Cholera disease symptoms. Cholera: symptoms, causes of the disease, prevention and treatment. Basic principles of cholera therapy

Cholera belongs to the category of acute intestinal diseases. Cholera begins to develop when water or food contaminated with bacteria from the Vibrio cholerae family enters the body. The disease has a short incubation period (often manifests itself within 24 hours after infection), is accompanied by unpleasant symptoms, and can be fatal if left untreated. Such severe consequences are due to the fact that the cholera causative agent produces enterotoxin, which causes numerous disturbances in the gastrointestinal tract and leads to severe dehydration of the body due to incessant diarrhea. Cholera often provokes severe vomiting, during which water-salt metabolism is also disrupted.

Cholera is one of the quarantine infections. When boiled, cholera pathogens die literally within a few seconds, but in favorable conditions they multiply at an extremely rapid rate. Cholera bacteria enter the external environment with the feces and vomit of a sick person, and then infect healthy people through water, food, household contact, or mixed means. High susceptibility to cholera has more than once become the cause of large-scale epidemics. An example is 1992, when insufficient and ineffective cholera prevention led to more than 100,000 people falling ill in South India and Bengal. In general, over the years of civilization’s existence, this infection has claimed millions of lives and continues to regularly reap its terrible harvest in the countries of Africa and Southeast Asia. The severe epidemic situation in these regions is far from accidental. The fact is that cholera, the symptoms of which usually appear after drinking contaminated water or food, develops most intensively in those places where there are problems with fresh water disinfection and timely medical care.

How does cholera enter the human body?

During cholera epidemics, the source of bacteria is the excrement of infected people. Most often, cholera embryos are found in coastal waters and salt water, from where they penetrate city sewers and other water supplies. Note also that accidental contact with a person sick with cholera will not lead to infection, since the disease is not transmitted directly. At the same time, the cholera pathogen can easily enter the body during the sharing of personal hygiene items, so compliance with basic precautions is still necessary.

Symptoms of cholera

Let us immediately note that the symptoms of cholera are very diverse. In some cases, when cholera is diagnosed, no treatment is required at all (this includes situations with so-called asymptomatic carriage), while in other people cholera leads to severe conditions and death.

The incubation period rarely lasts more than 5-6 days. The onset of the disease is always acute, and the symptoms of cholera are pronounced:

• diarrhea, which intensifies at night and in the morning - the stool is watery, does not have an unpleasant odor, and over time takes on the appearance of “rice water”;
• profuse vomiting;
• disruption of the functioning of the main body systems, the intensity of which depends on the degree of dehydration;
• lack of appetite;
• weight loss;
• constant thirst.

If there is a suspicion that a person is developing cholera, diagnosis, among other things, is based on the clinical picture of the development of the disease. Experts distinguish 4 degrees of cholera:

• I degree – dehydration is mild;
• II degree – patients experience a drop in fluid to 6% of body weight, an acceleration of ESR, and a decrease in the number of red blood cells. Patients complain of dizziness, dry mouth, thirst, and severe weakness. In addition, their fingers turn blue, muscle twitching and hoarseness appear;
• III degree - for severe cholera, treatment involves constant monitoring of blood pressure and body temperature, since a sudden collapse of vital systems is quite possible. Fluid loss reaches up to 9% of body weight, and patients may completely stop urinating. There is a decrease in the concentration of potassium and chlorine in the blood of sick people;
• IV degree - critical loss of fluid, development of a state of prostration, shock. Patients' facial features become sharper, dark circles appear around the eyes, the skin takes on a bluish tint and becomes sticky to the touch. Heart sounds are muffled, there is a sharp drop in blood pressure, and a decrease in body temperature to 34 degrees. Such cholera, the symptoms of which indicate numerous malfunctions in the functioning of basic systems, often ends in the death of the patient.

If you do not consult a doctor in time, even mild cholera can lead to numerous complications: abscesses, pneumonia, cellulitis, erysipelas and phlebitis. For this reason, you should closely monitor for warning signs of cholera after consuming food or water and contact a health care provider immediately for an accurate diagnosis.

Diagnosis of cholera

When diagnosing cholera, recognition of the infection is made on the basis of a characteristic epidemiological history and clinical picture. To confirm cholera, bacteriological examinations of stool, gastric contents and vomit are used. In addition, patients are prescribed laboratory physical and chemical blood tests.

Treatment of cholera

If infection is suspected, patients must be hospitalized. If there are obvious signs of dehydration, rehydration therapy is carried out immediately in those volumes that are determined by the patient’s condition. Typically, recovery measures involve oral fluid administration. It can also be delivered to the stomach through a thin tube if a person is unable to drink on his own. Within an hour, a cholera patient should consume at least 1-1.5 liters. liquids. If the disease is accompanied by severe vomiting, then treatment of cholera involves the mandatory introduction of polyonic solutions into the blood.

After the patient's condition has normalized, correction of losses continues. Water-salt therapy is completed only after the bowel movements become normal and the amount of urine exceeds the volume of feces. After the cessation of vomiting, tetracycline or chloramphenicol is prescribed intravenously in the treatment of cholera. The course of treatment for cholera lasts for 5 days in 6-hour cycles. With timely consultation with a doctor and adequate assistance, cholera can be treated successfully without any serious complications.

Prevention of cholera consists of observing sanitary and hygienic rules, thoroughly washing food, and observing established technological standards in public catering establishments. We also strongly recommend that you avoid drinking raw tap water when preventing cholera.

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Cholera is a particularly dangerous, acute anthroponotic 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, difficult to control quarantine infections.

The very name “cholera” means “gutter” and “bile flow”; these concepts came from ancient doctors, because they considered the cause of this disease to be “excessive flow of bile, as a result of which water flows from the body as if through a gutter.” India is considered the cradle of the infection. The epidemic situation became a little better after the genome of Vibrio cholerae was deciphered and dangerous sections of genetic information were eliminated from there - thus a vaccine was created in 2000.

The causative agent of cholera

The causative agent of cholera is the cholera vibrio Vibrio cholerae, or Vibrio El-Tor (the latter species causes the disease much more often). The causative agent of cholera is slightly curved, shaped like a comma. It has the following structure, which determines the characteristics of its life activity and the symptoms it causes:

It has 1 flagellum on its surface (that’s why it is called a monotrich), which determines its mobility;
Chemotaxis (targeted movement towards nutrients) is one of the factors that determines its movement;
Cholerogen exotoxin is a leading factor in determining 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 for the passage of subunit A; “A” - this part causes the release of salts and water from cells and intercellular substance into the intestinal lumen, by activating cascade chemical reactions, resulting in severe diarrhea with severe dehydration.
Enzymes (mucinase, protease, neurominidase, lecithinase) - destroying the intestinal mucosa, facilitating the penetration of the pathogen into the deeper layers of the intestinal mucosa;
To help the exotoxin and enzymes come pili - formations on the surface of the pathogen that resemble suction cups, which make its attachment to the enterocytes even stronger, this gives the pathogen a chance to multiply and colonize (fill) the intestines;
There is also endotoxin, but it is of more scientific importance than practical.

The cholera causative agent does not form capsules and spores, but despite this, it is quite stable in the external environment: high survival rate at low temperatures (ice and river water - 1 month, sea water - 1.5 months), in soil up to 3 months, in feces up to 3 days, in raw vegetables and fruits – up to 5 days. But the pathogen is less resistant to low temperatures (at 100° - instant death), also to drying, UV radiation and the action of disinfectants.

Regarding 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 widespread distribution, both geographically and bypassing age and gender restrictions. Outbreaks are characterized by summer-autumn seasonality, as favorable conditions are formed for the fecal-oral transmission mechanism of the pathogen.

Causes of cholera infection

The source is a sick person or carrier. Routes – water, food, contact and household. The predisposing factor is 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 depend on the severity of dehydration.

1st degree – manifested by a mild or erased clinic. At this degree, fluid loss = 1-3% of 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.

Stage 2 – moderate degree, with a loss of 4-6% of total body weight, the frequency of vomiting and diarrhea up to 20 times a day, against the background of this, isolated cramps of the calf muscles/hands/feet/masticatory muscles develop. Cyanosis (cyanosis) of the nasolabial triangle also occurs (in this case, it is worth thinking about decompensation from the cardiovascular system, namely the right side of the heart).

3rd degree - severe degree of dehydration, accompanied by a loss of body weight by 7-9%, stool and vomiting more than 20 times per day and, as a result, symptoms of 1st and 2nd degrees worsen: thirst increases, the appearance of cyanosis on the extremities, convulsions become more extensive and painful, the voice is weak and barely audible. Due to the large loss of fluid, the turgor and elasticity of the skin decrease, and it becomes wrinkled (“washerwoman’s hand” symptom). A “Hippocrates mask” appears on the face - pointed features, sunken eyes. As a compensatory reaction, centralization of blood circulation occurs, that is, all blood from the periphery rushes to the internal organs and especially to the brain, and pallor of the skin is observed. But since centralization requires increased work of the heart, tachycardia (increased heart rate) and tachypnea (rapid breathing) occur.

Grade 4 is a very severe degree, which indicates an almost complete depletion of the body’s compensatory capabilities and extreme dehydration (literally in 12 hours, body weight loss decreases by 12%). This degree can be either a consequence of previous degrees or a separately occurring disease. But be that as it may, 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 (no urination - there is simply nothing left), hypovolemia (decrease in the volume of circulating blood, and as a manifestation of this - ↓ blood pressure). Stop vomiting and change it to convulsive hiccups. Stopping diarrhea and replacing it with free flow of intestinal fluid when pressing on the anterior abdominal wall (intestinal area). Rectal examination reveals a gaping anus. Ash-colored skin is the development of total cyanosis as a consequence of hypovolemia and impaired microcirculation.

Children under 3 years of age have some peculiarities of the course: due to the insufficient development of the compensatory reaction, they tolerate dehydration worse and the central nervous system suffers first of all: adynamia occurs (literally - lack of movement), clonic convulsions, impaired consciousness with the possible development of coma. Laboratory diagnostic difficulties also arise - in children it is impossible to rely on plasma density when 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 profuse, which is why it is often called “fountain vomiting”;
Diarrhea in the form of rice water.

Diagnosis of cholera

1. Objectively, based on symptoms.
2. Bacteriological method - by inoculating the test material (feces and vomit) on nutrient media. Using this method, you can not only identify the pathogen, but also distinguish Vibrio cholerae from other species similar to it.
3. Serological method - blood serum is used and the reactions RIF (immunofluorescence reaction) and RNHA (indirect hemagglutination reaction) are performed - these two express methods are aimed at determining the antigen of Vibrio cholerae. ELISA (enzyme-linked immunosorbent assay) – determines the strength of the immune system.
4. Relative plasma density and hematocrit - their indicators will indicate the degree of dehydration.

Treatment of cholera

1. It is necessary to compensate for fluid and salt losses in accordance with the degree of dehydration (these indicators require laboratory specifications), therefore all patients must be hospitalized, since they undergo primary and corrective rehydration in the hospital. During treatment, the acid-base state and electrolyte levels are monitored to prevent overdose.

2. Etiotropic therapy (against the pathogen) - the use of antibiotics, and it is better to have a narrow spectrum, i.e. specifically against Vibrio cholerae (Polymyxin), but in some cases they also use a wider spectrum of action (ciprofloxacin, doxycycline, ofloxacin, etc.). The choice of antibiotic also depends on the degree of dehydration.

3. Prescription of general strengthening treatment in the form of prebiotics, probiotics, symbiotics, a complex immunoglobulin preparation (CIP) and vitamin complexes are possible.

There is no need for a specific diet or rehabilitation.

Complications of cholera

Due to impaired hemostasis and microcirculation, coronary insufficiency occurs and, as a result, myocardial infarction (impaired blood supply to the heart muscle), mesenteric thrombosis, acute cerebral failure, phlebitis. Cholera is deadly and can result in death if not treated promptly.

Preventing cholera

Specific: “cholera corpuscular inactivated vaccine” and chemical vaccines (mono- and bivalent). Vaccination is carried out according to epidemic indications. Non-specific: control and compliance with sanitary and epidemiological standards, control over water supply. Persons who have recovered from the disease are subject to 5-day observation and bacteriological examination 3 times. Contact patients are monitored using bacteriological testing and, as a preventive measure for the occurrence of the disease in contact patients, it is permissible to use antibiotics in prophylactic doses for 4 days.

General practitioner Shabanova I.E.

Before revealing the symptoms of the disease and the effect on the body, we will give a definition of the disease. Cholera is a viral infectious disease caused by the microorganism Vibrio cholerae. The main site of injury is the small intestine. The patient experiences loose stools, vomiting, and intoxication. When sick, a person loses up to 40 liters of fluid per day, causing dehydration and the risk of death. Every year the disease affects more than 5 million people - 3-5% die. Refers to infections that pose a particular danger to human life. Cholera is characterized by dyspeptic syndromes, in which dehydration of the body is pronounced.

The disease cholera has been known since antiquity and came to Europe in the 19th century. The peak of the pandemic in Russia occurred in the second half of the 19th century, coinciding with the Crimean War - mortality was in six figures. In 1854, more than 500 people became infected with cholera in central London. J. Snow's report on the impact of the water supply on the spread of cholera gave impetus to improving sewage systems.

The cholera bacterium was discovered by F. Pacini in 1853 and E. Nedzvetsky in 1872.

Cholera has spread to all corners of the globe. The main centers of infection are countries in Africa and Latin America. Infectious spread is associated with the unsanitary conditions in which a person lives. The causative agents are microbes found on objects and unprocessed foods.

The history of the disease began its journey from antiquity, taking the lives of tens of millions of people. Treatment must be taken seriously. Infectious diseases have claimed more lives than wars!

Properties of Vibrio cholerae

By producing poison, microbes damage the intestinal mucosa. Under the influence of poison, the water-salt balance is disrupted, causing dehydration of the human body.

Properties of toxins:

• Destruction of the epithelium of the small intestine.
• They irritate the digestive tube, causing vomiting and loose bowel movements.
• They disrupt the water-salt balance.

The bacterium develops at 16-40C. The optimal variant for the existence of Vibrio cholerae is 36-37C. Temperatures below zero are not scary.

The causative agent of the disease is not susceptible to alkali; the bacteria live on food, surfaces and soil for up to a month, and in water - a couple of months.

Pathogenesis during cholera:

Contaminated food, liquid → penetration into the small intestine → suction of bacteria to the intestinal walls → increase in the microbial population on the intestinal mucosa → release of CTX toxins, poison disorients the normal functioning of the small intestine → due to toxins, the water-salt balance, water and salt particles are disturbed leave the intestines → cells dehydrate and die, bacteria leave the body along with dead cells.

Etiology of the disease: the source of the disease is a bacterium represented by the biotype of the disease and El Tor. Cholera Clinic Bengal has the ability to secrete an exotoxin similar to the biotype of the cholera bacterium.

Causes of cholera

Causes of the disease:

• Infected person.
• Carrier of bacteria. By external signs it does not look charged.

The patient's stool and vomit are odorless. Contaminated substances are not noticed, which leads to the spread of infectious disease.

The mechanism of transmission of bacteria is fecal-oral; vibrios leave the body through feces and vomiting. The disease is not transmitted by airborne droplets.

The main routes of infection with cholera:

• Through water: contaminated water has a high bacteria content. There is a huge risk of infection while swimming. Washing dishes and food in such water is not recommended.
• Contact household: household items, door handles, dishes, linen and other items with which the patient has been in contact are full of pathogens.
• Food: dairy and fish products, fruits and vegetables that have not undergone heat treatment. gets onto products through water, carriers, flies.

Symptoms of the disease

Signs of cholera:

• Vomiting from eating food.
• Increased body temperature.
• Dehydration: dry mouth.
• Cholera stool: liquid, colorless, white-gray.

The incubation period of cholera is a couple of hours, usually 2–3 days.

Infection classification:

• Erased.
• Easy.
• Moderate weight.
• Heavy.
• Very heavy.

There are 4 degrees of dehydration:

• The first is that dehydration is 1-3% of body weight.
• The second phase is 4-6% of the patient’s total weight (moderate severity).
• Third, the patient loses 7-9% of a person’s total fluid.
• Fourth – dehydration more than 9%.

The erased form of cholera is characterized by one-time loose stools, lack of dehydration, and no fever. The first signs are a strong urge to stool, watery bowel movements. There is no pain syndrome, the number of “trips” to stool increases, and the volume of bowel movements increases. As a result of dehydration, malaise, desire to drink, and dry mouth appear. The period of the painful condition is 1-2 days.

With fluid loss in the second stage, the infection progresses, diarrhea is combined with frequent vomiting. The color scheme of feces and vomit is identical. There is dry mouth, pale retina, and aging skin. The frequency of bowel movements is up to 10 times a day. Severe complications: limb cramps, hoarseness of voice. The duration of the disease is up to 5 days.

The severe form is characterized by exicosis due to strong loose stools (up to 1.5 liters of fluid are lost per 1 act of bowel movement). Symptoms: skin laxity, the appearance of tachypnea, increasing tachycardia, thready pulse, rapidly falling blood pressure, decreased urination.

Algid type of cholera (more severe in form) – rapid development of infection, accompanied by severe vomiting and frequent urge to stool. Immunity is weakened. After a couple of hours, the body temperature reaches 34-35C. The patient loses more than 12% of fluid in the body. Symptoms of cholera: shortness of breath, anuria, development of paralysis of the intestinal muscles.

Appearance of the patient:

• sunken eyes;
• loss of voice;
• dullness of the sclera;
• retracted stomach.

Laboratory diagnostics show test results: blood density exceeds 1.035; index of the ratio of erythrocyte volume to total plasma volume – 0.65-0.7 l/l.

The danger of developing cholera in children under 3 years of age

Children under three years of age are most susceptible to cholera. Dehydration is worse tolerated by children. It is much more difficult for children to determine the level of dehydration based on plasma density. For a clear and accurate analysis, you should weigh the baby.

The differential characteristics of symptoms differ from the course in adults. Features of cholera vibrio in children:

• Unreasonable increase in temperature.
• Adynamia.
• Severe epileptiform seizures.

The duration of the disease is up to 10 days. Timely rehydration and replacement of electrolytes are the main goal of rapid recovery of the body.

Diagnostics

During an epidemiological outbreak, the diagnosis of the disease is not difficult. In areas where cholera has not manifested itself, bacterial confirmation is necessary.

Methods for diagnosing the disease:

• objective – the severity of the disease is determined by the symptoms;
• bacteriological - culture of feces and vomit is taken. The causative agent of cholera is determined;
• serological - using blood serum, the presence of vibrio antigen is determined;
• relative density of plasma - helps to determine the extent of the disease.
• express diagnostics.

It is important to diagnose the disease in time in order to prescribe the correct treatment for cholera and avoid consequences.

Treatment of the disease

Methods to combat the disease include:

1. Fatty broths.
2. Soups made with dairy products.
3. Flour products.
4. Dairy products.
5. Fresh and dried fruits and vegetables.
6. Sweets - jam, honey, sugar.
7. Spicy food.
8. Smoked products.

Allowed products:

• Water soup with rice and oatmeal.
• Porridge on the water.
• Crackers.
• Steamed cutlets with lean meat products: chicken, veal, rabbit.
• Compote of currants and quince.
• Skim cheese.

Treatment with medications

To combat dehydration, the patient needs to drink and inject a solution of water and salt into the intestines. In severe cases of the disease, the solution is injected into a vein.

Antibiotics are used to destroy bacteria:

• Levomycetin.
• Doxycycline.

It is necessary to consult with a doctor to determine the dosage and number of doses per day.

Traditional methods of treating cholera

Cholera cannot be treated with folk remedies! Traditional methods of treatment are not recommended to be used as the main ones - they are used as accompanying main ones.

• Warming – at a low temperature, the patient should apply burners to the body; the room temperature should not be less than 35C.
• Periwinkle. Recipe: 1 tsp. Brew dried herbs in a glass of water. Cool, strain, take 100 ml three times a day. The drink helps with loose stools and disinfects the intestines.
• Red wine containing tannin stops the population of cholera bacteria.
• Chamomile, mint tea. Dilute in an equal amount of herbs. 5 tbsp. Dilute the mixed material in a liter of liquid. Boil. Drink 1.5-2 liters per day in small doses. Has anti-inflammatory properties.

Consequences of the disease

Lack of steps to cure the disease, procrastination leads to:

• Hypovolemic shock (low blood pressure).
• Impaired kidney function. It is characterized by a decrease in the excretion of nitrogenous waste, urine density, and acidosis.
• Muscle cramps.
• Thrombophlebitis.
• Breathing disorders.
• Acute circulatory disorders in the brain.
• Re-infection with other types of microbes.

Prevention

Persons arriving from cholera-prone countries must be monitored for at least 5 days.

Sanpin (Sanitary Norms and Rules) about cholera include measures to prevent the spread of the disease throughout the country.

Prevention of cholera:

• The sick person is moved to a separate room - an isolation ward. After the symptoms disappear, it is released. It is important to carry out 3 diagnoses once a day. The results of the study should show the absence of microbes in the body.
• They collect those who have been in contact with the infected person - they take blood tests three times and prescribe antibiotic treatment.
• The workplace and the room in which the patient was located must be disinfected. It is done within 3 hours after hospitalization.

During disinfection, it is necessary to follow precautionary measures to eliminate the possibility of infection - carry out the procedure in special clothing, gloves, and a mask.

Vaccination against disease

Specific prevention includes a vaccine administered under the skin. Emergency prevention includes the use of drugs that prevent the spread of bacteria.

Vaccination against cholera is an important step in preventing the occurrence of the disease. The effectiveness of medications injected under the skin has not been fully proven and their use is not recommended. The cholera vaccine is not a universal protective method. It is in addition to other measures that kill the source of infection and the virus.

Vaccination helps to identify carriers of the infection in adults and children and prevent the spread of the disease. In addition to the vaccine, a buffer solution is taken to protect the drug from the effects of stomach acid. 2 doses are administered with an interval of 1 week. The Dukoral vaccine protects the body for six months. Children over 2 years of age can be vaccinated.

Cholera is an intestinal infection caused by various bacteria that can lead to serious damage to the body and death!

Cholera is an acute intestinal infection caused by Vibrio cholerae. The disease is characterized by profuse diarrhea and vomiting, leading to. Residents of European countries perceive cholera rather as a historical fact. However, this disease is currently reported in 53 countries, mainly in Africa and Asia. According to WHO, about 3-5 million cases of cholera are registered annually, of which 100-120 thousand end in death! Cases of cholera in European countries are rare, often imported from other countries that are disadvantaged in this regard. However, in countries with access to the sea, the occurrence of this infection is also possible. Thus, 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.

Cholera epidemics

Cholera is a particularly dangerous infection that can lead to great human losses. Until the beginning of the 19th century, cholera was suffered only in South Asia (the basins of the Brahmaputra and Ganges rivers). However, the disease soon spread across all continents. So, for the period 1817-1926. There have been six recorded pandemics that have killed millions of people. Significant cholera epidemics with large numbers of deaths were observed in the 19th century in many regions of Russia.

Scientists and doctors were able to study in more detail the causative agent of cholera and the mechanism of transmission of the disease, which helped to develop effective anti-epidemic measures. Thanks to this, the spread of cholera in its historical foci in India was stopped for thirty-five years. However, in 1961, cholera appeared on the island. Sulawesi and quickly spread to other continents, thus creating the seventh cholera pandemic, which lasted thirty years.

Outbreaks of cholera are still being recorded, mainly in African and Asian countries.

Causes

Vibrio cholerae is a convoluted bacillus bacterium with high mobility. Cholera is caused by the classic Vibrio cholerae or Vibrio Eltor.

The source of infection is an infected person. The patient releases bacteria through vomiting and feces, which contaminates the environment. The mechanism of transmission of cholera is fecal-oral. Often the disease spreads through waterborne transmission. A person becomes ill when drinking water contaminated with cholera vibrios, ingesting it while swimming, as well as after eating vegetables and fruits washed with such water. A food route of transmission is also possible when a person eats fish, as well as seafood and crayfish grown in contaminated water. And, finally, the contact-household route, because vibrios get on household items, dishes, and door handles. By holding such objects and then touching your mouth with your hands, a person risks getting cholera.

Impact of Vibrio cholerae

When cholera vibrios are swallowed, they enter the stomach. Here, under the influence of hydrochloric acid, some of them die, the other part moves into the intestines. The intestinal alkaline environment is very comfortable for bacteria. Vibrios begin their vigorous life activity and release a toxin. Under the influence of the toxin, cell permeability increases. Water, as well as potassium, chlorine, sodium, and protein enter the intestinal lumen from the extracellular space. At the same time, intestinal peristalsis increases, causing profuse diarrhea and vomiting. Minerals and proteins are also removed with the liquid, which ultimately leads to dehydration and disruption of water-mineral metabolism. In just one hour, a patient can lose a liter of fluid!

Symptoms of cholera

The clinical picture of the disease and its severity will depend on the severity of cholera. About 80% of all cholera cases are mild or moderate. The severe form of the disease is less common, but it is the one that poses a 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 the urge to defecate, most often this happens at night or in the morning. It is typical that this is not accompanied, except perhaps by discomfort in the navel area. The stool quickly loses its fecal character, becomes colorless, and then... In liquid feces you can find what is medically called “rice-water stool.” After three to five hours it appears.

The severity of the patient's condition is determined by the degree of dehydration ():

• I degree - fluid loss is 1-3% of body weight;
• II degree - 4-6% of body weight;
• III degree - 7-9% of body weight;
• IV degree - 10% or more of body weight.

At mild form of the disease The frequency of stool varies from three to ten times. At first, mushy stool is noted, then it becomes more and more watery. The patient may feel fluid transfusion in the intestines. After a couple of hours without a previous one, vomiting occurs. The patient vomits first the food he eats, then the stomach contents. In mild forms of cholera, fluid loss is moderate. Mild thirst and muscle weakness are also noted. Temperature, heart rate, and blood pressure are usually normal.

At moderate cholera The frequency of stools increases to fifteen to twenty times per day. Repeated vomiting is observed, which also resembles rice water. Vomit may be yellowish in color due to bile. In this case, the signs of dehydration become much more pronounced: the patient is bothered by severe thirst, which cannot be quenched by drinking water, severe muscle weakness, and a decrease in the volume of urine excreted. On examination, dry skin, mucous membranes, coating on the tongue, hoarseness, a slight decrease in blood pressure and increased heart rate are noted.

Severe cholera characterized by a very short incubation period, frequent watery stools and repeated fountain vomiting. In just a few hours, the patient loses a large amount of fluid (from 7-9%, which corresponds to degree III dehydration). The condition of patients rapidly deteriorates: thirst increases, skeletal muscle cramps do not stop, and severe weakness develops. The skin and mucous membranes are dry, the eyeballs are sunken, and the facial features are pointed. Skin turgor is reduced: when you grab a skin fold on the abdomen, it straightens out in about two seconds. The skin of the fingers gathers in small folds, this symptom is called “washerwoman’s hands.” Diuresis is reduced. Body temperature may also be reduced.

Note:with cholera, the temperature never rises above 36.6 degrees. The more severe the disease, the lower the body temperature drops.

During the examination, the doctor can also determine persistent, increased heart rate and breathing. The patient's voice becomes barely audible.

Symptoms of atypical cholera

It is worth noting that cases of atypical forms of the disease are currently increasing. These include “dry cholera”, fulminant, and also with an erased course.

At fulminant cholera profuse and uncontrollable diarrhea with vomiting can lead to the development of dehydration shock in just ten to twelve hours. With this form of the disease, the patient’s condition is very serious, consciousness is depressed. The patient has no voice at all, and skeletal muscle spasms practically do not stop. The trapped skin fold on the abdomen does not straighten out for more than two seconds. The patient's eyelids and mouth are unable to close completely due to decreased tone. Body temperature drops to 35-34 degrees. The skin becomes bluish, and the tip of the nose and fingers become purple. There is rapid heartbeat and breathing, and blood pressure cannot be determined. There is no diuresis. This form of cholera is often fatal.

For dry cholera characterized by the rapid development of hypovolemic shock, the signs of which are the absence of diuresis, decreased blood pressure, rapid breathing, convulsions, and depression of the central nervous system. It is typical that hypovolemic shock develops even before the onset of diarrhea and vomiting. Dry cholera is characterized by high mortality.

Erased form of the disease clinically may not manifest itself as anything. Typically, infections are detected during laboratory testing of people, carried out according to epidemiological indicators. The danger is that people with an erased form of the disease also release Vibrio cholerae into the external environment. Such a person can cause infection to other people.

Diagnostics

To diagnose cholera, feces and vomit are collected from the patient before it begins. Bacterial testing of selected samples is carried out. This is the gold standard for diagnosing cholera.

In addition, serological diagnosis of the disease can be performed. To do this, a blood sample is taken. The following diagnostic methods are used: RNGA, RN, .

Express diagnostic methods can also be used, but they are rather indicative. Express diagnostics include the method of immobilization and microagglutination of Vibrio cholerae under the influence of anticholera serum.

Principles of cholera treatment

All people with cholera, as well as those with a presumptive diagnosis, are required to be sent to an infectious diseases hospital. Patients are placed in separate boxes, and if there are a large number of patients, a special department is organized.

Basic principles of cholera therapy:

1. Restoration of BCC (circulating blood volume);
2. Restoration of electrolyte balance;
3. Effect on the pathogen.

Rehydration therapy is carried out in two stages. The goal of the first stage (initial rehydration) is to restore the existing deficiency of water and electrolytes. The purpose of the second stage (compensatory rehydration) is to eliminate ongoing water-electrolyte losses.

Primary rehydration should be carried out as early as possible, even at the prehospital stage. It is usually carried out within the first four hours.

To restore water and electrolyte balance, saline solutions are used. For cholera with mild to moderate dehydration, it is enough to take oral solutions: these are ORS (oral saline solution), Regidron. The solution is taken in fractional teaspoons every minute. The calculation of the required dose of the solution is made taking into account fluid losses.

In case of severe dehydration, saline solutions (Trisol, Acesol, Quartasol) are prescribed intravenously, first as a stream, then as a drip.

In addition, it is used in the fight against cholera. Their use can reduce symptoms and duration of the disease. Vibrio cholerae is sensitive to tetracycline, doxycycline, azithromycin, ciprofloxacin.

The patient is discharged after complete clinical recovery and a negative result of a three-fold bacterial stool test.

Preventing cholera

Cholera is a disease that can lead to epidemics. This is why WHO is implementing preventive measures around the world.

Prevention must be carried out on a national scale. Thus, to prevent the disease, it is necessary to establish a water supply system; the drinking water supplied must be disinfected and regularly tested. In addition, it is necessary to introduce monitoring of the state of water in reservoirs and testing it for the presence of Vibrio cholerae. In areas where cholera is endemic, the use of an oral vaccine is recommended.

Of course, personal prevention also plays an important role. This is especially important as people now travel a lot and may end up in a cholera-resistant country. Preventative measures are very simple:

• Do not swim in unknown bodies of water;
• Do not drink raw water, drink only safe water;
• Wash your hands thoroughly after using the toilet and before eating;
• Do not eat food in places of uncertified trade;
• Do not eat raw seafood and fish.

Grigorova Valeria, medical observer

Cholera I Cholera (Greek cholera, cholē bile + rheō to flow, to bleed)

In the mucous membrane of the gastrointestinal tract, catarrh is noted, while the functional ability of the epithelium is preserved.

Immunity. After the illness, the pathogen remains relatively resistant to this serological type of pathogen.

Clinical picture. The incubation period is from 1 to 5 days, more often 1-2 days. usually begins acutely, in some cases there may be prodromal phenomena in the form of malaise, weakness, and sometimes an increase in temperature to 37-38°. The first clinically pronounced sign of H. is. The stool quickly becomes watery, cloudy white, reminiscent of rice, without a fecal odor. usually appears suddenly following diarrhea without previous nausea; the vomit also looks like rice water. Most patients have diarrhea and are not accompanied by abdominal pain. They feel increasing weakness, dry mouth, pain and convulsive twitching in the muscles, especially the calf muscles.

The severity of the disease is determined by the degree of dehydration of the body. In patients with degree I dehydration, fluid loss does not exceed 3% of body weight; bowel movements often remain mushy, there may be no vomiting, signs of dehydration and hemodynamic disturbances are absent or mild.

With third degree dehydration, fluid loss is 7-9% of body weight, diarrhea and vomiting are repeated. There are convulsions, hoarseness of voice, sharpened facial features, sunken eyes, reduced skin turgor mainly on the extremities, decreased; tachycardia, severe arterial hypotension, oliguria or are observed.

With IV degree dehydration, the maximum fluid loss is 10% or more of body weight (decompensated dehydration). In some patients with continuous bowel movements and profuse vomiting, this condition may develop within the first 2-3 h, in most patients - within 10-12 h after the onset of the disease. It is observed that the skin turgor is sharply reduced, it is cold, sticky to the touch, and bluish; characterized by tonic convulsions, a decrease in body temperature to 35-34° (hence the former name of the disease - cold); develop (see Infectious-toxic shock) , anuria.

Diagnosis is based on the clinical picture and epidemiological history data (staying for 5 days prior to the disease in areas unaffected by cholera; contact with patients; drinking undisinfected water). The final one is determined based on the examination of the patient’s feces or vomit and the detection of the pathogen. For this purpose, freshly excreted or vomited masses in the amount of 1-2 ml placed in a test tube with 1% peptone water. If it is located far away, feces or vomit in a sterile jar with a ground-in stopper, placed in and then in a tightly closed sealed box, is sent with a special courier. Serological studies are of auxiliary value. In the blood, neutrophilia, increased plasma density and hematocrit, hyponatremia, metabolic acidosis, etc. are detected.

With food poisoning, signs of general intoxication are expressed (headache, muscle pain), and vomiting appears from the first hours of the illness; characterized by abdominal pain, foul-smelling stool, signs of dehydration are usually moderate. In case of poisoning with poisonous mushrooms, there are sharp, cramping pains in the abdomen, changes in the psychoneurological status (delirium, there may be blurred vision, in the eyes, ptosis), while the phenomena of gastroenteritis subside, the phenomena of hepatic-renal failure come to the fore. In case of poisoning with salts of heavy metals and arsenic, the symptoms described above (not characteristic of cholera) are observed, with the exception of focal neurological symptoms; in addition, there may be hypochromic symptoms, and in severe cases, the development of coma.

Treatment. If cholera is suspected, it is mandatory. If the patient has signs of dehydration already at the prehospital stage, rehydration should be immediately started in a volume determined by the degree of dehydration of the patient’s body, which corresponds to the body weight deficiency. In most cases, rehydration is accomplished by oral fluids. The patient is given a drink or liquid (oralite, rehydron, citroglucosolan) is injected into the stomach in small portions. Within an hour, the patient should drink 1-1.5 l liquids. In case of repeated vomiting, increasing fluid loss, patients with degree III and IV dehydration must be given intravenous polyionic drugs such as “Quartasol” or “Trisol”. Typically, intravenous primary rehydration (replenishment of fluids that occurred before the start of treatment) is carried out within 2 h, oral 2-4 h. Next, correction of ongoing losses is carried out. Before administration, the solutions are heated to 38-40°. First 2-3 l pour in at speeds up to 100 ml in 1 min, then the perfusion rate is gradually reduced to 30-60 ml in 1 min. Water-salt therapy is canceled after the volume of bowel movements has significantly decreased and they have passed feces, vomiting has stopped and the amount of urine exceeds the number of bowel movements for the last 6-12 h. After vomiting stops, all patients are prescribed 0.3-0.5 orally G or chloramphenicol 0.5 G every 6 h within 5 days.

The use of cardiovascular drugs with a diuretic effect, the introduction of pressor amines that contribute to the development of renal failure, and colloidal solutions are contraindicated.

Forecast with timely and correct treatment, it is usually favorable. Fatalities are less than 1%.

Prevention. In our country, measures are being taken to prevent the possibility of cholera; implement measures to prevent the importation of cholera from abroad (see Sanitary protection of the territory) . Providing the population with good quality drinking water and water supply sources is important () , sanitary supervision over the storage and sale of food products, the operation of public catering establishments (see Food products , Sanitary supervision) , for the neutralization of wastewater, the destruction of flies.

If there is a threat of the appearance and spread of cholera in a certain territory (district, region), patients with acute gastrointestinal diseases are actively identified, they are hospitalized in pharmacist departments with a mandatory one-time bacteriological examination for cholera. Persons arriving from areas affected by cholera are identified; in the absence of certificates of observation (Observation), they are subject to five-day medical observation with a single bacteriological examination for cholera. Constant laboratory monitoring is carried out to monitor vibrio contamination of water from open reservoirs, centralized water supply sources, and wastewater.

Control over the sanitary protection of water sources and the supply of disinfected water to the population is being strengthened (see Water) , the sanitary condition of populated areas, public catering establishments and the food industry, crowded places (beaches, recreation areas, train stations, marinas, airports, cinema halls, hotels, markets, etc.). public restrooms. Sanitary control points are being created on railway, water and air transport, and on highways to identify and hospitalize patients with gastrointestinal disorders in order to prevent the importation of cholera.

If cholera occurs on (a house, a village, a city district, a city, and possibly a district), by decision of government authorities, on the recommendation of health authorities, it may be imposed. The organization of anti-epidemic measures in the outbreak is carried out by an emergency anti-epidemic commission. Active identification and hospitalization of cholera patients, vibrio carriers, as well as patients with acute gastrointestinal disorders are being carried out. Persons who have been in contact with patients (from the moment of development of clinical manifestations) and vibrio carriers are isolated for 5 days (see Isolation of infectious patients) , They are subject to medical observation with three-time (during the first 24 hours) bacteriological examination for cholera and preventive treatment with antibiotics. Identified patients are isolated in a separate room before hospitalization; Persons caring for the patient must wear a protective suit and strictly adhere to the sanitary and anti-epidemic regime. Current and final disinfection is carried out in the outbreak . In some cases, for epidemic indications, antibiotics are given to the entire population in the outbreak.

If a patient is identified with suspected cholera, he immediately reports this to higher authorities, provides the patient with the necessary medical care and begins organizing anti-epidemic measures. In this case, you should strictly observe personal preventive measures and carry out ongoing disinfection (Disinfection) .

For persons who have suffered from cholera and vibrio carriers for 3 months. is carried out, in the first month a bacteriological examination of feces is indicated once every 10 days and bile once, then feces are examined once a month.

Within a year after the elimination of a cholera outbreak, active identification (door-to-door visits once every 5-7 days) of patients with acute gastrointestinal disorders is carried out. Patients are immediately isolated, hospitalized and subjected to three-time (within 3 days) bacteriological examination for vibrio carriage.

During the year after the elimination of a cholera outbreak, constant monitoring of compliance with sanitary and preventive measures is carried out. At least once every 10 days, a bacteriological examination of water from drinking water sources, open reservoirs and household wastewater is carried out for the presence of vibrio cholerae. Work is systematically carried out on hygienic education of the population, in particular on the prevention of cholera and other gastrointestinal diseases.

Bibliography: Guide to Infectious Diseases, ed. IN AND. Pokrovsky and K.M. Lobana, s. 42, M., 16; , ed. E.P. Shuvalova, s. 3, M., 1989.

1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M.: Soviet Encyclopedia. - 1982-1984.

See what “Cholera” is in other dictionaries:

CHOLERA- CHOLERA. Contents: History...................... 265 Cholera in Russia and the USSR................ 269 Etiology.... .... ... ......... 272 ​​Epidemiology X.................. 278 Geographical distribution and statistics 281 Pathological anatomy ... Great Medical Encyclopedia

- (new Latin cholera). An epidemic disease characterized by vomiting, chills, bluish skin, frequent bowel movements and painful cramps. Dictionary of foreign words included in the Russian language. Chudinov A.N., 1910. CHOLERA name... ... Dictionary of foreign words of the Russian language

An acute infectious human disease caused by Vibrio cholerae. Like all vibrios, it has the shape of a slightly curved rod, is gram-negative, has active motility due to a single flagellum, is a chemoorganotroph... Dictionary of microbiology

Hulda, scoundrel, scoundrel, bitch, bitch Dictionary of Russian synonyms. cholera see scoundrel Dictionary of synonyms of the Russian language. Practical guide. M.: Russian language. Z. E. Alexandrova. 2011… Synonym dictionary