Cholera: Symptoms, Causes, Methods of Treatment and Prevention
Cholera is an acute intestinal infection caused by cholera vibrio.The disease is characterized by profuse diarrhea and vomiting, leading to dehydration of the body.In European countries, cholera is perceived rather as a historical fact.However, at present, this disease is registered in 53 countries, mainly in Africa and Asia.According to the WHO, about 3-5 million cases of cholera are registered each year, of which 100-120 thousand result in death!The cases of cholera in European countries are rare, often imported from other countries that are not so good in this respect.However, in countries that have access to the sea, the occurrence of this infection is also not excluded.So, in the Ukrainian city of Mariupol in 2011, an outbreak of cholera was registered.And the cholera epidemic in Haiti, which began in October 2010, affected 7% of the population of this state and, as of May 2015, took the lives of 9,700 people.Table of contents: Cholera epidemics Cholera: causes of occurrence Cholera Vibrio Effects Symptoms of cholera
Cholera is a particularly dangerous infection, it can lead to great human losses.Until the beginning of the XIX century, cholera was affected only in South Asia( basins of the Brahmaputra and Ganges rivers).However, the disease soon spread to all continents.Thus, for the period 1817-1926.Six pandemics were recorded that claimed the lives of millions of people.Significant epidemics of cholera with a large number of deaths were observed in the XIX century in many regions of Russia.
Scientists and physicians managed to study the causative agent of cholera, the mechanism of disease transmission, which helped to develop effective anti-epidemic measures.Thanks to this, the spread of cholera in its historical outbreaks in India was stopped for thirty-five years.However, in 1961 cholera originated on Fr.Sulawesi and quickly spread to other continents, so there arose the seventh cholera pandemic, which lasted thirty years.
Cholera outbreaks are being registered and currently, mainly in African and Asian countries.
Reasons for the occurrence of
Cholera Vibrio is a crimson rod bacterium with high mobility.Cholera is caused by a classical cholera vibrio or Elbrus vibrio.
The source of the infection is an infected person.The patient secretes bacteria with vomiting, feces, which pollutes the objects of the environment.The mechanism of cholera transmission is fecal-oral.Often the disease is spread due to the waterway transmission.A person gets sick when drinking water contaminated with cholera, swallowing while swimming, and after eating vegetables and fruits washed with such water.It is possible and the food route of transmission, when a person consumes fish, as well as seafood, cancers grown in contaminated water.Well, finally, the contact-household way, because for household items, dishes, door handles fall vibrios.Taking over such objects, and then, touching the mouth with his hands, a person runs the risk of getting sick with cholera.
Effects of cholera vibrio
When ingested cholera vibrios, they enter the stomach.Here, under the influence of hydrochloric acid, part of them die, the other part - moves into the intestine.The intestinal alkaline environment is very comfortable for the bacteria.Vibrios begin their vigorous life and release a toxin.Under the influence of a toxin, the permeability of cells increases.Out of the extracellular space, water enters the lumen of the intestine, as well as potassium, chlorine, sodium, and protein.This increases the peristalsis of the intestine, so there is profuse diarrhea and vomiting.With the liquid, mineral substances and proteins are also removed, which as a result leads to dehydration and disturbance of water-mineral metabolism.Within just one hour a patient can lose a liter of fluid!
Symptoms of cholera
The clinical picture of the disease, its severity will depend on the severity of the cholera.About 80% of all cases of cholera occur in mild or moderate form.The severe form of the disease is less common, but it is the real threat to life.There are typical and atypical cholera.
Symptoms of typical cholera
The incubation period of cholera lasts from six hours to five days, often two days.The disease begins acutely.For no apparent reason a person has desires for defecation, more often it happens at night or in the morning.It is characteristic that this is not accompanied by pain in the abdomen, unless discomfort in the navel.The chair quickly loses its stained character, becomes colorless, and then watery.In liquid stools, white flakes can be found, which is called in the medicine "feces in the form of rice broth".After three to five hours, vomiting occurs.
The degree of severity of the patient's condition is determined by the degree of dehydration:
- I degree - loss of fluid is 1-3% of body weight;
- ІІ degree - 4-6% of body weight;
- ІІІ degree - 7-9% of body weight;
- IV degree - 10% or more of body weight.
With , the mild form of disease, the stool ratio varies between three and ten times.At first, there is a mushy stool, then it becomes more and more watery.The patient may feel a transfusion of fluid in the intestine.After a couple of hours without previous nausea, vomiting occurs.The patient tears first eaten food, then gastric contents.With a mild form of cholera, the loss of fluid is moderate.There is also a mild thirst, a muscle weakness.The parameters of temperature, heart rate, blood pressure are usually normal.
With of moderate severity of cholera , the stool count is increased to fifteen or twenty times per day.There is repeated vomiting, which also resembles a rice broth.Vomit can be dyed yellow due to bile.In this case, signs of dehydration become much more pronounced: the patient is troubled by a strong thirst, which can not be quenched by water intake, severe muscle weakness, muscle cramps of limbs, a decrease in the volume of excreted urine.On examination, dryness of the skin, mucous membranes, plaque in the tongue, hoarseness of the voice, a slight decrease in blood pressure and a rapid heartbeat are noted.
The severe form of the cholera is characterized by a very short incubation period, frequent watery stools and repeated vomiting with a "fountain".Just a few hours the patient loses a large amount of fluid( from 7-9%, which corresponds to dehydration of the third degree).The condition of patients is rapidly deteriorating: thirst increases, skeletal muscle cramps do not stop, and severe weakness develops.Skin and mucous membranes are dry, eyeballs are sunken, and facial features are pointed.The turgor of the skin is reduced: when the skin folds on the abdomen is grasped it expands about two seconds.The skin of the fingers of the hand is collected in small folds, this symptom was called "the hand of the laundress".Diuresis is reduced.Body temperature can also be reduced.
Note: with cholera temperature never rises above 36.6 degrees.The heavier the course of the disease, the lower the body temperature.
During the examination, the doctor can also determine a persistent decrease in pressure, increased heart rate and respiration.The patient's voice becomes barely audible.
Symptoms of atypical cholera
It should be noted that at the present time cases of atypical forms of the disease are becoming more frequent.They include "dry cholera", lightning, and also with an erased current.
With fulminant cholera , abundant and indomitable diarrhea with vomiting can lead to the development of a dehydration shock in just some ten to twelve hours.With this form of the disease, the patient's condition is very difficult, the mind oppressed.The patient completely lacks a voice, and the spasms of skeletal muscles practically do not stop.The seized skin fold on the abdomen does not spread more than two seconds.Eyelids and the patient's mouth are unable to completely close due to a decrease in tone.Body temperature drops to 35-34 degrees.The skin becomes cyanotic, and the tip of the nose, fingers - purple.There is a rapid heartbeat and breathing, the pressure can not be determined.Diuresis is absent.This form of cholera often leads to death.
For dry cholera is characterized by rapid development of hypovolemic shock, which features are absence of diuresis, lowering of arterial pressure, rapid breathing, convulsions, suppression of the central nervous system.It is characteristic that the hypovolemic shock develops even before the appearance of diarrhea and vomiting.Dry cholera is characterized by high lethality.
The erased form of the disease can clinically not show itself.Usually, infection is detected in a laboratory study of people produced by epidemiological indicators.The danger is that people with an erased form of the disease also secrete the cholera vibrio into the external environment.Such a person can cause other people to get infected.
For the diagnosis of cholera, even before the onset of antibiotic therapy, the patient is treated with feces and vomit.Bacterial examination of the selected samples is carried out.This is the gold standard for diagnosing cholera.
In addition, serological diagnosis of the disease can be carried out.For this, a blood sample is taken.The following diagnostic methods are used: RNGA, PH, ELISA.
Express diagnostic methods may also be used, but they are more indicative.The method of immobilization and microagglutination of cholera vibrios under the influence of anticholera sera is applied to escrack diagnostics.
Principles of treatment of cholera
All people with cholera, as well as with a presumptive diagnosis, are sent to the infectious hospital without fail.Patients are placed in separate boxes, and with a large number of patients, a special department is organized.
Basic principles of cholera therapy:
- Recovery of BCC( circulating blood volume);
- Recovery of electrolyte balance;
- Effect on causative agent.
Rehydration therapy is carried out in two stages.The goal of the first stage( initial rehydration) is the restoration of the formed deficit of water and electrolytes.The purpose of the second stage( compensatory rehydration) is to eliminate the continuing water electrolyte losses.
Primary rehydration should be performed as early as possible, even at the pre-hospital stage.Usually it is carried out for the first four hours.
Saline solutions are used to restore the water-electrolyte balance.In cholera with mild to moderate dehydration, oral solutions are sufficient: it is OPC( oral saline), Regidron.The solution is taken fractionally by the tea( table) spoon every minute.Calculation of the required dose of the solution is made taking into account the fluid loss.
With a severe degree of dehydration, saline solutions( Trisol, Acesol, Quartazol) are administered intravenously first with a stream, then drip.
In addition, antimicrobial agents are used to combat cholera.Their use reduces the symptoms and duration of the disease.Cholera vibrios are sensitive to tetracycline, doxycycline, azithromycin, ciprofloxacin.
The patient is discharged after a complete clinical recovery and a negative result of a triplicate bacterial stool study is obtained.
Prevention of cholera
Cholera is a disease that can lead to epidemics.This is why WHO is implementing preventive measures around the world.
Prevention should be carried out on a national scale.So, in order to prevent the disease, it is necessary to establish a water supply system, the supplied drinking water must be disinfected and regularly investigated.In addition, it is necessary to introduce monitoring of the state of water in reservoirs with the study of it for the presence of cholera vibrio.In areas of endemic dysfunctions, cholera is recommended to use an oral vaccine.
Of course, personal prevention plays an important role.This is especially important, because now people travel a lot and may find themselves in an unfavorable country with regard to cholera. Preventative measures are very simple:
- Do not swim in unknown water bodies;
- Do not consume raw water, drink only safe water;
- Thoroughly wash hands after toilet, before eating;
- Do not eat in places of uncertified trade;
- Do not consume raw seafood and fish.
Grigorova Valeria, medical reviewer