight, incidence of vomiting and diarrhea up to 20 times a day, on a background of the developing single leg cramps / hands / feet / masticatory muscles.Also, there is cyanosis (cyanosis) nasolabial triangle (in this case it is necessary to think of decompensation with the cardiovascular system, namely, the right heart).

grade 3 - severe dehydration, accompanied by a loss of body weight by 7-9%, stools and vomiting more than 20 times per day, and, as a consequence, the symptoms are exacerbated by 1 and 2 degrees: amplified thirst, the appearance of cyanosis in the extremities, seizures become moreextensive and painful, his voice weak and barely audible.Due to the large loss of fluid, there is a decrease of turgor and elasticity of the skin, it becomes wrinkled ( "washerwoman's hand" sign).The face appears "mask of Hippocrates" - pointy features, sunken eyes.As a compensatory response occurs centralization of circulation, ie, all the blood rushes from the periphery to the internal organs, especially the brain, there is a pale skin.But because it is necessary to centralize the intense work of the heart, there is tachycardia (increased heart rate) and tachypnea (rapid breathing).

grade 4 - very severe degree, which indicates almost complete depletion of the compensatory capacity of the organism and the most extreme dehydration (literally 12 hours, body weight loss is reduced by 12%).This degree may be as a result of previous degrees and separately onset.But be that as it may, it is the same occurs: lowering the temperature to 34 ° C (however, this degree is often called "algidnoy" - cold).There is shortness of breath, anuria (no urination - simply have nothing), hypovolemia (decrease in circulating blood volume, and as a manifestation of this - ↓ blood pressure).Termination vomiting and change it into convulsive hiccups.Termination of diarrhea and change it free expiration of intestinal fluid with pressure on the anterior abdominal wall (in the region of the intestine).Rectal examination - gaping anus.Ashen skin color - the development of a total of cyanosis as a consequence of hypovolemia and microcirculatory disorders.

Children up to 3 years, there are some features of the course: because of the lack of development of compensatory reactions, they are worse tolerate dehydration and primarily affected the central nervous system: there is a weakness (literally - the lack of movement), klonichesie seizures, impaired consciousness with the possible development of coma.Also, there are laboratory diagnostic difficulties - children can not focus on the plasma density in determining the severity of dehydration, because they have a larger volume of the extracellular fluid.

Features symptoms at any rate:

• Vomiting is not accompanied by nausea and very abundant, so it is often called the "fountain of vomit";
• Diarrhea as congee.

cholera diagnosis

1. Obktivno on symptoms.
2. Bacteriological method - by sowing on nutrient media of the material (feces and vomit).Since one can not only identify the pathogen using this method, and Vibrio cholerae distinguish from other species, such him.
3. Serological method - using blood serum and placed the reaction RIF (immunofluorescence) and IHA (indirect hemagglutination reaction) - these two eksperss method, aimed at identifying the antigen cholera.ELISA (enzyme-linked immunosorbent assay) - determines the intensity of the immune system.
4. The relative density of the plasma and hematocrit - their performance will be talking about the degree of dehydration.

Cholera Treatment

1. It should be compensation of fluid loss and salts according to the degree of dehydration (these figures require laboratory concrete), so that all patients should be hospitalized, because it is held in the hospital and the primary corrective regidrotatsiya.On fonelecheniya held control of acid-base status and electrolytes to prevent them from overdose.

2. Causal therapy (against the causative agent) - use of antibiotics, with rather narrow range, ie specifically against Vibrio cholerae (Polymyxin B), but in some cases, use and a wider range of activities (ciprofloxacin, doxycycline, ofloxacin, and others.).The choice of antibiotic also depends on the degree of dehydration.

3. Appointment of restorative treatment in the form of prebiotics, probiotics, simbiotikov, possible complex immunoglobulin preparation (TRC) and vitamin complexes.

in particular diet and rehabilitation is not necessary.

Complications cholera

Due to violations of hemostasis and microcirculation occurs coronary insufficiency and therefore - myocardial infarction (circulatory disorders of the heart muscle), mesenteric thrombosis, acute cerebral insufficiency, phlebitis.Cholera is deadly, with delayed treatment may be fatal.

cholera prevention

specific "cholera vaccine inactivated corpuscular" and chemical vaccine (mono- and bivalent).Vaccination is carried out by epidemic indications.Non-specific: control and compliance sanepidnorm, control of water supply.For individuals recover established 5 day observation and bacteriological examination of 3-yoh multiply.Patients after contact is established with observation and bacteriological tests as prevention of disease in patients with contact permissible antibiotics in prophylactic doses, for 4 days.

therapists Shabanova IE