Complication of cholera. Cholera. Causes, symptoms and signs, diagnosis and treatment of the disease. Three forms of cholera

Cholera A is an acute intestinal anthroponotic infection caused by bacteria - Vibrio cholerae. The causative agent of cholera is characterized precisely by the fecal-oral mechanism of infection, since it affects the body’s small intestine with watery diarrhea, as well as vomiting. In addition, the human body rapidly loses a sufficient amount of fluid and electrolytes. Thus, almost complete dehydration of the body develops, up to hypovolemic shock, and sometimes death.

Cholera is an infection caused by bacteria - Vibrio cholerae.

So, cholera tends to spread in the form of severe and serious epidemics. And the largest endemic foci are primarily located in the countries of Africa, India (Southeast Asia), and Latin America. In addition, cholera is included in a group of diseases with a tendency to have a very severe course, as well as the ability to develop a pandemic in the body. Today, the fight against infectious cholera is subject to previously adopted international health regulations, as well as (quarantine infections).

Causes

The main modes of transmission of cholera occur precisely through the fecal-oral mechanism, the source of infection of which is the human body, which is already infected with cholera. In addition, the source of cholera is also healthy (transient) vibrio carrier, which releases Vibrio cholerae bacteria into the environment through feces and vomit.

Healthy people play a huge role in the spread of this disease. vibrio carriers. And the ratio between them is approximately this: carriers/patients sometimes reaches 4:1, and with the Vibrio cholerae 01 variant and 10:1 with non-01 Vibrio cholerae (NAG vibrios).

The main cause of infection can also occur when consuming undisinfected drinking water, when water enters the body when swimming in dirty ponds, as well as during normal washing. In addition, infection can occur by consuming food that has been contaminated during cooking, storage, washing or serving, and especially food that has not been exposed to heat treatment(shrimp, shellfish, lightly salted fish, dried). There is still a chance to become infected with cholera through contact and household contact, for example through ordinary dirty hands. In addition, cholera vibrios are also transmitted by ordinary flies.

The main cause of cholera infection can occur when water enters the body while swimming in dirty ponds.

Therefore, in the spread of this disease, a very important role is played by insufficient sanitary and hygienic conditions, dense population clusters, and also where large population migration occurs. In such areas, experts note endemic as well as imported foci of the cholera virus. For example, in endemic areas of Southeast Asia, Africa, and Latin America, cholera is recorded all year round. But imported epidemics will be associated primarily with intensive migration of people. Therefore, in these endemic areas, it is children who suffer from the disease more often, since adults have already acquired in a natural way protective immunity. It is also worth noting that the largest increase in cholera disease is recorded during the warm period.

So, in approximately 4-5% of people with cholera who have already recovered, chronic vibrio forms in the gallbladder. And this will be especially true for older people.

Thus, after suffering from cholera, the human body, of course, develops immunity, but this will not protect the body from infection with other serotypes of Vibrio cholerae bacteria.

Symptoms

Main symptoms of cholera:

its aggravated onset;
the onset of diarrhea in the body: at first almost painless, but profuse bowel movements from 3 to 30 times a day. And in some cases, the total volume of feces reaches 250 ml/kg of the total weight of a person during the day;
stool with signs of mushy or liquid feces, first white-gray in color, and then completely colorless. The feces have no odor or blood at all, but there are floating flakes in it. And all this is very similar to “rice congee”;
vomiting begins from the food eaten, and the vomiting looks like “rice water”;
an increase in body temperature usually does not occur, and in very advanced cases, body temperature, on the contrary, drops to 35-35.5 ° C;
dehydration of the body occurs: severe thirst, dry mucous membranes and the person’s face becomes as if with sharpened features. In addition, the eyes become sunken or, as doctors also call it, it becomes like “the face of Hippocrates.” The pulse becomes thread-like, skin turgor decreases - “washerwoman’s hands”, tachycardia, hypotension, as well as weakness, lethargy and stupor;
oliguria, anuria: convulsive contractions of the masticatory and calf muscles appear;
hypokalemia: cardiac arrhythmias.

The following degrees of dehydration:

1st degree - fluid loss that does not exceed 3% of the initial body weight;
2nd degree - loss of more than 4 - 6% of the initial body weight;
3rd degree - loss of 7 to 9% of the body’s original body weight;
4th degree - more than 9% of the initial body weight.

Also, with a large loss of fluid in the body, algid develops (which from Latin means algidus “cold”) - this symptom complex, which is caused by severe dehydration and loss of sodium chloride, potassium, bicarbonates, also accompanied by hypothermia and hemodynamic disorders. Symptoms of anuria, tonic muscle spasms of the limbs, as well as rather severe shortness of breath will also appear.

Diagnostics

Required history data (information collection process): endemic area as well as known epidemic.
General clinical picture

Laboratory diagnostic studies

The main purpose of diagnosis: indication of the bacterium Vibrio cholerae in human feces or vomit, in water, as well as the determination and content of agglutinins and vibriocidal antibodies in paired sera in the blood of a sick person.

Method and technique

Conducting inoculation of bacteriological material (water, feces, vomit) on thiosulfate-citrate-bile salt-sucrose agar (which in English means TCBS). In addition, sowing in 1% alkaline peptone water; and subsequent reseeding should be done on a second peptone water and sowing on alkaline agar plates.
Isolation of pure culture, as well as its identification.
Determination of the agglutination reaction together with specific sera.

Treatment

The need for recovery, as well as maintaining the circulating blood volume and electrolyte composition of tissues.

The treatment process is carried out in two stages:

1) Complete replenishment of all lost fluid - rehydration (this is in a volume that corresponds to the initial deficit in the total body weight of the body).
2) Further correction of possibly ongoing losses of water, as well as electrolytes.
All this can be done either orally or parenterally. And the choice of route of administration will depend, first of all, on the severity of the disease, the degree of dehydration and the presence of vomiting. It is worth noting that intravenous jet administration of the necessary solutions is recommended for patients with grade 3 and 4 dehydration.

The World Health Organization today recommends the following solution for oral rehydration:

So, to start intravenous rehydration in patients with obvious signs of dehydration, Ringer's solution is better suited. And hypokalemia will be corrected by additional administration of potassium supplements to the body.

Comparative characteristics of the electrolyte composition of cholera stool and Ringer's solution (mml/L)

Etiotropic therapy

The main drug of choice is tetracycline. Tetracycline therapy itself begins after the first circulatory disorders have been eliminated, and its dose is 500 mg. for every 6 hours. Doxycycline 300 mg can also be used. , but only once. It is worth remembering that all these drugs are not recommended for use in children under 8 years of age. Besides, effective drugs There are also ciprofloxacin and erythromycin.

Prevention

Prevent the introduction of infection from possible endemic foci.
Strict adherence to all sanitary and hygienic measures: hand washing, water disinfection, mandatory heat treatment of all food, constant disinfection of places for common use and other ways.
Efficiency consists, first of all, in early detection and timely isolation and competent subsequent treatment of patients, as well as vibration carriers.
Prevention with a special cholera vaccine, as well as cholera toxoid. However, the cholera vaccine has a fairly short period of action (3-6 months).

Sincerely,

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

It is a particularly dangerous infection.

Cause of illness

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

The source of cholera vibrios is only a person, a patient or a vibrio carrier who came from a region unfavorable for cholera.

Transmission of infection occurs through the fecal-oral route. Most epidemics are associated with the consumption of contaminated water, but 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 in those around them. Infection is possible through fish and crayfish caught in polluted waters and not subjected to proper heat treatment, since vibrios in them can not only survive for a long time, but also multiply.

People's susceptibility to cholera is high. Infection is facilitated by reduced acidity of gastric contents, which occurs when drinking heavily.

Cholera is typical for South and Southeast Asia (India, Indonesia, Thailand, etc.). In the 70s, it emerged from this region and became widespread. In 1970 there was a cholera epidemic in Astrakhan, in 1994 in Dagestan it affected 2,321 people, and in 1995 it largely affected Ukraine with the pathogen spreading to other regions. It spreads more easily than other intestinal infections.

Cholera development process

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

Persistent immunity does not develop after an illness; repeated illnesses 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 sudden onset of painless diarrhea. In most cases, bowel movements are watery from the very beginning. They are a cloudy white liquid with floating flakes, are odorless and resemble rice water in appearance. In severe cases, the initial volume of stool may exceed 1 liter. In the coming hours from the onset of the disease, fluid loss can amount to several liters, which quickly leads to a serious condition for the patient. Vomiting appears suddenly after diarrhea, is not accompanied by any tension or a feeling of nausea, very quickly becomes watery and also similar in appearance to rice water. Soon severe muscle cramps appear, often in the calf area.

Persons who have had close contact with a patient or vibrio carrier and who suffer from diseases of the gastrointestinal tract are hospitalized. They are discharged after 5 days of medical observation and examination for Vibrio cholerae.

Thank you

The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

The names of some diseases seem to come to us from the pages of history textbooks. In the Middle Ages from cholera Entire cities died out. Today, it seems to us, this disease is over. But it's not quite like that. It turns out that in the early nineties there was a cholera epidemic in Latin America! Therefore, it is impossible to say that humanity has completely defeated cholera... the site) will help you find out from this article.

Cholera infection

The causative agent of cholera is Vibrio cholerae. A person with cholera sheds Vibrio cholerae in their stool or during vomiting. You can become infected with cholera if you drink untreated water from open reservoirs; you can “catch” vibrio while swimming in a dirty river or lake. One of the serious carriers of cholera is flies.

After the cholera pathogen enters the body and before the first signs of the disease appear, it can take from a couple of hours to five days. But usually it’s a day or two. The course of the disease can be very different. In some people, cholera goes away almost unnoticeably, with incomprehensible symptoms, and some die within two days.
At the same time, there are even cases recorded when a person is a carrier of the cholera pathogen, but does not get sick himself, although he secretes the pathogen and can infect others.

However, do not think that cholera today is a less terrible disease than it was in the Middle Ages. Ninety percent of those infected with cholera develop a moderate or severe form.

What are the symptoms of cholera?

This is an abrupt onset of the disease, characterized by diarrhea. Bowel movements can occur up to thirty times a day. Moreover, their number is quite large. At the same time, the appearance of feces in cholera is very characteristic. The stool is liquid, at first gray in color, then becomes completely colorless. It may contain whitish inclusions. Cholera always occurs with vomiting. At first, the patient vomits what he has eaten, then the vomit becomes discolored. All the patient’s discharge, both feces and vomit, are similar in appearance to a decoction of rice cereal.

With cholera, the body temperature never rises. On the contrary, it may be a degree or one and a half below normal.

Constant diarrhea and vomiting remove all fluid from the body. The patient's mucous membranes dry out and he is thirsty all the time. The eyes are sunken, the skin sags. Blood pressure decreases, the rhythm of cardiac activity is not clear and rhythmic. The pulse is difficult to hear. The patient reacts poorly to what is happening around him, is very weakened, and has difficulty thinking.

Patients with cholera often experience spasms of the lower extremities and facial muscles. Due to the removal of salts from the body, the heart functions worse.
In order to differentiate the severity of the disease, degrees of dehydration in cholera were introduced. There are only four degrees. In the first degree, fluid in an amount of up to three percent of body weight is removed from a person. And with the fourth, more than nine percent of body weight.

It is dehydration and the removal of potassium, sodium and other salts from the body that causes most of the dangerous symptoms of cholera and its complications.
Cholera is especially difficult for children. Dehydration occurs more quickly in children than in adults. This entails a malfunction of the central nervous system. In children, convulsive conditions appear more often. In children, cholera occurs with an increase in body temperature. Cholera in children often leads to coma.
Cholera causes severe complications. It is often accompanied by hypovolemic shock, kidney failure, and coma.

Preventing cholera

When visiting countries that still experience occasional cholera outbreaks, be sure to take precautions. Do not drink untreated water from reservoirs, do not swim or put water in your mouth. Do not wash dishes or fruits in open water. Such simple rules, as well as taking care of your health and using dietary supplements (dietary supplements), will help you avoid contracting cholera. Before use, you should consult a specialist.

Reviews

Any of us in a past life could well have died from this infection.

I watched the film “The Painted Veil”, and it turns out that this kind of rubbish is cholera. I felt so sorry for the doctor! - the hero Edward Norton, immediately went to the Internet to look for information about this disease. I could not even imagine that the topic of cholera is still relevant today. You should never forget even about the most ancient diseases; viruses and bacteria are very insidious, they mutate and adapt. You never know what you might encounter tomorrow.

I wasn’t too lazy and looked for it myself: Cholera is typical for South and Southeast Asia (India, Indonesia, Thailand, etc.). In the 70s, it emerged from this region and became widespread. In 1970 there was a cholera epidemic in Astrakhan, in 1994 in Dagestan it affected 2,321 people, and in 1995 it largely affected Ukraine with the pathogen spreading to other regions.

Well, why are these realities not for our country? In Russia, there have also been outbreaks of cholera several times, in the middle zone and not so long ago. If you want, look for information and you will not be very pleasantly surprised and will no longer be so calm about it.

Just 3 days ago I had a situation that we usually call “being poisoned by something.” On Saturday morning it got so high that I barely had time to run...
I sinned on the lunchtime fish pie, on the evening pizza, and on the store-bought salads.
I didn’t feel sick, but I was very weak. And also terrible shortness of breath, which is not at all typical for me, a fairly trained person, although no longer young. I simply lacked oxygen, as if I were in the mountains at a good altitude.
At the same time, my mouth was constantly dry, and I drank a lot, after which I almost immediately ran to the toilet.
At first there was no temperature.
Due to the fact that I felt very bad, about 4 hours after initial symptoms artificially induced vomiting - I felt better almost immediately. After that I fell asleep almost immediately. When I woke up I felt my temperature rising. I tried it on - 37.7.
I never called a doctor; I took an intestinal antibiotic for a day.
On Sunday (the next day) my condition was as if I had nothing yesterday.
On Monday it got worse again.
Today (Tuesday) I decided to sit at home, the boss called - office building sealed, they found cholera bacillus.
I made an appointment with a therapist and will get tested right away...

So all this is not so far away and long ago and can reach us at any moment.

The name cholera is certainly familiar. But I never delved into what exactly this cholera means and how it proceeds. In general, we are not too interested in such diseases, because for us it is really just history. And for some countries this is reality today. It's good that it's not for us. It’s also very scary to imagine these medieval epidemics. After all, there weren’t really any medicines back then, and in general people had little idea how to deal with it.

Treatment cholera is mainly pathogenetic, aimed at restoring the disturbed water-salt balance in the patient’s body. Rehydration therapy is equivalent to resuscitation measures and is carried out in a volume corresponding to the loss of water and salts. Patients are injected intravenously with a stream (subsequently by drip) of saline solution No. 1 (5:4:1), containing 5 g of sodium chloride, 4 g of sodium bicarbonate () and 1 g of chloride per 1 liter of distilled or, better, double-distilled pyrogen-free water.

The amount of saline solution administered, depending on the degree of dehydration of the body and the patient’s condition, ranges from 10 to 20-30 liters or more per course of treatment (3-4 days).

If necessary (hyperkalemia), use solution No. 2 (6: 4), containing 6 g of sodium chloride and 4 g of sodium bicarbonate. These solutions are administered in cases of severe and moderate cholera. For mild forms of the disease, water-salt solutions are prescribed orally.

Antibiotics - oletethrin, chloramphenicol - are widely used in combination with pathogenetic agents. Tetracycline is prescribed in tablets of 300,000 units 4 times a day for 5 days; chloramphenicol - 0.5 g 4 times a day for 5 days.

Prevention. General sanitary measures are important: protection of water supply sources, preparation, storage and sale in public catering establishments, control of flies, removal and neutralization of sewage and garbage, instilling sanitary skills in the population. A decisive role belongs to measures for the sanitary protection of the territory of the USSR from the importation of cholera from abroad and its spread (see).

When cholera diseases appear, early detection and isolation of patients is necessary. In cholera outbreaks, door-to-door visits are regularly carried out in order to identify and immediately hospitalize in specially created isolated hospitals all persons suffering from gastrointestinal disorders. Patients with an established diagnosis of cholera are transferred to a cholera hospital. Persons who have come into contact with a cholera patient are also isolated in special rooms (isolators), in which bacteriological examination and emergency prophylaxis with antibiotics are carried out. In special hospitals, the necessary anti-epidemic regime is observed.

Persons traveling outside the outbreak are first sent to an observatory for the maximum incubation period (5 days), where a one-time bacteriological examination is required (see Observation).

For epidemic indications, cholera vaccine is used. It is administered starting from 2 years of age, twice subcutaneously with an interval of 7-10 days. Adults - 1.0 ml for the first vaccination and 1.5 ml for the second, children 2-5 years old - 0.3 ml and 0.5 ml, respectively, 5-10 years old - 0.5 ml and 0.7 ml, 10 -15 years - 0.7 ml and 1.0 ml. carried out after 6 months. at the dose of the first vaccination.

Doctors say that infectious diseases have killed more people throughout history human lives than continuous wars. The leading role in this belongs to especially dangerous infections, which include cholera. Thousands of people die from this disease every year, the exact number of deaths is difficult to calculate, and statistics are deliberately downplayed.

Why is cholera so difficult to fight? What features does this bacterium have? How does the infection occur and why does the disease claim millions of lives? How is cholera transmitted and what can be done to prevent it? What would be helpful for people traveling to countries with annual disease outbreaks to know?

What is cholera

Throughout the history of mankind, scientists have counted 7 massive outbreaks or pandemics of cholera, each of which claimed thousands and even millions of lives. Now hundreds and thousands of people die every year, depending on the area where the infection occurs.

But cholera was known in ancient times. Hippocrates and Galen also spoke about it in their works. In European countries, they became more interested in the causative agent of the disease in the 19th century, which contributed to a more thorough study of not only the causes and routes of transmission of cholera, but also measures to prevent the disease. Scientists believe that this was the impetus for improving the water supply system. The interest of biologists helped to discover two main variants of the pathogen - classical and El-Tor vibrio, named after the station where this species was discovered.

Due to frequent outbreaks of the disease and a large number of deaths, cholera is a particularly dangerous type of infection.

Therefore, the incidence rate is monitored annually by local health systems and WHO.

The causative agent of cholera

The infection is of the bacterial type, that is, the causative agent of cholera is bacteria. About 150 serogroups of vibrios are known in nature. But the cause of this serious illness is two variants of the pathogen - classic and El Tor.

Vibrio cholerae (vibrio cholerae) is a special type of bacteria in the form of straight or slightly curved rods with one or two flagella. They do not form spores or capsules, love an alkaline environment (therefore they prefer to reproduce in the human intestine), and are easy to grow in a laboratory. Another feature of bacteria is their high enzymatic activity, which helps them decompose many complex carbohydrates in the human body and not only.

The distinctive features of the causative agent of cholera are as follows.
Sensitive to dryness and light.
Vibrio cholerae does not feel comfortable in acid and quickly dies under the influence of antiseptics and conventional disinfectants.
It does not like high temperatures (it dies almost immediately when boiled) and the effects of antibiotics.
It persists for a long time in feces, bed linen, and soil.
The causative agent of cholera loves water, that is, it is able to survive there for a long time.
There are two important differences in the structure of bacteria - endo and exotoxins. These are protein-lipid structures that are the first to be released in the event of destruction of the pathogen.
Cholera toxin or exotoxin is its damaging factor, which leads to numerous changes in the human body, in particular, it is released in the intestines, which is why it is also called enterotoxin.

Bacteria are in environment and in the human body for years and even centuries.

Epidemiology of cholera

Cholera epidemics occur annually and involve millions of cases and thousands of deaths. The number of countries where it is not possible to get rid of the pathogen includes mainly developing ones. Southeast Asia is the leader in the number of cases. The countries of Africa and Latin America are not far behind them.

Sporadic cases of cholera (periodic outbreaks of the disease) are also observed in Russia. In most cases, these are imported infections or the result of the influence of neighboring countries.

WITH early XIX century, namely in 1816 and until the end of the 20th century in 1975, scientists counted 7 cholera pandemics, when the disease easily spread to many countries (Russia, India, England, USA, Japan). And although no more pandemics have been recorded yet, cholera is still among the most dangerous diseases, since it is not possible to destroy the pathogen.

Why can't you get rid of bacteria?

Without special treatment, vibrios are stable in the external environment.
The main risk factors for cholera infection are contaminated water, contact with a sick person or bacteria-transmitting agent, and consumption of contaminated foods. The disease still flourishes due to imperfect water supply systems in developing countries, lack of disinfection of sewage water and a large number of cholera bacteria. According to doctors, the number of the latter exceeds the number of sick people by 4 times.
Bacteria are able to mutate, which helps them become more resistant in the external environment. In the history of the development of infection, a case was recorded when cholera vibrio was re-isolated from sludge treated with disinfectants, but no cases of the disease were observed in humans.

Reasons for the spread of the disease

How can you get an infection? The transmission mechanism characteristic of cholera is fecal-oral, that is, through contaminated environmental objects. It is not always possible to perfectly treat all surfaces and household items around a sick person. At the same time, the pathogen, being around, is transmitted to healthy people through unwashed hands.

What are the routes of transmission of cholera?

Waterborne when swimming in open contaminated waters, if you drink water contaminated with cholera bacteria or wash food in such water. This path is considered the leading one.
Contact during communication or as a result of touching an infected person or bacteria carrier at the time the cholera pathogen is released into the environment.
Can a person become infected with cholera through food? - yes, it is called alimentary, when a person eats contaminated foods. Moreover, they themselves may contain cholera vibrios or the bacteria may get onto the products during processing when an infected person, say, sneezed on the product during active bacterial excretion.

What are the ways for bacteria to enter the human body during cholera? - only through the mouth. It has been established that many animals are capable of accumulating the causative agent of cholera and spreading it when they eat them. For example, unprocessed oysters, fish, shrimp and shellfish, in which the pathogen sometimes persists for years, can serve as a temporary reservoir of infection.

Another cause of cholera infection or one of the factors of infection transmission are insects, on whose body vibrios can be found after contact with a patient. Therefore, during the development of epidemics, it is better to avoid encounters with flies, cockroaches, and mosquitoes.

The reservoir of infection is always a sick person who can infect others for several weeks after the illness. People with mild, chronic forms of the disease during the period of exacerbation and bacteria carriers also play an important role in the spread of cholera.

What happens in the human body during cholera infection?

Cholera is a cyclic acute infection that may not develop if a person is absolutely healthy and the amount of pathogen that has entered the body is very small. This happens because one of the significant barriers to infection is the acidic environment of the stomach. Bacteria are not friendly with an acidic environment; they quickly lose their pathogenic properties in the gastric contents.

But, having reached the small intestine, the situation changes dramatically, because there is already an alkaline environment in which vibrios feel very comfortable. Some bacteria are destroyed along the way, releasing endotoxin. Some of them reach the intestines. With the help of special formations - fimbriae (small filamentous processes) they attach to the walls of the small intestine and remain here for a long time.

The pathogenesis of cholera is directly related to the action of exotoxin, which penetrates enterocytes through special active zones of small intestinal cells. This destructive factor leads to an imbalance in the functioning of enzyme systems. Therefore, a large amount of fluid and electrolytes begins to be released into the intestines, which include potassium, chlorine, sodium and other elements necessary for the body.

As a result of this action of the exotoxin, a sharp loss of fluid occurs, because all of it rushes out.

Degrees of dehydration in cholera

Repeated vomiting and diarrhea are important prognostic signs of cholera, thanks to which the severity of the infection and more can be determined. Based on the amount of fluid lost by the body per day, one can make a prediction regarding the consequences of the disease.

How many degrees of dehydration (dehydration) are there in cholera? There are 4 in total, but there are minor differences between children and adults.

I degree is characterized by fluid loss in adults from 1 to 3%, in children about 2%.
II degree - from 4 to 6%, in children up to 5%.
III degree - the total amount of fluid lost does not exceed 9%, for children the upper limit is 8%.
IV degree is critical, when a person loses moisture in the amount of 10% or more of the total body weight; in children, this degree is set if a loss of 8% or more has occurred.

Symptoms of cholera

The manifestations of the disease are practically no different when infected with classical vibrio and El Tor vibrio. The incubation period of cholera lasts on average 48 hours, the maximum is 5 days, and with the lightning-fast course of the disease it does not exceed several hours.

Typically, a distinction is made between mild, moderate and severe degrees of infection.

The classic version of the disease is a moderate course. The symptoms of cholera are as follows.

During an examination of a sick person, the doctor notes an increase in heart rate, a decrease in blood pressure, and dry tongue and skin. Sometimes the skin takes on a bluish tint (cyanotic).

Under ideal conditions, diarrhea lasts from a few hours to 1-2 days, and the frequency of stool depends on the severity of the disease.

Mild cholera

This is one of the most favorable courses of the disease.

Signs of mild cholera are:

diarrhea no more than 10 times during the day;
dry mouth, weakness and thirst;
vomiting may be absent or infrequent;
first degree dehydration;
all symptoms disappear within two days.

Cholera in this case ends with complete recovery without any complications.

Moderate infection

If in the first case patients often do not even go to the doctor, then the average degree of cholera will require medical care.

For medium degree The course of the disease is typical:

fast start;
frequent stools, up to 20 times a day, which gradually takes on the appearance of rice water;
despite diarrhea, abdominal pain may not bother a person, but tenesmus or false urge to go to the toilet are observed;
frequent vomiting, which is not preceded by nausea, as is the case with other infectious diseases;
thirst, cramps and severe general weakness;
second degree of dehydration of the body.

Severe cholera

One of the most dangerous courses of the disease is its severe degree. With this type of cholera, stools exceed 20 times a day. There is a sharp deterioration in the condition, a pronounced loss of fluid, in which there is dry skin, shortness of breath, cyanotic skin, a decrease in the amount of urine excreted per day (oliguria) to its complete absence (anuria). Dehydration corresponds to stage 3 of the disease.

As cholera progresses, a typical appearance sick person:

sunken eyes, increased dryness of mucous membranes and skin;
the skin on the hands wrinkles - “washerwoman’s hands”;
a person retains consciousness for a long time;
the amount of urine excreted decreases during the day, which indicates the onset of kidney problems;
spasms of individual muscle groups appear;
Body temperature may be within normal limits or slightly reduced.

If treatment is not started in a timely manner, the number of deaths from this form of cholera reaches 60%.

Other types of cholera

Cholera is an acute infection with diverse clinical manifestations. In addition to the classic course of the disease, there are several other forms that you need to know about.

The so-called dry cholera. It is characterized by an acute onset without diarrhea and vomiting. The danger of the disease is that dehydration and shock develop almost before our eyes. It is typical for weakened patients who already had any diseases before infection.
The fulminant form of cholera occurs over several hours or days. With this variant of the course of the disease, all of the above symptoms occur quickly, the person “burns out” right before our eyes.

These are the most unfavorable variants of the course of cholera, which in most cases end in death, even with timely treatment.

Features of the development of cholera in children

Children, like older people, belong to a special category of patients. Their immune system is not yet fully developed, so many infections proceed with some differences, and sometimes much more aggressively than in adults.

Cholera in children has the following differences.

The infection is especially severe in children in the first years of life.
Dehydration occurs faster, but its manifestations are not immediately noticeable. Clinical signs of dehydration are difficult to immediately detect even for a specialist.
Lack of potassium leads to various cramps, which occur more often.
During the height of cholera, children develop symptoms of brain dysfunction, which is manifested by lethargy and impaired consciousness.
Sometimes secondary infections occur against the background of the main one, so the body temperature is often elevated.

The child’s body is more difficult to tolerate a lack of fluid during the development of cholera, so even with a slight degree of dehydration, emergency assistance is required.

Diagnosis of infection

Diagnosis of cholera begins with clarifying the medical history, but in most cases it is carried out in stages.

Complications of cholera

Timely treatment started saved the lives of more than one person. But even high-quality assistance in full will not save you under certain conditions. What can interfere with recovery? - these are special forms of the disease.

The following complications of cholera are possible.

In weakened sick people, abscesses and phlegmon (purulent melting of tissues) are sometimes observed.
One of the rare, but quite possible, complications in modern conditions is sepsis or bacterial blood poisoning.
Dehydration shock in cholera develops in the case of IV degree dehydration. This condition is characterized by: diffuse cyanosis of the skin, when certain areas of the human body acquire a bluish tint (tip of the nose, ears, eyelids); decrease in body temperature to 34 ºC; the patient's voice becomes silent; the eyes sink, the eyelids darken, which in medicine is called the symptom of “dark glasses”; The patient is characterized by severe shortness of breath and tachycardia.
Deterioration of brain function with the development of coma.

Despite the severe course, the prognosis for the development of even severe forms of cholera can be favorable if treatment is carried out in full. In the case of fulminant forms, a large number of deaths are observed.

Treatment of cholera

Therapy should be started immediately. Treatment of cholera is carried out only in a hospital setting in specially equipped isolated boxes or in temporarily adapted rooms, which often happens in the event of epidemics.

An undoubted advantage is the possibility of using special etiotropic therapy, which is aimed directly at destroying the causative agent of cholera.

intravenous rehydration

What is prescribed when the disease develops?

Rehydration or restoration of fluid loss is carried out, for which water-salt solutions are used - with mild and moderate severity of cholera, patients are given them to drink; in severe cases, it is administered intravenously.
At the next stage, the water-mineral composition of the blood is corrected and the same solutions are prescribed.
From the very first days antibacterial drugs are prescribed medicines, the course of treatment is at least 5 days.
While the condition is improving, doctors do not recommend sticking to certain diets. Meals and frequency of meals are slightly adjusted.

Prevention

Prevention of cholera is carried out directly in the foci of infection and in countries with outbreaks of the disease. That is, it can be divided into emergency and planned.

Nonspecific prevention of cholera

Anti-epidemic measures for cholera are carried out at the source of infection.

In addition, sanitary and educational work is carried out among the population about the disease and the first actions if an infection is detected. Nonspecific prevention of cholera includes monitoring of bacteria carriers. They are regularly invited to the clinic for medical examinations. In case of bacterial excretion, a preventive course of treatment is carried out.

Vaccinal prevention of cholera

Adults are urgently administered a single dose of cholerogen or toxoid in a dose of 0.8 ml. The injection promotes the development of immunity in 95% of cases. According to epidemic indications, revaccination can be carried out no earlier than after 3 months, which provides 100% protection against cholera.

But nowadays there are more modern types of cholera vaccine - oral. them on this moment There are 3 types.

“WC/rBs vaccine” consists of killed whole bacterial cells. Taken twice with a break of a week. It is administered at any age, is well tolerated and provides protection in 90% of cases.
“Modified WC/rBs vaccine”, which is used in Vietnam.
“Vaccine against cholera CVD 103-HgR” is a weakened live defense against infection. Enter once.

Cholera vaccinations are done in a clinic, or you can contact the State Sanitary and Epidemiological Service yourself. In our regions, such protection can be obtained, depending on the indications, free of charge or at one’s own request for a fee if a person travels to countries or areas with an outbreak of cholera. There is one disadvantage of such immunization - it protects for only a few months, no more than six months.

The cholera vaccine is well tolerated, reactions are observed in the form of weakness, malaise, and minor muscle pain. It is advisable to think about protection against cholera in advance, and get vaccinated no later than 10 days before departure.

Why is cholera a particularly dangerous type? Because in a few hours it can take the lives of hundreds of people. It is easy to become infected, because the pathogen can be found not only in a sick person, but also in the environment. What can save a life? Correct prevention and timely treatment.