Cholera - Causes, symptoms and treatment. MF.

Cholera is a particularly dangerous, acute anthroponous infectious disease of a bacterial nature characterized by epidemic prevalence and causing massive loss of fluid with rapid dehydration and a high risk of mortality in the absence of adequate treatment. Refers to highly dangerous, unmanaged quarantine infections.

The very name of "cholera" means "trough" and "bile", these concepts came from the doctors of antiquity, because they considered the cause of this disease "excessive flow of bile, as a result of which the water flows from the body as a groove."Cradle of infection is considered India. The epidemic situation became slightly better after deciphering the genome of the cholera vibrio and eliminating dangerous genetic information from there - so the vaccine was created in 2000.

Cholera causative agent

The causative agent of cholera is the cholera Vibrio cholerae, or Vibrio El-Tor( the last species causes the disease more often).The causative agent of the cholera is slightly curved, in the form of a comma. It has the following structure, which predetermines the characteristics of its vital activity and the symptoms it causes:

• It has 1 flagellum on its surface( therefore it is called monotrich), which predetermines its mobility;
• Chemotaxis( targeted movement to nutrients) is one of the factors that predisposes its movement;
• Exotoxin holirogen is the leading factor that predisposes the symptoms. It consists of 2 subunits - A and B. "B" - it recognizes the intestinal cell( enterocyte) and establishes a connection with it, by forming a connecting channel, to pass the subunit A;"A" - this part causes the release of salts and water from the cells and intercellular substance into the intestinal lumen, by activating cascade chemical reactions, resulting in severe diarrhea with drastic dehydration.
• Enzymes( mucinase, protease, neurominidase, lecithinase) - destroying the intestinal mucosa, facilitate penetration of the pathogen into the deeper layers of the intestinal mucosa;
• To help exotoxin and enzymes come saws - formations on the surface of the pathogen, resembling suckers that make it stronger to enterocytes, it gives the causative agent a chance to multiply and colonize the intestine;
• There is also endotoxin, but it has more scientific value than practical.

Cholera vibrio

Capsule and spore causative agent of cholera does not form, but despite this, it is fairly stable in the external environment: high survival at low temperatures( ice and river water - 1 month, sea water - 1.5 months), in soilup to 3 months, in feces up to 3 days, in raw vegetables and fruits - up to 5 days. But the causative agent is less resistant to low temperatures( at 100 ° - instantaneous death), also to drying, UVI and the action of disinfectants.

Concerning the prevalence, it was believed that this indicator is high in endemic areas( natural foci): India, Bangladesh, Pakistan, Indonesia. But the sad experience of 2010 made us suspect the widespread distribution, both geographically and bypassing age and sex restrictions. Flares are characterized by summer-autumn seasonality, because favorable conditions are created for the fecal-oral mechanism of transmission of the pathogen.

Causes of infection with cholera

Source - sick person or carrier. Ways - water, food, contact-household. The predisposing factor is the crowding and socialization of the population, as well as low acidity in the stomach.

Symptoms of cholera

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

1 degree - manifested by an easy or erased clinic. At this degree, loss of fluid = 1-3% of the total body weight, due to vomiting and diarrhea up to 10 times a day, this fluid loss leads to dry mouth and thirst. Symptoms last up to 2 days.

2 degree - medium degree, with a loss of 4-6% of the total body weight, the frequency of vomiting and diarrhea up to 20 times a day, against the background of this, single spasms of the gastrocnemius muscles / hands / stop / masticatory muscles develop. Also there is a cyanosis( cyanosis) of the nasolabial triangle( in this case it is worth thinking about decompensation from the cardiovascular system, namely, the right heart).

3 degree - severe dehydration, accompanied by a loss of body weight of 7-9%, stool and vomiting more than 20 times a day and, as a result, symptoms of 1 and 2 degrees are aggravated: thirst increases, cyanosis on the limbs, cramps become more extensiveand painful, the voice is weak and barely audible. Because of the large loss of fluid, there is a decrease in the turgor and elasticity of the skin, it becomes wrinkled( the symptom "hand of the laundress").On his face appears "mask Hippocrates" - pointed features, sunken eyes. As a compensatory reaction, there is a centralization of blood circulation, ie, all blood from the periphery rushes to the internal organs and especially to the brain, the pallor of the skin is observed. But tk for centralization requires increased work of the heart, there is tachycardia( rapid heartbeat) and tachypnoe( frequent breathing).

4 degree - very severe degree, which indicates the almost complete depletion of the compensatory capabilities of the body and the most extreme dehydration( literally in 12 hours, weight loss is reduced by 12%).This degree can be as a consequence of previous degrees, and a separately started disease. But anyway, it proceeds the same way: a decrease in temperature to 34 ° C( therefore, this degree is often called "algid" - cold).There is shortness of breath, anuria( there is no urination - there is simply nothing), hypovolemia( decrease in the volume of circulating blood, and as a manifestation of this - ↓ blood pressure).Stopping vomiting and changing it to a convulsive hiccough. Termination of diarrhea and its replacement by free flow of intestinal fluid when pressing on the anterior abdominal wall( on the intestinal region).When rectal examination - a gaping anus. The skin of the ashy shade is the development of total cyanosis, as a consequence of hypovolemia and microcirculation disorders.

Children under 3 years of age have some peculiarities of the course: due to insufficient development of the compensatory reaction, they tolerate dehydration worse and the central nervous system suffers first: there is an adynamia( literally - absence of movement), clonic convulsions, impaired consciousness with possible development of coma. Also there are laboratory diagnostic difficulties - children can not be guided by the plasma density in determining the severity of dehydration, because they have a larger volume of extracellular fluid.

Features of symptoms at any degree:

• Vomiting is not accompanied by nausea and is very plentiful, therefore it is often called "vomiting fountain";
• Diarrhea in the form of rice broth.

Diagnosis of cholera

1. Obviously, by symptoms.
2. Bacteriological method - by sowing on the nutrient medium of the test material( stool and vomit).With the help of this method, you can not only determine the pathogen, but also distinguish the cholera vibrio from other species similar to it.
3. Serological method - serum is used and RIF reactions( reaction of immunofluorescence) and RNGA( indirect hemagglutination reaction) are put - these two expert-methods are aimed at determining the antigen of cholera vibrio. ELISA( enzyme immunoassay) - determines the intensity of immunity.
4. Relative density of plasma and hematocrit - their indicators will talk about the degree of dehydration.

Treatment of cholera

1. It is necessary to compensate for losses of fluid and salts in accordance with the degree of dehydration( these indicators require laboratory specificity), therefore all patients should be hospitalized, because in the hospital they undergo primary and corrective rehydration. On the background of the treatment, the acid-base state and the level of electrolytes are monitored to prevent their overdose.

2. Etiotropic therapy( against the pathogen) - the use of antibiotics, and better than a narrow spectrum, that is, specifically against the cholera vibrio( polymyxin), but in some cases a wider spectrum of action is used( ciprofloxacin, doxycycline, ofloxacin, etc.).The choice of antibiotic also depends on the degree of dehydration.

3. The appointment of restorative treatment in the form of prebiotics, probiotics, symbiotics, a complex immunoglobulin preparation( KIP) and vitamin complexes are possible.

There is no need for a specific diet and rehabilitation.

Complications of cholera

Because of the violation of hemostasis and microcirculation, coronary insufficiency occurs and as a result - myocardial infarction( impaired blood flow to the heart muscle), mesenteric thrombosis, acute cerebral insufficiency, phlebitis. Cholera is deadly, with untimely treatment possible fatal outcome.

Cholera Prevention

Specific: "cholera corpuscular inactivated vaccine" and chemical vaccines( mono- and bivalent).Vaccination is carried out on epidemic indications. Nonspecific: control and compliance with sanepidnorms, control over water supply. For persons who have recovered, a 5-day observation is established and bacteriological study is 3-fold. For contact patients, surveillance using bacteriological testing is established and, as a preventive measure for the occurrence of the disease in contact patients, it is permissible to use antibiotics in preventive doses for 4 days.

Therapist doctor Shabanova I.Е.