The bacterial disease cholera. Causes of cholera disease

What diseases come to mind when talking about large-scale epidemics of the past? Most often, plague, smallpox and, of course, cholera are remembered. The latter, although practically irrelevant for developed countries today, still represents a certain problem in developing countries. Everything you need to know about cholera: symptoms, causes of the disease, prevention and treatment are detailed in the article. In addition, the infection is often imported from endemic regions, so this information can be useful for residents of developed countries, especially travelers and tourists.

What is cholera?

The name comes from two Greek words- "bile" and "flow", to some extent reflecting the symptoms of the disease. Cholera is an anthroponotic (the source of infection is a sick person) intestinal infection with an oral-fecal transmission mechanism.

The causative agent is Vibrio cholerae, a Gram-negative aerobic bacterium. The disease is manifested by intense diarrhea, vomiting, and rapid dehydration. The latter is accompanied by a loss of electrolytes, which without treatment causes death within 1-2 days. The main endemic foci today are India, South America, Africa and southeast Asia.

Historical information

On the Indian Peninsula, cholera has been known since antiquity, while in Europe the disease was known only from the descriptions of Galen and Hippocrates until the 18th century. Cholera epidemics in the Ganges River valley were a common occurrence due to the hot climate, unsanitary conditions and the peculiarities of the religious cult (bathing in polluted waters, for example, pilgrimages). From there, they subsequently began to spread around the world, causing a wave of almost continuous pandemics since 1817.

In total, 7 of them were recorded, and the first one reached Astrakhan through all of Asia, and Europe at that time was saved only by the cold. The second lasted 20 years, starting in 1829. It covered Russia, European countries and even reached the USA with Japan. The most deadly was the third pandemic, which claimed only in the territory Russian Empire over a million human lives. The subsequent ones were less ambitious, but they also led to a significant reduction in the population of the Eurasian continent.

Even the first pandemics became the impetus for the fundamental study of the disease, the identification of the causative agent of cholera and the search for effective ways treatment. Sources were disinfected drinking water, dwellings, sewerage and water supply systems in cities were improved. However, until the middle of the last century, when the last pandemic occurred (1961-75), cholera still posed a serious danger to humanity.

Today, despite the generally favorable situation, the disease in some regions can take on the character of an epidemic. For example, from 2010 to 2015 in Haiti, about 10,000 people died from this infection.

The causative agent of cholera: etiology and epidemiology

For research to identify the pathogen, samples of feces and vomit of patients, water, and sludge are taken. Vibriocidal antibodies and agglutinins are determined in paired blood sera. Initially, inoculations are performed on nutrient media, then a pure culture is isolated and identified, and its biochemical properties are studied. DNA analysis by PCR allows you to determine whether the pathogen belongs to a specific serogroup.

cholera treatment

If this disease is suspected, hospitalization in the infectious diseases department is mandatory. There, therapy is carried out aimed at restoring water electrolyte balance, destruction of the causative agent of infection and cleansing the intestines.

Rehydration

It is carried out in two stages, the first of which is the replenishment of the volume of lost fluid, and the second is the maintenance of its normal level. To treat cholera in a person with mild or moderate disease, an oral solution of water and electrolytes is usually given. Severe stages of dehydration are an absolute indication for intravenous infusions. Ringer's solution is usually used with additional administration of potassium preparations.

Rehydration should be carried out under the control of blood electrolyte balance and glucose levels.

Antibiotic therapy

Treatment of cholera with antibiotics can reduce fluid loss and shorten the duration of the disease by several days. The greatest activity against cholera vibrio is shown by drugs based on.

Cholera is an acute infectious disease characterized by a predominant lesion of the small intestine and manifested in the form of vomiting, diarrhea and severe dehydration. There are always outbreaks of disease that originate in India and spread around the world in the form of epidemics and pandemics.

The causative agent of cholera is Vibrio cholerae, a bacterium that enters environment with the faeces of a sick person or a healthy vibrio carrier. The bacteria enter the body via the fecal-oral route through contaminated water, inseminated food, and unwashed hands.

Vibrio cholerae settles in the mucous membrane of the small intestine, multiplies and produces cholera toxin, which leads to the release of fluid into the intestinal lumen. As a result - vomiting, dehydration, hypokalemia and other metabolic disorders.

Without treatment, a person quickly dies from complications of the disease: dehydration (hypovolemic shock), acute liver and kidney failure, cardiac arrest and neurological disorders. Modern treatment involves combating dehydration and metabolic disorders with the help of heavy drinking with the addition of salts and minerals, intravenous saline and mineral solutions, the destruction of cholera vibrios with antibiotics, inactivation of cholera toxin with enterosorbents, concomitant therapy. With timely treatment, the prognosis is favorable, patients fully restore their ability to work one month after the onset of the disease.

Prevention of cholera is reduced to the prevention of an epidemic with the help of a set of state and interstate sanitary and hygienic measures, observance of the rules of personal hygiene, and vaccination of the population.

The source of Vibrio cholerae is a sick person or a healthy carrier who releases bacteria into the environment along with feces and vomit.

Transmission routes:

  • fecal-oral - through contaminated water (when drinking, swallowing while diving), contaminated food, in particular, not subjected to heat treatment before consumption (shrimp, shellfish, smoked fish, etc.);
  • contact-household, primarily through unwashed hands.

Symptoms and severity of cholera

The incubation period (from the moment of infection to the appearance of the first symptoms of cholera) lasts 1-2 days. 80% of infected people either do not get cholera or carry it in mild to moderate form.

Here typical symptoms cholera:

  • acute onset;
  • : Abundant (up to 250 ml at a time) bowel movements up to 20 times a day. The stools are initially mushy, then liquid white gray color and, finally, colorless, odorless and blood impurities with floating flakes that resemble rice water;
  • vomiting - at first eaten food, and then resembling rice water;
  • dehydration of the body, characterized by thirst, pointed facial features, sunken eyes, severe dryness of the skin and mucous membranes, etc.;
  • decrease in body temperature (up to 35 degrees) in severe cases; reduced blood pressure;
  • small urination (oliguria) and complete cessation of urination (anuria);
  • convulsions of chewing and calf muscles;
  • associated with hypokalemia.

There are 4 degrees of dehydration in cholera:

  • I degree - the body loses up to 3% of the initial body weight;
  • II degree - loss of 4-6% of the initial body weight;
  • III degree - loss of 7-9% of the initial body weight;
  • IV degree - loss of more than 9% of the initial body weight. In this case, due to severe dehydration and loss of salts (potassium and sodium chlorides, as well as bicarbonates), the so-called algid develops: low temperature, severe weakness, hypotension, oligo- and anuria, convulsions, cessation of stool, severe dryness of the skin (decrease in its turgor, “washerwoman’s hands”). You should know that algid also develops with.

The course of cholera is divided into 3 degrees of severity:

  • mild degree - and vomiting (in half of the cases, single). I degree of dehydration. Patients complain of weakness, thirst, dry mouth. Symptoms go away after 2 days;
  • moderate degree - acute onset with frequent stool(up to 15 times per knock). Dehydration II degree. Vomiting without preceding nausea. Discomfort in the abdomen (a feeling of "fluid transfusion"). Dryness, decreased skin turgor,. There are no pains in the abdomen. Spasms of masticatory and calf muscles. Patients feel weakness, thirst, dry mouth;
  • severe degree - manifested by III and IV degrees of dehydration. Frequent, copious, rice-water-like stools, vomiting (also rice-water-like), pointed facial features and sunken eyes, hoarse voice, dry tongue, decreased skin turgor, wrinkles, and skin folds, drop in temperature and blood pressure, oligo- and anuria, liver failure. Patients experience severe weakness and convulsions, as well as indomitable thirst. Without treatment, coma and death occur.

Diagnosis of cholera

The disease is diagnosed by questioning, examination and laboratory confirmation (microbiology).

From laboratory methods, bacteriological examination is used (identification of cholera vibrio in feces and vomit), as well as serological examination (determination of agglutinins and vibriocidal antibodies in the patient's blood).

cholera treatment

In all cases, hospitalization of the patient and isolation from others is required.

First of all, they fight dehydration: prescribe plentiful drink with the addition of salts and minerals, intravenous rehydration is carried out, in particular, using Ringer's solution. Potassium deficiency is corrected by the separate administration of potassium preparations.

Antibacterial drugs are prescribed only for III and IV degrees of dehydration. Azithromycin, Co-trimoxazole, Erythromycin, Tetracycline and Doxycycline are used (the last 2 drugs are not recommended for children under 8 years of age).

To inactivate cholera toxin, enterosorbents are prescribed.

With timely complex treatment the prognosis is favorable - patients return to work in about a month. After recovery, the patient develops immunity, but infection with other serotypes of cholera vibrio is possible.

Includes state (interstate) and personal sanitary and hygienic measures, as well as vaccination of the population:

  • prevention of the introduction of cholera vibrio from the foci of infection;
  • early detection and isolation of patients with cholera and healthy carriers of cholera vibrio;
  • disinfection of reservoirs and public places;
  • household water disinfection (primarily boiling), frequent hand washing, thorough heat treatment of food, etc.;
  • use of one of 3 types of oral cholera vaccine (WC/rBS vaccine, modified WC/rBS vaccine, CVD 103-HgR vaccine) and cholerogen toxoid.

Which doctor to contact

At the first sign of cholera, consult with. Contact the doctors of the medical video consultation service website. how our doctors answer patients' questions. Ask a question to the service doctors for free without leaving this page, or . with your favorite doctor.

Cholera- infectious acute illness characterized by damage to the small intestine water-salt metabolism, varying degrees of dehydration due to fluid loss with watery stools and vomit. Refers to the number of quarantine infections. The causative agent is Vibrio cholerae in the form of a curved stick (comma). When boiled, it dies after 1 minute. Some biotypes are stored for a long time and multiply in iodine, in silt, in the organisms of the inhabitants of water bodies. The source of infection is a person (patient and bacillus carrier). Vibrios are excreted in faeces and vomit. Epidemics of cholera are water, food, contact-household and mixed. Susceptibility to cholera is high.

Cholera periodically spread to many countries of the world and entire continents, claimed millions of human lives; the last, seventh, pandemic of the disease began in 1961. The epidemic situation of cholera in the world remains tense, up to several thousand people fall ill every year. In the countries of the South and South-East Asia and in a number of African countries (more than half of the cases of diseases are recorded on the African continent), there are endemic foci of cholera and epidemics periodically occur.

Symptoms and course. Very diverse - from asymptomatic carriage to severe conditions with severe dehydration and death.

The incubation period lasts 1-6 days. The onset of the disease is acute. The first manifestations include sudden diarrhea, mainly at night or morning hours. The stool is initially watery, later becomes " rice water» odourless, possible admixture of blood. Then profuse vomiting joins, appearing suddenly, often erupting in a fountain. Diarrhea and vomiting are usually not accompanied by abdominal pain. With a large loss of fluid, the symptoms of the lesion gastrointestinal tract recede into the background. Violations of the activity of the main systems of the body, the severity of which is determined by the degree of dehydration, become the leading ones.

1 degree: dehydration is expressed slightly.

Grade 2: weight loss by 4-6%, a decrease in the number of erythrocytes and a drop in hemoglobin levels, an acceleration of ESR. Patients complain of severe weakness, dizziness, dry mouth, thirst. Lips and fingers turn blue, hoarseness of voice appears, convulsive twitches of the calf muscles, fingers, chewing muscles are possible.

3 degree: weight loss of 7-9%, while all of the listed symptoms of dehydration are intensified. With a drop in blood pressure, collapse is possible, body temperature drops to 35.5-36 0C, urine output may completely stop. Blood from dehydration thickens, the concentration of potassium and chlorine in it decreases.

Grade 4: fluid loss is more than 10% of body weight. Facial features are sharpened, “dark glasses” appear around the eyes. The skin is cold, clammy to the touch, cyanotic, prolonged tonic convulsions are frequent. Patients are in a state of prostration, shock develops. Heart sounds are sharply muffled, blood pressure drops sharply. The temperature drops to 34.5 0C. Not uncommon deaths.

Complications: pneumonia, abscesses, phlegmon, erysipelas, phlebitis.

Recognition. Characteristic epidemiological anamnesis, clinical picture. Bacteriological examination of feces, vomit, gastric contents, laboratory physical and chemical blood tests, serological reactions.

cholera treatment

If cholera is suspected, hospitalization is mandatory. If the patient has signs of dehydration already on prehospital stage rehydration therapy should be immediately started in the amount determined by the degree of dehydration of the patient's body, which corresponds to a deficiency in body weight. In most cases, rehydration is carried out by oral administration liquids. The patient is given a drink or injected through a thin tube into the stomach in small portions of liquid (oralite, rehydron, citroglucosolan). Within an hour, the patient should drink 1-1.5 liters of liquid. With repeated vomiting, increasing loss of fluid, patients with III and IV degrees of dehydration must intravenously inject polyionic solutions such as Quartasol or Trisol. Usually intravenous primary rehydration (replenishment of fluid loss that occurred before the start of treatment) is carried out within 2 hours, oral 2-4 hours.

Next, carry out the correction of continuing losses. Before the introduction, the solutions are heated to 38-40 °. The first 2-3 liters are infused at a rate of up to 100 ml per 1 min, then the perfusion rate is gradually reduced to 30-60 ml per 1 min. Water-salt therapy is canceled after the volume of bowel movements significantly decreases and they become fecal in nature, vomiting stops and the amount of urine exceeds the number of bowel movements during the last 6-12 hours. 5 g or chloramphenicol 0.5 g every 6 hours for 5 days.

The prognosis for timely and adequate treatment of cholera is favorable.

- an acute infectious disease characterized by an epidemic spread in the summer-autumn period and the development in severe cases of profuse with rapid loss of fluid and salts, leading to dehydration.

It is a particularly dangerous infection.

Cause of illness

Cholera is caused by vibrio cholerae - curved rods with a flagellum, which causes their pronounced mobility. They survive for a very long time in open water bodies into which sewage water flows and when the water warms up more than 17? Resistant to low temperatures may overwinter in frozen water sources. On the food products vibrios survive 2-5 days, on tomatoes and watermelons with sunlight- 8 hours. They quickly die under the influence of various disinfectants, instantly die when boiled. Very sensitive to acids, which is used in the disinfection of drinking water.

The source of cholera vibrios is only a person who is sick or carrying a vibrio who came from a cholera-prone region.

The infection is transmitted by the fecal-oral route. Most epidemics are associated with the use of contaminated water, however, in everyday life, the spread of the disease is facilitated by direct contamination of food with infected feces and vomit, which in cholera are odorless and colorless, as a result of which the natural disgust and desire to quickly clean contaminated objects disappear. Infection through fish, crayfish caught in polluted reservoirs and not subjected to proper heat treatment is possible, since in them vibrios are able not only to persist for a long time, but also to multiply.

Human susceptibility to cholera is high. Infection is facilitated by reduced acidity of gastric contents, which occurs with heavy drinking.

Cholera is typical for South and Southeast Asia (India, Indonesia, Thailand, etc.). In the 1970s, it left this region and became widespread. In 1970 there was an epidemic of cholera in Astrakhan, in 1994 in Dagestan it covered 2321 people, in 1995 it hit Ukraine to a large extent with the removal of the pathogen to other regions. It spreads more easily than other intestinal infections.

Development of cholera

The gate of infection is the digestive tract. Once in the stomach, Vibrio cholerae often die due to the presence there of hydrochloric acid. The disease develops only when the cholera vibrios overcome the stomach and reach the small intestine. There they intensively multiply and produce a toxin, which causes an intensive release of tissue fluid into the lumen of the small intestine, reaching 1 liter per hour. As a result, the blood thickens and dehydration of body tissues occurs.

Persistent immunity after the disease does not develop, repeated diseases are possible.

Signs of cholera

The incubation period lasts from several hours to 5 days.

The disease begins acutely. The first sign of cholera is a sudden onset of painless diarrhea. Most stools are watery from the start. They are a cloudy white liquid with floating flakes, odorless and appearance reminiscent of rice water. In severe cases, the initial stool volume may exceed 1 liter. In the next few hours from the onset of the disease, fluid loss can amount to several liters, which quickly leads to a serious condition of the patient. Vomiting comes on suddenly after diarrhea, without any tension and feeling of nausea, very quickly becomes watery and also similar in appearance to rice water. Soon there are strong muscle cramps, more often in the calf area.

Persons who have been in close contact with a patient or a carrier of vibrio and suffering from diseases of the gastrointestinal tract are hospitalized. They are discharged after a 5-day medical observation and examination for cholera vibrios.


Find something else of interest:

Cholera

What is Cholera -

Cholera (lat. cholera)- acute intestinal anthroponotic infection caused by bacteria of the species Vibrio cholerae. Characterized fecal-oral mechanism infection, damage to the small intestine, watery diarrhea, vomiting, rapid loss of body fluids and electrolytes with the development of varying degrees of dehydration up to hypovolemic shock and death.

It usually spreads in the form of epidemics. Endemic foci are located in Africa, Latin America, India (Southeast Asia).

What provokes / Causes of Cholera:

More known 140 Vibrio cholerae serogroups; they are divided into agglutinated by the typical cholera serum O1 (V. cholerae O1) and non-agglutinated by the typical cholera serum O1 (V. cholerae non 01).

"Classic" cholera is caused by vibrio cholerae O1 serogroup (Vibrio cholerae O1). There are two biovars (biotypes) of this serogroup: classic (Vibrio cholerae biovar cholerae) and El Tor (Vibrio cholerae biovar eltor).

According to morphological, cultural and serological characteristics, they are similar: short curved movable rods with a flagellum, gram-negative aerobes, stain well with aniline dyes, do not form spores and capsules, grow on alkaline environments(pH 7.6-9.2) at 10-40°C. Vibrio cholerae El Tor, in contrast to the classical ones, are able to hemolyze sheep erythrocytes (not always).
Each of these biotypes is subdivided into serotypes according to the O-antigen (somatic). Serotype Inaba (Inaba) contains fraction C, serotype Ogawa (Ogawa) - fraction B and serotype Gikoshima (more correctly Gikoshima) (Hikojima) - fractions B and C. H-antigen of cholera vibrios (flagellate) - common to all serotypes. Vibrio cholerae form cholera toxin (English CTX) - a protein enterotoxin.

Vibrio cholerae non-01 causes varying degrees of cholera-like diarrhea, which can also be fatal.

An example is the large epidemic caused by Vibrio cholerae serogroup O139 Bengal. It began in October 1992 in the Madras port of South India and spread rapidly along the coast of Bengal, reaching Bangladesh in December 1992, where it caused more than 100,000 cases in the first 3 months of 1993 alone.

Pathogenesis (what happens?) during Cholera:

The gate of infection is the digestive tract. Vibrio cholerae often die in the stomach due to the presence of hydrochloric (hydrochloric) acid there. The disease develops only when they overcome the gastric barrier and reach the small intestine, where they begin to multiply rapidly and secrete exotoxin. In experiments on volunteers, it was found that only huge doses of cholera vibrio (10 "microbial cells) caused individuals disease, and after preliminary neutralization of the hydrochloric acid of the stomach, the disease could be caused already after the introduction of 106 vibrios (i.e., 100,000 times lower dose).

The occurrence of cholera syndrome is associated with the presence of two substances in the vibrio:
1) protein enterotoxin - cholerogen (exotoxin) and
2) neuraminidase.
Cholerogen binds to a specific enterocyte receptor - ganglioside.

Neuraminidase, splitting the acid residues of acetylneuraminic acid, forms a specific receptor from gangliosides, thereby enhancing the action of cholerogen. The cholerogen-specific receptor complex activates adenylate cyclase, which, with the participation and through the stimulating effect of prostaglandins, increases the formation of cyclic adenosine monophosphate (AMP). AMP regulates by means of an ion pump the secretion of water and electrolytes from the cell into the intestinal lumen. As a result of activation of this mechanism, the mucous membrane of the small intestine begins to secrete great amount isotonic fluid that the colon cannot absorb. Profuse diarrhea begins with isotonic fluid.

Rough morphological changes epithelial cells in patients with cholera cannot be detected (with a biopsy). It was not possible to detect cholera toxin either in the lymph or in the blood of the vessels extending from the small intestine. In this regard, there is no evidence that the toxin in humans affects any organs other than the small intestine. The liquid secreted by the small intestine is characterized by a low protein content (about 1 g per 1 liter), contains the following amounts of electrolytes: sodium - 120 ± ± 9 mmol / l, potassium - 19 ± 9, bicarbonate - 47 ± 10, chlorides - 95 ± ± 9 mmol/l. Fluid loss reaches 1 liter within an hour. As a result, a decrease in plasma volume occurs with a decrease in the amount of circulating blood and its thickening. There is a movement of fluid from the interstitial to the intravascular space, which cannot compensate for the ongoing loss of the liquid protein-free part of the blood. In this regard, hemodynamic disorders, microcirculation disorders quickly occur, which lead to dehydration shock and acute renal failure. The acidosis developing at shock amplifies deficiency of alkalis.

The concentration of bicarbonate in faeces is twice that of its content in blood plasma. There is a progressive loss of potassium, the concentration of which in the faeces is 3-5 times higher than that of the blood plasma. If you enter enough fluids intravenously, then all violations quickly disappear. Wrong treatment or its absence lead to the development of acute renal failure and hypokalemia. The latter, in turn, can cause intestinal atony, hypotension, arrhythmia, changes in the myocardium. The cessation of the excretory function of the kidneys leads to azotemia. Violation of blood circulation in the cerebral vessels, acidosis and uremia cause a disorder of the functions of the central nervous system and consciousness of the patient (drowsiness, stupor, coma).

Symptoms of Cholera:

incubation period of cholera ranges from several hours to 5 days (usually 2-3 days). By severity clinical manifestations There are erased, light, moderate, severe and very severe forms, determined by the degree of dehydration. V. I. Pokrovsky distinguishes the following degrees of dehydration: I degree, when patients lose a volume of fluid equal to 1-3% of body weight (erased and mild forms), II degree - losses reach 4-6% (moderate form). III degree - 7-9% (severe) and IV degree of dehydration with a loss of more than 9% corresponds to a very severe course of cholera. Currently, I degree of dehydration occurs in 50-60% of patients, II - in 20-25%, III - in 8-10%, IV - in 8-10%.

At erased forms of cholera there can be only once liquid stools with good health of patients and the absence of dehydration. In more severe cases, the disease begins acutely, without fever and prodromal phenomena. The first clinical signs are the sudden urge to defecate and the passage of mushy or, at the outset, watery stools. Subsequently, these imperative urges are repeated, they are not accompanied by pain. The bowel movements are easy to pass, the intervals between bowel movements are reduced, and the volume of bowel movements increases each time. The stools look like " rice water»: translucent, cloudy white in color, sometimes with gray floating flakes, odorless or with a fresh water odor. The patient notes rumbling and discomfort in the umbilical region. In patients with mild form cholera defecation is repeated no more than 3-5 times a day, their general state of health remains satisfactory, slight sensations of weakness, thirst, dry mouth. The duration of the disease is limited to 1-2 days.

At moderate (dehydration II degree) the disease progresses, vomiting joins the diarrhea, increasing in frequency. The vomit has the same "rice water" appearance as the stool. It is characteristic that vomiting is not accompanied by any tension and nausea. With the addition of vomiting, dehydration - exsicosis - progresses rapidly. Thirst becomes excruciating, the tongue is dry with a “chalky coating”, the skin and mucous membranes of the eyes and oropharynx turn pale, skin turgor decreases, the amount of urine decreases up to anuria. Stool up to 10 times a day, plentiful, does not decrease in volume, but increases. There are single convulsions of the calf muscles, hands, feet, chewing muscles, unstable cyanosis of the lips and fingers, hoarseness of the voice. Develops moderate tachycardia, hypotension, oliguria, hypokalemia. The disease in this form lasts 4-5 days.

Severe form of cholera (III degree of dehydration) characterized sharply pronounced signs exicosis due to very abundant (up to 1-1.5 liters per defecation) stool, which becomes such from the first hours of the disease, and is just as abundant and repeated vomiting. Patients are concerned about painful cramps in the muscles of the limbs and abdominal muscles, which, as the disease progresses, change from rare clonic to frequent and even give way to tonic convulsions. The voice is weak, thin, often barely audible. The turgor of the skin decreases, the skin gathered in a fold does not straighten out for a long time. The skin of the hands and feet becomes wrinkled - "the laundress's hand". The face takes on the appearance characteristic of cholera: sharpened facial features, sunken eyes, cyanosis of the lips, auricles, earlobes, nose. Palpation of the abdomen is determined by the transfusion of fluid through the intestines, increased rumbling, the noise of splashing fluid. Palpation is painless. The liver and spleen are not enlarged. Tachypnea appears, tachycardia increases to 110-120 beats / min. Pulse of weak filling (“thread-like”), heart sounds are muffled, blood pressure progressively falls below 90 mm Hg. Art. first maximum, then minimum and pulse. Body temperature is normal, urination decreases and soon stops. The thickening of the blood is expressed moderately. Indicators of relative plasma density, hematocrit index and blood viscosity on upper bound norms or moderately increased. Expressed hypokalemia of plasma and erythrocytes, hypochloremia, moderate compensatory hypernatremia of plasma and erythrocytes.

A very severe form of cholera (formerly called algidus) characterized by a rapid sudden development of the disease, starting with massive continuous bowel movements and profuse vomiting. After 3-12 hours, the patient develops serious condition algida, which is characterized by a decrease in body temperature to 34-35.5 ° C, extreme dehydration (patients lose up to 12% of body weight - degree IV dehydration), shortness of breath, anuria and hemodynamic disturbances like hypovolemic shock. By the time the patients arrive at the hospital, they develop paresis of the muscles of the stomach and intestines, as a result of which the patients stop vomiting (replaced by convulsive hiccups) and diarrhea (gaping anus, free flow of intestinal water» from the anus with light pressure on the anterior abdominal wall). Diarrhea and vomiting reappear during or after rehydration. Patients are in a state of prostration, drowsiness turns into stupor, then into a coma. Disorder of consciousness coincides in time with respiratory failure - from frequent superficial to pathological types respiration (Cheyne-Stokes, Biota). The color of the skin in such patients acquires an ashy hue (total cyanosis), “dark glasses around the eyes” appear, the eyes are sunken, the sclera is dull, the gaze is unblinking, the voice is absent. The skin is cold and clammy to the touch, the body is cramped (the posture of the "wrestler" or "gladiator" as a result of general tonic convulsions). The abdomen is retracted, with palpation, a convulsive contraction of the rectus abdominis muscles is determined. Convulsions painfully increase even with slight palpation of the abdomen, which causes concern for patients. There is a pronounced hemoconcentration - leukocytosis (up to 20-109 / l), the relative density of blood plasma reaches 1.035-1.050, the hematocrit index is 0.65-0.7 l / l. The level of potassium, sodium and chlorine is significantly reduced (hypokalemia up to 2.5 mmol/l), decompensated metabolic acidosis. Severe forms are more often noted at the beginning and in the midst of an epidemic. At the end of the outbreak and during the inter-epidemic period, mild and obliterated forms predominate, indistinguishable from diarrhea of ​​another etiology.

In children under 3 years of age cholera is the most severe. Children are more susceptible to dehydration. In addition, they have a secondary lesion of the central nervous system: adynamia, clonic convulsions, convulsions, impaired consciousness up to the development of coma are observed. In children, it is difficult to determine the initial degree of dehydration. They cannot be guided by relative density plasma due to the relatively large extracellular fluid volume. It is therefore advisable to weigh the children at the time of admission for the most reliable determination of their degree of dehydration. Clinical picture cholera in children has some features: a frequent increase in body temperature, more pronounced apathy, adynamia, a tendency to epileptiform seizures due to rapid development hypokalemia. The duration of the disease ranges from 3 to 10 days, its subsequent manifestations depend on the adequacy substitution treatment electrolytes. In case of emergency replacement of fluid and electrolyte losses, normalization physiological functions occurs quickly and deaths are rare. The main causes of death with inadequate treatment of patients are hypovolemic shock, metabolic acidosis and uremia as a result acute necrosis tubules.

When patients are in areas high temperatures, contributing to a significant loss of fluid and electrolytes with sweat, as well as in conditions of reduced water consumption due to damage or poisoning of water sources, as with other similar causes of human dehydration, cholera is most severe due to the development mixed mechanism dehydration due to a combination of extracellular (isotonic) dehydration, characteristic of cholera, with intracellular (hypertonic) dehydration. In these cases, the frequency of stool does not always correspond to the severity of the disease. Clinical signs of dehydration develop with few bowel movements, and often a short time a significant degree of dehydration develops, threatening the life of the patient.

Massive fecal contamination of water sources, consumption of a significant amount of infected water by people who are in a state of neuropsychic shock (stress) or thermal overheating, starvation and exposure to other factors that reduce the body's resistance to intestinal infections, contribute to the development of mixed infections: cholera in combination with shigellosis, amoebiasis, viral hepatitis, typhoid paratyphoid and other diseases. cholera has more severe course in patients with various concomitant bacterial infections accompanied by toxemia. Due to thickening of the blood and a decrease in urination, the concentration of bacterial toxins becomes higher, which leads to severe clinical symptoms of the combined infectious process. So, when cholera is combined with shigellosis, Clinical signs enterocolitis and intoxication - cramping abdominal pain and fever to febrile or subfebrile numbers. Defecation is usually accompanied by tenesmus, stools with an admixture of mucus and blood ("rusty stools"). The syndrome of acute distal colitis is pronounced, spasm, induration and soreness are noted sigmoid colon. With sigmoidoscopy in these cases, catarrhal-hemorrhagic manifestations characteristic of dysentery are revealed. However, after a few hours, the volume of bowel movements rapidly increases, which take the form of "meat slops". In most cases, concomitant shigellosis infection aggravates the course of cholera, but in some patients both infections can proceed favorably. When cholera is combined with amoebiasis, the diagnosis of intestinal amoebiasis is verified by finding tissue forms of dysenteric amoeba in feces.

Severe illness observed also in cholera that occurs in a patient with typhoid fever. The appearance of intense diarrhea on the 10-18th day of illness is dangerous for the patient due to the threat intestinal bleeding and perforation of ulcers in the ileum and cecum, followed by the development of purulent peritonitis.
The occurrence of cholera in eggs with various types of malnutrition and a negative fluid balance leads to the development of the disease, the features of which are a lower frequency of stools and moderate volumes of stools compared to the usual course of monoinfection, as well as a moderate amount of vomit, acceleration of the process of hypovolemia (shock!), azotemia (anuria!), hypokalemia, hypochlorhydria, other severe electrolyte imbalance, acidosis.

With blood loss caused by various surgical injuries, cholera patients experience accelerated blood clotting (blood loss!), a decrease in central blood flow, impaired capillary circulation, the occurrence of renal failure and subsequent azotemia, as well as acidosis. Clinically, these processes are characterized by a progressive drop in blood pressure, cessation of urination, severe pallor of the skin and mucous membranes, high thirst and all symptoms of dehydration, followed by a disorder of consciousness and a pathological type
breathing.

Diagnosis of Cholera:

During an epidemic outbreak, the diagnosis of cholera in the presence of characteristic manifestations of the disease does not present difficulties and can be made on the basis of only clinical symptoms. The diagnosis of the first cases of cholera in an area where it did not exist before must be confirmed bacteriologically. AT settlements where cases of cholera have already been reported, patients with cholera and acute gastrointestinal diseases should be actively identified at all stages of care medical care, as well as through house-to-house rounds by medical workers and sanitary commissioners. When a patient is diagnosed with a gastrointestinal disease, they are taken Urgent measures for his hospitalization.

Main method laboratory diagnostics cholera- bacteriological examination to isolate the pathogen. Serological methods are of secondary importance and can be used mainly for retrospective diagnosis. For bacteriological examination, feces and vomit are taken. If it is impossible to deliver the material to the laboratory in the first 3 hours after taking, preservative media (alkaline peptone water, etc.) are used. The material is collected in individual vessels washed from disinfectant solutions, on the bottom of which a smaller, disinfected by boiling, vessel or sheets of parchment paper are placed. Allocations (10-20 ml) with the help of metal disinfected spoons are collected in sterile glass jars or test tubes, closed with a tight stopper. In patients with gastroenteritis, material can be taken from the rectum using a rubber catheter. For active sampling, rectal cotton swabs and tubes are used.

When examining convalescents and healthy individuals who have been in contact with sources of infection, a saline laxative (20-30 g of magnesium sulfate) is preliminarily given. During shipment, the material is placed in a metal container and transported in a special vehicle with an attendant. Each sample is provided with a label, which indicates the name and surname of the patient, the name of the sample, the place and time of taking, the alleged diagnosis and the name of the person who took the material. In the laboratory, the material is inoculated on liquid and solid nutrient media to isolate and identify a pure culture. A positive response is given after 12-36 hours, a negative one - after 12-24 hours. For serological studies, an agglutination reaction and determination of the titer of vibriocidal antibodies are used. It is better to examine paired sera taken at intervals of 6-8 days. From the accelerated methods of laboratory diagnosis of cholera, methods of immunofluorescence, immobilization, microagglutination in phase contrast, RNGA are used.

At clinical diagnostics cholera must be differentiated from gastrointestinal forms of salmonellosis, acute dysentery Sonne, acute gastroenteritis caused by Proteus, enteropathogenic coli, staphylococcal food poisoning, rotavirus gastroenteritis. Cholera proceeds without the development of gastritis and enteritis, and only conditionally can it be attributed to the group of infectious gastroenteritis. The main difference is that with cholera there is no increase in body temperature and no pain in the abdomen. It is important to clarify the order of occurrence of vomiting and diarrhea. For all bacterial acute gastroenteritis and toxic gastritis, vomiting first appears, and then after a few hours - diarrhea. With cholera, on the contrary, diarrhea first appears, and then vomiting (without other signs of gastritis). Cholera is characterized by such a loss of fluid with feces and vomit, which in a very short time (hours) reaches a volume that is practically not found in diarrhea of ​​​​a different etiology - in severe cases, the volume of fluid lost can exceed the body weight of a cholera patient.

Cholera treatment:

The main principles of therapy for patients with cholera are:
a) restoration of circulating blood volume;
b) restoration of the electrolyte composition of tissues;
c) impact on the pathogen.

Treatment should begin in the first hours from the onset of the disease. In severe hypovolemia, it is necessary to immediately rehydrate by intravascular administration of isotonic polyionic solutions. Therapy for patients with cholera includes primary rehydration (replenishment of water and salts lost before treatment) and corrective compensatory rehydration (correction of ongoing losses of water and electrolytes). Rehydration is considered as a resuscitation event. Patients with severe cholera who need emergency care, are sent to the rehydration department or ward immediately, bypassing admission department. During the first 5 minutes, the patient must determine the pulse and respiration rate, blood pressure, body weight, take blood to determine the relative density of blood plasma, hematocrit, electrolyte content, degree of acidosis, and then begin the jet injection of saline.

Various polyionic solutions are used for treatment. The most approved solution is "Trisol" (solution 5, 4, 1 or solution No. 1). To prepare the solution, apyrogenic bidistilled water is taken, to 1 liter of which 5 g of sodium chloride, 4 g of sodium bicarbonate and 1 g of potassium chloride are added. More effective is currently considered a solution of "Kvartasol", containing 4.75 g of sodium chloride, 1.5 g of potassium chloride, 2.6 g of sodium acetate and 1 g of sodium bicarbonate per 1 liter of water. You can use the solution "Acesol" - for 1 liter of pyrogen-free water 5 g of sodium chloride, 2 g of sodium acetate, 1 g of potassium chloride; solution "Chlosol" - for 1 liter of pyrogen-free water 4.75 g of sodium chloride, 3.6 g of sodium acetate and 1.5 g of potassium chloride and solution "Laktosol" containing 6.1 g of sodium chloride per 1 liter of pyrogen-free water, 3 .4 g of sodium lactate, 0.3 g of sodium bicarbonate, 0.3 g of potassium chloride, 0.16 g of calcium chloride and 0.1 g of magnesium chloride. The World Health Organization recommends a "WHO solution" - for 1 liter of pyrogen-free water 4 g of sodium chloride, 1 g of potassium chloride, 5.4 g of sodium lactate and 8 g of glucose.

Polyion solutions administered intravenously, preheated to 38~40°C, at a rate of 40-48 ml/min in the II degree of dehydration, in severe and very severe forms(dehydration III-IV degree) begin the introduction of solutions at a rate of 80-120 ml / min. The volume of rehydration is determined by the initial fluid loss, calculated from the degree of dehydration and body weight, clinical symptoms and the dynamics of the main clinical indicators characterizing hemodynamics. Within 1 - 1.5 hours, primary rehydration is carried out. After the introduction of 2 l of the solution, further administration is carried out more slowly, gradually reducing the rate to 10 ml/min.

In order to inject fluid at the required rate, it is sometimes necessary to use two or more systems simultaneously for one-time transfusion of fluid and inject solutions into the veins of the arms and legs. In the presence of appropriate conditions and skills, the patient is given a kavakatheter or catheterization of other veins is performed. If venipuncture is not possible, a venesection is performed. The introduction of solutions is decisive in the treatment of seriously ill patients. Cardiac agents during this period are not shown, and the introduction of pressor amines (adrenaline, mezaton, etc.) is contraindicated. As a rule, 15-25 minutes after the start of the introduction of solutions, the patient's pulse and blood pressure begin to be determined, and after 30-45 minutes shortness of breath disappears, cyanosis decreases, lips become warmer, and a voice appears. After 4-6 hours the patient's condition improves significantly. He starts drinking on his own. By this time, the volume of injected fluid is usually 6-10 liters. With prolonged administration of the Trisol solution, metabolic alkalosis and hyperkalemia may develop. Continue if necessary infusion therapy it should be carried out with Quartasol, Chlosol or Acesol solutions. Patients are prescribed potassium oro-tat or panangin 1-2 tablets 3 times a day, 10% solutions of sodium acetate or citrate 1 tablespoon 3 times a day.

To support reached state, carry out the correction of ongoing losses of water and electrolytes. You need to enter as many solutions as the patient loses with feces, vomit, urine, in addition, it is taken into account that an adult loses 1-1.5 liters of fluid per day with breathing and through the skin. To do this, organize the collection and measurement of all secretions. Within 1 day, you have to inject up to 10-15 liters of solution or more, and for 3-5 days of treatment - up to 20-60 liters. To monitor the course of treatment, systematically determine and map intensive care relative plasma density; hematocrit, severity of acidosis, etc.
With the appearance of pyrogenic reactions (chills, fever), the introduction of the solution is not stopped. A 1% solution of diphenhydramine (1-2 ml) or pipolfen is added to the solution. With pronounced reactions, prednisone is prescribed (30-60 mg / day).
Can't do therapy isotonic saline sodium chloride, since it does not compensate for the deficiency of potassium and sodium bicarbonate, can lead to plasma hyperosmoticity with secondary cell dehydration. It is wrong to introduce large quantities 5% glucose solution, which not only does not eliminate the electrolyte deficiency, but, on the contrary, reduces their concentration in plasma. Also transfusion of blood and blood substitutes is not shown. The use of colloidal solutions for rehydration therapy is unacceptable.

Patients with cholera who do not have vomiting should receive in the form of a drink "Glucosol" ("Rehydron") of the following composition: sodium chloride -3.5 g, sodium bicarbonate -2.5 g, potassium chloride -1.5 g, glucose - 20 g per 1 liter of drinking water. Glucose improves the absorption of electrolytes in small intestine. It is advisable to pre-prepare sample salts and glucose; they must be dissolved in water at a temperature of 40-42 ° C immediately before giving to patients.

AT field conditions can be used oral rehydration with sugar-salt solution, for which 2 teaspoons are added to 1 liter of boiled water table salt and 8 teaspoons of sugar. The total volume of glucose-salt solutions for oral rehydration should be 1.5 times the amount of water lost with vomiting, feces and perspiration (up to 5-10% of body weight).

In children under 2 years of age, rehydration is carried out by drip infusion and continues for 6-8 hours, and in the first hour only 40% of the volume of liquid necessary for rehydration is injected. In young children, replacement of losses can be achieved by infusion of a solution using a nasogastric tube.

Children with moderate diarrhea can be given a drinking solution containing 4 teaspoons of sugar, 3/4 teaspoon of table salt and 1 teaspoon of water per liter of water. drinking soda with pineapple or orange juice. In case of vomiting, the solution is given more often and in small portions.

Water-salt therapy is stopped after the appearance of fecal stools in the absence of vomiting and the predominance of the amount of urine over the number of stools in the last 6-12 hours.

Antibiotics, being additional means, reduce the duration of clinical manifestations of cholera and accelerate the clearance of vibrios. Assign tetracycline 0.3-0.5 g every 6 hours for 3-5 days or doxycycline 300 mg once. In the absence of them or if they are intolerant, treatment with trimethoprim with sulf-methaxazole (cotrimoxazole) 160 and 800 mg twice a day for 3 days or furazolidone 0.1 g every 6 hours for 3-5 days can be carried out. Children are prescribed trimethoprim-sulfomethaxazole at 5 and 25 mg/kg of body weight
2 times a day for 3 days. Fluoroquinolones are promising in the treatment of cholera, in particular ofloxacin (tarivid), which is currently widely used in intestinal infections pathogens that are resistant to commonly used antibiotics. It is prescribed 200 mg orally twice a day for 3-5 days. Vibrio carriers are given a five-day course of antibiotic therapy. Taking into account the positive experience of US military doctors who used streptomycin orally in Vietnam with persistent vibratory excretion, it can be recommended in these cases to take 0.5 g of kanamycin orally 4 times a day for 5 days in these cases.

A special diet for cholera patients is not required. Those who have been ill with severe cholera during the convalescence period are shown products containing potassium salts (dried apricots, tomatoes, potatoes).

Patients who have had cholera, as well as vibrio carriers, are discharged from the hospital after clinical recovery and three negative bacteriological examinations of feces. Examine feces 24-36 hours after the end of antibiotic therapy for 3 consecutive days. Bile (portions B and C) is examined once. Employees Food Industry, water supply, children's and medical institutions, excrement is examined five times (for five days) and bile once.

Forecast with timely and adequate treatment, as a rule, favorable. Under ideal conditions, with prompt and adequate rehydration with isotonic polyionic solutions, mortality approaches zero, and serious consequences are rare. However, experience shows that at the beginning of epidemic outbreaks, the mortality rate can reach 60% as a result of the lack of pyrogen-free solutions in remote areas for intravenous administration, difficulties in organizing emergency treatment in the presence of a large number of patients.

Cholera Prevention:

Complex preventive measures carried out in accordance with official documents.

The organization of preventive measures provides for the allocation of premises and schemes for their deployment, the creation of a material and technical base for them, special training medical workers. A complex of sanitary and hygienic measures is being taken to protect water supply sources, remove and disinfect sewage, and sanitary and hygienic control over food and water supply. With the threat of the spread of cholera, patients with acute gastrointestinal diseases are actively identified with their mandatory hospitalization in provisional departments and a single examination for cholera. Persons arriving from cholera foci without a certificate of observation in the outbreak are subject to a five-day observation with a single examination for cholera. Control over the protection of water sources and disinfection of water is being strengthened. Flies are being fought.

Main anti-epidemic measures on the localization and elimination of the focus of cholera:
a) restrictive measures and quarantine;
b) identification and isolation of persons in contact with patients, vibrio carriers, as well as with contaminated objects of the external environment;
d) treatment of patients with cholera and vibrio carriers;
e) prophylactic treatment;
f) current and final disinfection.

For persons who have undergone cholera or vibrio carrying, a dispensary observation, the terms of which are determined by orders of the Ministry of Health. Preventive and sanitary-hygienic measures in settlements are carried out within a year after the elimination of cholera.

For specific prevention use cholera vaccine and cholerogen toxoid. Vaccination is carried out epidemic indications. A vaccine containing 8-10 vibrios per 1 ml is injected under the skin, the first time 1 ml, the second time (after 7-10 days) 1.5 ml. Children 2-5 years old are administered 0.3 and 0.5 ml, 5-10 years old - 0.5 and 0.7 ml, 10-15 years old - 0.7-1 ml, respectively. Cholerogenatoxin is administered once a year. Revaccination is carried out according to epidemic indications not earlier than 3 months after primary immunization. The drug is injected strictly under the skin below the angle of the scapula. Adults are injected with 0.5 ml of the drug (also 0.5 ml for revaccination). Children from 7 to 10 years old are administered 0.1 and 0.2 ml, respectively, 11-14 years old - 0.2 and 0.4 ml, 15-17 years old - 0.3 and 0.5 ml. The International Certificate of Vaccination against Cholera is valid for 6 months after vaccination or revaccination.

Which doctors should you contact if you have cholera:

Are you worried about something? Do you want to know more detailed information about Cholera, its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can book an appointment with a doctor– clinic Eurolaboratory always at your service! The best doctors will examine you, study external signs and help identify the disease by symptoms, advise you and provide needed help and make a diagnosis. you also can call a doctor at home. Clinic Eurolaboratory open for you around the clock.

How to contact the clinic:
Phone of our clinic in Kyiv: (+38 044) 206-20-00 (multichannel). The secretary of the clinic will select a convenient day and hour for you to visit the doctor. Our coordinates and directions are indicated. Look in more detail about all the services of the clinic on her.

(+38 044) 206-20-00

If you have previously performed any research, be sure to take their results to a consultation with a doctor. If the studies have not been completed, we will do everything necessary in our clinic or with our colleagues in other clinics.

You? You need to be very careful about your overall health. People don't pay enough attention disease symptoms and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific symptoms, characteristic external manifestations- so called disease symptoms. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you just need to several times a year be examined by a doctor not only to prevent a terrible disease, but also to maintain healthy mind in the body and the body as a whole.

If you want to ask a doctor a question, use the online consultation section, perhaps you will find answers to your questions there and read self care tips. If you are interested in reviews about clinics and doctors, try to find the information you need in the section. Also register for medical portal Eurolaboratory to be constantly up to date latest news and updates of information on the site, which will be automatically sent to you by mail.