Cholera is the sharp intestinal infection arising at defeat of the person a cholera vibrio. Cholera is shown by the expressed frequent diarrhea, plentiful repeated vomiting that leads to considerable loss of liquid and dehydration of an organism. Are signs of dehydration dryness of integuments and mucous, decrease in turgor of fabrics and wrinkling of skin, a point of features, an oligoanuriya. The diagnosis of cholera is confirmed by results of bacteriological crops of kalovy and emetic masses, serological techniques. Treatment includes isolation of the cholera patient, a parenteral regidratation, therapy with tetracycline antibiotics.
Cholera – especially dangerous infection caused by an enteropatogenny bacterium of Vibrio cholerae, proceeding with development of a heavy gastroenteritis and the expressed dehydration up to development of dihydration shock. Cholera tends to epidemic distribution and a high lethality therefore WHO is carried to high-pathogenic quarantine infections. The most often epidemic outbreaks of cholera are registered in the countries of Africa, Latin America, Southeast Asia. By estimates of WHO, annually 3-5 million people catch cholera, about 100-120 thousand cases come to an end fatally. Thus, today cholera remains a global problem of world health care.
Characteristic of the activator
Today more than 150 types of the cholera vibrioes differing on serological signs are revealed. Cholera vibrioes divide into two groups: And yes to V. Holer cause group A vibrioes. The cholera vibrio represents the gramotritsatelny mobile bacterium emitting in the course of activity thermostable endotoxin, and also thermolabile ().
The activator is steady against action of the environment, keeps viability in a flowing reservoir up to several months, till 30 o'clock in sewage. Good nutrient medium is milk, meat. The cholera vibrio perishes at chemical disinfection, boiling, drying and impact of a sunlight. Sensitivity to tetratsiklina and ftorkhinolona is noted.
The tank and source of an infection is the sick person or the tranzitorny carrier of an infection. Bacteria in the first days with an emetic and fecal masses are most actively allocated. It is heavy to reveal the infected persons with easily proceeding cholera, however they constitute danger in respect of infection. In the center of detection of cholera are exposed to inspection all contacting, regardless of clinical manifestations. Transmissibility decreases eventually, and usually by 3rd week there is a recovery and release from bacteria. However in certain cases the carriage proceeds about one year and more. Prolongation of a carriage is promoted by the accompanying infections.
Cholera is transmitted household (dirty hands, objects, ware), food and the waterway on fecal oral mechanism. Now the special place in transfer of cholera is allocated to flies. The waterway (the polluted water source) is the most widespread. Cholera is an infection with a high susceptibility, most easily there is infection of the people with hypoacidosis, some anemias infected with helminths, abusing alcohol.
The incubatory period at infection with a cholera vibrio proceeds from several hours to 5 days. Beginning of a disease sharp, usually at night or in the morning. The intensive painless desire to defecation which is followed by discomfortable feeling in a stomach acts as the first symptom. Originally the chair has the diluted consistence, but keeps kalovy character. Quickly enough the frequency of defekation increases, reaches 10 and more times per day, at the same time the chair becomes colourless, watery. At excrement cholera are usually not fetid unlike other infectious diseases of intestines. The increased secretion of water in a gleam of intestines promotes noticeable increase in number of the allocated kalovy masses. In 20-40% of cases of kcal gets a consistence of rice broth. Usually excrements have an appearance of greenish liquid with the white friable flakes similar to rice.
Rumbling, swirling in a stomach, discomfort, transfusion of liquid in intestines is quite often noted. The progressing liquid loss by an organism leads to manifestation of symptoms of dehydration: dryness in a mouth, thirst, then appears feeling of a cold snap of extremities, a ring in ears, dizziness. These symptoms speak about considerable dehydration and demand emergency measures on restoration of a water-salt homeostasis of an organism.
As frequent vomiting often joins diarrhea, loss of liquid is aggravated. Vomiting arises usually several hours later, sometimes the next days after the beginning of diarrhea. Vomiting is plentiful, repeated, begins suddenly and is followed by intensive feeling of nausea and pain in the top part of a stomach under a breast. Originally in emetic masses the remains of undigested food, then bile are noted. Over time, emetic masses also becomes watery, taking sometimes a form of rice broth.
At vomiting there is a bystry loss an organism of ions of sodium and chlorine that leads to development of muscular spasms, at first in muscles of fingers, then all extremities. When progressing deficiency of electrolytes muscular spasms can extend to a back, a diaphragm, a belly wall. Muscular weakness and dizziness increases up to impossibility to rise and reach a toilet. At the same time consciousness completely remains.
The expressed morbidity in a stomach, unlike the majority of intestinal infections, at cholera is not noted. 20-30% of patients complain of moderate pain. Also fever is not characteristic, body temperature remains in normal limits, sometimes reaches subfebrilny figures. The expressed dehydration is shown by decrease in body temperature.
Severe dehydration is characterized by a pobledneniye and dryness of integuments, decrease in turgor, cyanosis of lips and disteel phalanxes of fingers. Dryness is characteristic also of mucous membranes. With progressing of dehydration note a voice osiplost (elasticity of vocal chords decreases) up to an aphonia. Features are pointed, the stomach is pulled in, under eyes dark circles are shown, skin on small pillows of fingers and palms (a symptom of "hands of the laundress") is wrinkled. At a fizikalny research tachycardia, arterial hypotension is noted. The amount of urine decreases.
At further loss of liquid (loss more than 10% of body weight) and ions there is a progressing of dehydration. There is an anury, the considerable hypothermia, pulse in a beam artery is not probed, peripheral arterial pressure is not defined. At the same time diarrhea and vomiting become less frequent in connection with paralysis of intestinal muscles. This state is called dehydrational shock.
Dehydration of an organism differs on stages: at the first stage loss of liquid does not exceed 3% of body weight, the second and third stages means loss of 3-6 and 6-9% of body weight respectively, and at the fourth stage (dihydration shock) loss of liquid exceeds 9% of body weight. Increase of clinical displays of cholera can stop at any stage, the current can be erased. Depending on weight of dehydration and speed of increase of loss of liquid distinguish cholera of an easy, medium-weight and heavy current. The severe form of cholera is noted at 10-12% of patients. In cases of a lightning current development of dehydrational shock is possible within the first 10-12 hours.
Cholera can be complicated by accession of other infections, development of pneumonia, thrombophlebitis and a purulent inflammation (abscess, phlegmon), thrombosis of vessels of a bryzheyka and ischemia of intestines. Considerable loss of liquid can promote emergence of disorders of brain blood circulation, a myocardial infarction.
Diagnosis of cholera
Hard proceeding cholera is diagnosed on the basis of data of a clinical picture and fizikalny inspection. The final diagnosis is established on the basis of bacteriological crops of kalovy or emetic masses, intestinal contents (the section analysis). It is necessary to bring material for crops to laboratory no later than 3 hours from the moment of receiving, the result will be ready in 3-4 days.
There are serological techniques of detection of infection with a cholera vibrio (RA, RNGA, the vibrotsidny test, IFA, RKA), but they are not sufficient for final diagnostics, being considered as methods of the accelerated approximate definition of the activator. The accelerated techniques for confirmation of the preliminary diagnosis can be considered the luminescent and serological analysis, microscopy in the dark field of the vibrioes immobilized by O-serum.
Treatment of cholera
As the main danger at cholera is constituted by the progressing liquid loss, its completion in an organism is the main objective of treatment of this infection. Treatment of cholera is made in specialized infectious office with the isolated chamber (boxing) equipped with a special bed (Phillips's bed) with scales and ware for collecting excrements. For exact definition of degree of dehydration keep account of their volume, regularly define gematokrit, the level of ions in serum, an acid-base indicator.
Primary rehydration actions include completion of the available deficiency of liquid and electrolytes. In hard cases intravenous administration of polyionic solutions is made. After that make a compensatory regidratation. Introduction of liquid happens according to its losses. Developing of vomiting is not a contraindication to continuation of a regidratation. After restoration of water-salt balance and the termination of vomiting begin antibiotic treatment. At cholera appoint a rate of medicines of a tetracycline row, and in case of repeated allocation of bacteria – chloramphenicol.
There is no specific diet at cholera, in the first days can recommend a table No. 4, and after subsiding of the expressed symptomatology and restoration of intestinal activity (the 3-5th laziness of treatment) - food without features. Had cholera it is recommended to increase the products (dried apricots, tomato and orange juice, bananas) containing potassium in a diet.
Forecast and prevention of cholera
At timely and full treatment after suppression of an infection there occurs recovery. Now modern medicines effectively affect a cholera vibrio, and rehydration therapy promotes prevention of complications.
Specific prevention of cholera consists in single vaccination by cholera toxin before visit of regions with the high level of spread of this disease. If necessary in 3 months make a revaccination. Nonspecific measures of prevention of cholera mean respect for sanitary and hygienic norms in the inhabited places, at the enterprises of food, in regions of an intake of waters for needs of the population. Individual prevention consists in respect for hygiene, boiling of the used water, washing of food and their correct culinary processing. At detection of a case of cholera the epidemiological center is subject to disinfection, patients are isolated, all contact persons are observed within 5 days regarding detection of possible infection.