Cholera measures. How dangerous is cholera: symptoms, treatment

And intoxication. During illness, a person loses up to 40 liters of fluid per day, which can lead to fatal dehydration. Every year, 3-5 million people fall ill with cholera, about 100-150 thousand of them die.

The spread of cholera. Until 1817, only the inhabitants of India suffered from cholera, but then the disease spread beyond its borders. Today it is registered in 90 countries around the world. Despite all the efforts of doctors, cholera still cannot be defeated. In Africa, Latin America, and Southeast Asia, there are constant outbreaks of the disease. This is due to the unsanitary conditions in which people live. There is a high risk of contracting cholera among tourists visiting Haiti, the Dominican Republic, Cuba, and Martinique.

Most often, the disease breaks out after social disasters, earthquakes or other natural disasters. When a large number of people find themselves without drinking water. Wastewater ends up in bodies of water where people get water for cooking and where they wash. In such conditions, if one person gets sick, then others become infected. Therefore, cholera occurs in the form of epidemics, when up to 200 thousand people fall ill.

Properties of the pathogen. Bacteria produce toxins that damage the lining of the small intestine. It is with the action of bacterial poisons that electrolyte imbalance and dehydration are associated.

The toxins released by Vibrio cholerae have the following properties:

• destroy the epithelium of the small intestine;
• cause abundant release of water into the intestinal lumen. This fluid is eliminated from the body in the form of bowel movements and vomiting.
• interfere with the absorption of sodium salts in the intestines, which leads to disruption of the water-salt balance and to convulsions.

The optimal temperature for bacteria to live is 16-40 degrees. Vibrio cholerae feels best at a temperature of 36-37°C. Therefore, it actively develops in the human body and in small bodies of water in tropical countries. It is resistant to low temperatures and does not die when frozen.

Vibrio cholerae dies when dried, exposed to sunlight, heated to 60°C or higher, or in contact with acids. Therefore, people with high acidity of gastric juice rarely get sick. It dies quickly when treated with acids and disinfectants.

The causative agent of cholera loves an alkaline environment. Vibrio cholerae can live in soil, on contaminated foods and objects for several weeks. And in the water for several months.

Life cycle of Vibrio cholerae.

• Bacteria enter the human body with food and water.
• Some of them die in the stomach, but some overcome this barrier and end up in the small intestine.
• In this favorable alkaline environment, the vibrio attaches to the cells of the intestinal mucosa. It does not penetrate into the cells, but remains on the surface.
• Vibrio cholerae multiply and release the toxin CTX. This bacterial poison binds to the cell membranes of the small intestine and causes changes in their functioning. The exchange of sodium and chlorine in the cells is disrupted, which leads to the release of large amounts of water and salt ions into the intestinal lumen.
• Dehydration of cells leads to disruption of communication between them and death. Dead mucosal cells are removed from the body along with cholera vibrios.

Causes of cholera

Source of infection:

• a sick man;
• a bacteria carrier that secretes Vibrio cholerae, but has no signs of disease.

In a sick person, the feces and vomit are transparent and do not have a characteristic appearance or smell. Therefore, traces of contamination go unnoticed, which leads to the rapid spread of infection.

Mechanism of transmission of cholera fecal-oral – a sick person releases bacteria during vomiting and diarrhea. Penetration into the body of a healthy person occurs through the mouth. It is impossible to become infected with cholera through airborne droplets.

Transmission routes:

• Water (basic) – through water contaminated with feces. In warm fresh and salt water bodies contaminated with sewage, the concentration of bacteria is very high. People become infected by drinking water and while swimming. It is dangerous to wash dishes and food with such water.
• Contact-household - through objects, door handles, dishes, linen, contaminated with vomit or feces of the patient.
• Food - through oysters, mussels, shrimp, dairy products, fruits, fish and meat dishes that have not undergone heat treatment. Bacteria get onto food through dirty water, from carriers or through flies.

Risks of developing cholera

• Swimming in polluted bodies of water, washing dishes in them, drinking water.
• Eating seafood, especially raw shellfish.
• Visiting countries with a low standard of living, where there is no running water and sewerage, and sanitary standards are not observed.
• Large refugee camps with poor sanitation and no safe sources of drinking water.
• Wars, social cataclysms, when there is a shortage of drinking water.
• At risk are people suffering from gastritis with low acidity and achylia (a condition in which the gastric juice lacks hydrochloric acid).

Preventing cholera

What to do if you are at high risk of developing cholera?

In order to stop the spread of cholera, it is very important to isolate the sick person in a timely manner, taking appropriate precautions. This allows you to avoid infecting healthy people. The State Sanitary and Epidemiological Supervision bodies have developed special instructions in case of a high risk of cholera development.

1. All cholera patients and bacteria carriers are isolated in a special hospital or isolation ward. They are discharged after the symptoms of the disease disappear and three bacteriological examinations are performed with an interval of 1-2 days. Tests should confirm that there are no bacteria in the intestines.
2. They identify everyone with whom the patient has been in contact, take tests three times and administer chemoprophylaxis - a short course of antibiotics. Those who were in close contact are isolated in special boxes.
3. Disinfection is carried out in the room where the patient was and in his workplace. To do this, they call a disinfection team from the center of the State Committee for Sanitary and Epidemiological Surveillance. Disinfection is carried out no later than 3 hours after hospitalization of the patient.
4. The team carrying out disinfection puts on a type 2 anti-plague suit (overall) with oilcloth sleeves and an apron, a hood, and a respirator.
5. Disinfectant solutions are used to disinfect the floors and walls of premises to a height of 2 meters. For this use: chloramine 1%, sulfochloranthine 0.1-0.2%, Lysol 3-5%, perhydrol.
6. Clothes, bedding, carpets and other soft items are packed into bags and sent for disinfection in a disinfection chamber. The dishes are soaked in a 0.5% chloramine solution for 30 minutes.
7. In the department, the patient is given an individual bedpan, which after each use is soaked in a disinfectant solution: 1% chloramine for 30 minutes or 0.2% sulfochlorantine for 60 minutes.
8. In a hospital, clothes, dishes and bed linen are disinfected by boiling for 5-10 minutes or immersed in a 0.2% solution of sulfochlorantine for 60 minutes.
9. At least 2 times a day, the room where the patient is located is cleaned using disinfection solutions of 1% chloramine, 1% sodium hypochlorite.
10. Remains of food and the patient's secretions are covered with bleach in a ratio of 1:5.
11. Medical staff caring for a cholera patient is wearing a type IV suit - overalls with a hood. When taking tests and treating patients, add rubber gloves, an oilcloth (polyethylene) apron, rubber shoes and a mask.

What to do if you have had or are in contact with a person with cholera?

Those who had close contact with the patient (living together) are isolated in special boxes for 5 days. During this period, intestinal contents are examined three times.

The rest of the contacts are observed on an outpatient basis: for 5 days they come for examination and take tests.
For emergency prevention, when contact with a patient or carrier has taken place, one of the antibiotics is used.

A drug	Frequency of reception	Duration of treatment
Tetracycline	1.0 g 2-3 times a day	4 days
Doxycycline	0.1 g 1-2 times a day	4 days
Levomycetin	0.5 g 4 times a day	4 days
Erythromycin	0.5 g 4 times a day	4 days
Furazolidone (if intolerant to antibiotics)	0.1 g 4 times a day	4 days

People who have been in contact with the patient do not need to take special hygiene measures. It is enough to take a shower once a day and wash your hands thoroughly after each visit to the toilet.

Cholera vaccination

The World Health Organization recommends the use oral vaccines during disease outbreaks. WHO experts do not recommend the use of drugs that are injected under the skin due to their unproven effectiveness.

The vaccine is not a universal means of protection. It is just an addition to other anti-epidemic measures (isolation of patients, identification and treatment of contacts and carriers, exclusion of the spread of bacteria, preventive treatment, disinfection).

Vaccine Dukoral (WC-rbs)

A vaccine made from cholera vibrios and their toxin killed by formaldehyde and heat. The vaccine is administered with a buffer solution to protect the drug from the effects of stomach acid. Give 2 doses of the vaccine with an interval of 7 days. Dukoral provides 85-90% protection for 6 months. Over time, the effectiveness of the vaccine weakens - after 3 years it is only 50%. Applicable from 2 years of age.

Oral cholera vaccines Shanchol and mORCVAX

Vaccines from killed Vibrio cholerae of two serogroups without toxin components. Bacteria trigger protective reactions, leading to the appearance of stable immunity that protects against the disease for 2 years. The vaccination consists of 3 doses, which are administered at intervals of 14 days. The effectiveness of the vaccines is 67%. The vaccine can be administered to children starting from one year of age.
Studies have shown the safety and effectiveness of these vaccines.

Vaccine CVD 103-hgr from live weakened cholera vibrios has been discontinued.

Who is recommended for vaccination:

• refugees in overcrowded camps;
• urban slum dwellers;
• children in high-risk areas;
• persons who travel to regions with a high risk of cholera.

Vaccination is not required for tourists.

Symptoms and signs of cholera

The incubation period of cholera. From the moment of infection until symptoms appear, it takes from several hours to 5 days. Most often 1-2 days.

Degrees of cholera. The disease can occur in different forms, depending on the characteristics of the body. For some people, these are erased forms with minor digestive upset. Others lose up to 40 liters of fluid during the first day, which leads to death. Cholera is more severely affected by children and the elderly.

There are 4 degrees of dehydration of the body and the corresponding degrees of the disease:

• I – fluid loss is 1-3% of body weight – mild cholera, observed in 50-60% of cases;
• II – fluid loss 4-6% - moderate;
• III – fluid loss 7-9% - severe;
• IV – fluid loss of 10% of body weight or more - very severe, 10% of cases.

The disease always begins against the background of complete health. The temperature is usually not elevated, and with dehydration it drops below 36 degrees. The duration of the disease is 1-5 days.

Symptoms of cholera

Symptom	External signs	The mechanism of development of this symptom	Timing of appearance and disappearance of this symptom
Diarrhea (diarrhea)	The stool is loose at first. Then the discharge takes on the appearance of “rice water”: a clear, odorless liquid with white flakes. If the intestinal mucosa is severely damaged, then a slight admixture of blood appears and the stool looks like “meat slop”. The urge to defecate is almost impossible to control. Depending on the degree of dehydration, stool from 3 to 10 or more times a day. There are no abdominal pains. There may be slight soreness around the navel and slight rumbling.	Vibrio cholerae toxin causes swelling of the intestinal mucosa. Then the cells begin to secrete large amounts of water and electrolytes.	Diarrhea occurs from the first hours of illness. If the stool becomes fecal in nature, this indicates improvement.
Vomit	Vomiting stomach contents for the first time. Subsequently, profuse vomiting of watery liquid without color or odor. Vomiting from 2 to 20 or more times. There is no nausea. Vomiting causes virtually no tension in the muscles of the stomach and abdominal muscles.	The fluid secreted in the small intestine rises up the gastrointestinal tract.	Vomiting occurs 3-5 hours after the onset of the disease.
Thirst	With 1-3 degrees of dehydration, thirst is severe. At stage 4, patients cannot drink due to severe weakness.	Losing a lot of fluid causes a dry mouth and thirst.	Throughout the course of the disease.
Urine	The amount of urine decreases and it darkens.	The more fluid the body loses, the less urine is produced and the higher its concentration. With severe dehydration, patients stop urinating.	On the second day of illness. Normalization of urination indicates that the treatment is effective and the patient’s condition is improving.
Dryness of the mucous membranes of the mouth and eyes	Decreased amount of saliva produced. The tongue is dry, cracked. Hoarseness is the result of dry mucous membranes in the throat. The eyes are sunken, almost no tears come out	Dehydration leads to dry skin and mucous membranes. The work of all external secretion glands slows down.	10-15 hours after the onset of the disease.
Convulsions	Calf muscles, hands, facial muscles. With severe dehydration of degrees 3 and 4, cramps of all skeletal muscles. They are excruciating and painful.	Muscle spasms are associated with potassium deficiency, which is caused by diarrhea and vomiting.	From the 1st day of illness until the condition improves.
Pulse	Frequent pulse of weak filling.	The loss of fluid and bases leads to thickening of the blood, a decrease in its volume, an increase in its acidity - acidosis develops. The heart, by increasing the rate of contractions, tries to provide the body with oxygen.	For dehydration of 2-4 degrees. The pulse returns to normal after the water-salt balance is restored.
Increased breathing	Breathing is frequent and shallow.	The change in breathing rate is associated with the effect of acids on the nervous system and the respiratory center in the brain.	Appears with 2nd degree dehydration several hours after the onset of the disease.
Skin turgor (elasticity)	The skin is dry, pale, and in severe cases, bluish. Cold to the touch. Its elasticity is reduced. If you squeeze a fold of skin with two fingers, hold for 2 seconds and release, it will take time for the skin to even out.	The reason is skin dehydration. In the cells themselves and in the intercellular space, the number of water molecules decreases.	Appears 6-8 hours after the onset of the disease. Disappears after restoration of water-salt balance.
General state	Drowsiness, lethargy, irritability	Loss of strength is a sign of dehydration of the nervous system and poisoning of the body with toxins.	From the first hours of illness until recovery.

Diagnosis of cholera

Diagnosis of cholera is based on examination of the patient and the presence of characteristic symptoms (vomiting after diarrhea, dehydration). It takes into account whether a person could have become infected with cholera. Due to the nature of the disease, there is no need for instrumental diagnostics. The diagnosis is confirmed by laboratory diagnostic methods.

To diagnose cholera, the following material is examined:

• excreta;
• vomit;
• water from supposedly polluted water bodies;
• food that may have been contaminated;
• washouts from household items and the environment;
• intestinal contents of contacts and carriers;
• in those who died from cholera, fragments of the small intestine and gall bladder.

Laboratory methods for diagnosing cholera

Diagnostic method	How it is produced	What are the signs of cholera?
Microscopy of the material under study	A small amount of the test material is applied to a glass slide. They are stained with aniline dyes using the Gram method and examined under a microscope.	A large number of curved rods with one flagellum. Vibrio cholerae is a gram-negative bacteria, so it is not stained firmly with aniline dyes. Has a pink color.
Bacteriological research - inoculation on nutrient media.	The test material is inoculated on nutrient media: alkaline peptone water or nutrient agar. To reproduce Vibrio cholerae, the media are placed in a thermostat. At a temperature of 37 degrees, optimal conditions are created for bacterial growth.	A film of bacteria forms on liquid media. They are studied under a microscope. Live cholera vibrios are very mobile. In a drop of liquid they swim like a school of fish. On a thick medium, bacteria form round, bluish, transparent colonies.
Agglutination reaction with anticholera O-serum	Bacteria grown on media are diluted in test tubes with peptone water. Anticholera serum is added to one of them. The test tube is placed in a thermostat for 3-4 hours. To determine the type of vibrio cholerae, there are sera that cause gluing and precipitation of only one type of vibrio Inaba and Ogawa. Each of these species sera is added to one of the test tubes with Vibrio cholerae.	The serum causes agglutination only of Vibrio cholerae. The bacteria stick together and precipitate in the form of white flakes. A positive result proves that the disease is caused by this pathogen and not by another cholera-like vibrio.
Accelerated diagnostic methods take 25-30 minutes
Lysis (dissolution) by cholera bacteriophages - viruses that infect only Vibrio cholerae.	Bacteriophages are added to a test tube with peptone water. The liquid is stirred. Then a drop of it is examined under a microscope.	Viruses infect bacteria and after 5-10 minutes cholera vibrios lose their mobility.
Agglutination of chicken red blood cells	Chicken erythrocytes 2.5% are added to peptone water with a high content of the cholera pathogen.	Vibrio cholerae causes red blood cells to stick together. A precipitate in the form of reddish-brown flakes falls at the bottom of the test tube.
Hemolysis (destruction) of sheep red blood cells	Sheep erythrocytes are added to a test tube with a suspension of bacteria. The drug is placed in a thermostat for 24 hours. Vibrio cholerae causes the destruction of blood cells.	The solution in the test tube becomes homogeneous and turns yellow.
Immunofluorescent method	A preparation is prepared from material grown on nutrient media. It is treated with anticholera serum, which causes Vibrio cholerae to glow, and is examined under a fluorescent microscope.	Under a microscope, vibrios cholerae glow with a yellow-green light.
Method of immobilization of vibrios after treatment with specific cholera 01 serum	A drop of material (stool or vomit) is placed on a glass slide. A drop of diluted anticholera serum is also added there. Cover with a second glass and examine under a microscope.	Some bacteria stick together, forming small clusters that move slowly. Individual cholera vibrios retain their mobility.

Treatment of cholera

Hospitalization of patients. Treatment of cholera patients is carried out only in the infectious diseases department of the hospital in an isolated box. If there are a lot of patients, a cholera hospital is organized.

Regimen for the treatment of cholera. The patient needs bed rest for the entire period of the illness, as long as there are clinical manifestations: nausea, vomiting, weakness. It is advisable to use a Philips bed with a hole in the buttock area. It is also equipped with a scale to monitor fluid loss and a container to collect stool, urine and other secretions. Everything goes into a measuring bucket. Every 2 hours, the medical staff assesses the amount of fluid that the patient loses. Based on this, they calculate how many saline solutions need to be administered to prevent dehydration.
Physiotherapy, massage and physical therapy are not used in the treatment of cholera.

Diet for cholera. There are no special dietary restrictions. In the first days of illness, diet No. 4 is prescribed. It is indicated for intestinal diseases accompanied by severe diarrhea. These are liquid, semi-liquid and pureed dishes, boiled or steamed.

Prohibited:

• soups with strong meat and fish broths, milk soups
• fresh bread and flour products
• fatty meats and fish, sausages, canned food
• whole milk and fermented milk products
• legumes, millet, barley and pearl barley, pasta
• raw vegetables and fruits, dried fruits
• sweets, honey, jam
• coffee, carbonated drinks

Recommended:

• soups on low-fat broth with the addition of steamed quenelles and meatballs, egg flakes. Mucous decoctions of cereals
• water porridge made from semolina, pureed rice, oatmeal, buckwheat
• crackers from premium wheat bread
• boiled meat soufflé, steamed cutlets, quenelles, meatballs. Use lean meats: rabbits, chickens, turkeys, beef, veal
• fresh calcined or unleavened mashed cottage cheese in the form of steam soufflé
• 1-2 eggs per day as an omelet or soft-boiled
• tea, decoction of rose hips, dried blueberries, currants, quince

Such a strict diet is prescribed for 3-4 days until stool normalizes. Then they switch to diet No. 15. It does not have strict restrictions.

Prohibited:

• fatty meats
• spicy seasonings
• smoked meats

After an illness, foods containing potassium are needed: jacket potatoes, dried apricots, black currants, grapes. Potassium reserves are replenished in the body slowly. Therefore, these products must be consumed within 2 months.

Drug therapy for cholera

Restoring water-salt balance must be carried out from the first hours of illness. It is important that the body receives more fluid than it loses.

Water-salt solution drink or enter into the stomach using a nasogastric tube in case of dehydration of 1-2 degrees. Solution components:

• drinking water heated to 40 degrees - 1 l;
• sodium bicarbonate (baking soda) - 2.5 g;
• sodium chloride (table salt) - 3.5 g;
• potassium chloride - 1.5 g;
• glucose or sugar - 20 g.

You can use ready-made preparations Glucosolan, Regidron, one glass every 10 minutes for 3 hours. Next, the solution must be drunk constantly, in small sips throughout the day.

Saline solutions necessary for grades 3 and 4 dehydration. For the first 2 hours they are administered intravenously as a stream, after that by drip. Use the drugs Chlosol, Quartosol or Trisol. They replenish the deficiency of water and minerals.

Antibiotics for cholera. To combat Vibrio cholerae, one of the drugs is prescribed.

Nitrofurans. Furazolidone is an antimicrobial and antibacterial agent. It is taken 100 mg every 6 hours if antibiotics are intolerant.

The duration of treatment depends on the severity of cholera and is 3-5 days. After an illness, a person has a strong immune system.

Dispensary observation over those who have recovered, it is set for 3 months. In the first month you need to take tests once every 10 days. In the future, once a month.

Traditional methods of treating cholera.

Since cholera is a particularly dangerous infection and can cause death within the first day, self-medication in this case is unacceptable. Traditional methods can be used as an addition to primary therapy.

Warming. Since the patient’s body temperature decreases, it is necessary to warm him up. For this purpose, the person is covered with heating pads. The room temperature is maintained at least 25 degrees.

Periwinkle used to combat diarrhea and disinfect the intestines. To prepare tea, brew 1 teaspoon of dried raw material with a glass of boiling water. After cooling, the tea is filtered. Take 100 ml 3 times a day.

Red wine contains a lot of tannin, which stops the growth and reproduction of Vibrio cholerae. It is recommended to drink 50 ml of its dry wine every half hour.

Herb tea from chamomile, wormwood and mint. Herbs are mixed in equal proportions. To prepare tea, use 5 tablespoons of the mixture per liter of boiling water. Drink 2 liters a day in small portions. This remedy has an antimicrobial effect and relieves intestinal spasms.

Malt. Add 4 tablespoons of malt per liter of water. Boil for 5 minutes. Let it brew, filter, add 2 tsp. Sahara. This drink contains many minerals and biologically active substances.

Therefore, it was previously used to replenish fluids and salts.

In conclusion, let us remind you that protecting yourself from cholera is not difficult. It is enough to wash your hands and use clean water.

Follow the rules of hygiene and be healthy!

is an acute intestinal infection that occurs when a person is infected with Vibrio cholerae. Cholera is manifested by severe frequent diarrhea, profuse repeated vomiting, which leads to significant loss of fluid and dehydration of the body. Signs of dehydration include dry skin and mucous membranes, decreased tissue turgor and wrinkling of the skin, sharpening of facial features, and oligoanuria. The diagnosis of cholera is confirmed by the results of bacteriological culture of feces and vomit, and serological methods. Treatment includes isolation of the cholera patient, parenteral rehydration, and therapy with tetracycline antibiotics.

ICD-10

A00

General information

Cholera is a particularly dangerous infection caused by the enteropathogenic bacterium Vibrio cholerae, which occurs with the development of severe gastroenteritis and severe dehydration up to the development of dehydration shock. Cholera has a tendency to spread epidemically and has a high mortality rate, therefore WHO classifies it as a highly pathogenic quarantine infection.

Most often, epidemic outbreaks of cholera are recorded in the countries of Africa, Latin America, and Southeast Asia. According to WHO estimates, 3-5 million people become infected with cholera every year, and about 100-120 thousand cases of the disease are fatal. Thus, today cholera remains a global health problem.

Causes of cholera

Characteristics of the pathogen

To date, more than 150 types of Vibrio cholerae have been discovered, differing in serological characteristics. Vibrio cholerae is divided into two groups: A and B. Cholera is caused by vibrios of group A. Vibrio cholerae is a gram-negative, motile bacterium that secretes heat-stable endotoxin as well as heat-labile enterotoxin (cholerogen) during its life.

The pathogen is resistant to environmental influences, remains viable in a flowing body of water for up to several months, and up to 30 hours in wastewater. A good nutritional medium is milk and meat. Vibrio cholerae is killed by chemical disinfection, boiling, drying and exposure to sunlight. Sensitivity to tetracyclines and fluoroquinolones has been noted.

Transmission routes

The reservoir and source of infection is a sick person or a transient carrier of the infection. Bacteria are most actively released in the first days with vomit and feces. It is difficult to identify infected individuals with mild cholera, but they pose a risk of infection. In the area where cholera is detected, all those in contact are examined, regardless of clinical manifestations. Infectivity decreases over time, and usually by the 3rd week recovery and freedom from bacteria occurs. However, in some cases, carriage continues for up to a year or more. Concomitant infections contribute to prolongation of the carriage period.

Cholera is transmitted through household (dirty hands, objects, dishes), food and water via the fecal-oral mechanism. Currently, flies play a special role in the transmission of cholera. A waterway (a contaminated water source) is the most common. Cholera is an infection with high susceptibility; infection most easily occurs in people with hypoacidosis, some anemia, infected with helminths, and alcohol abusers.

Symptoms of cholera

Dyspepsia

The incubation period for infection with Vibrio cholerae lasts from several hours to 5 days. The onset of the disease is acute, usually at night or in the morning. The first symptom is an intense, painless urge to defecate, accompanied by an uncomfortable feeling in the abdomen. Initially, the stool has a liquefied consistency, but retains its fecal character. Quite quickly, the frequency of bowel movements increases, reaching 10 or more times per day, while the stool becomes colorless and watery.

With cholera, the stool is usually not foul-smelling, unlike other infectious bowel diseases. Increased secretion of water into the intestinal lumen contributes to a noticeable increase in the amount of excreted feces. In 20-40% of cases, the stool takes on the consistency of rice water. Typically, stool appears as a greenish liquid with white, loose flakes similar to rice.

Often there is rumbling, seething in the stomach, discomfort, and fluid transfusion in the intestines. The progressive loss of fluid in the body leads to symptoms of dehydration: dry mouth, thirst, then a feeling of coldness in the extremities, ringing in the ears, and dizziness. These symptoms indicate significant dehydration and require emergency measures to restore water-salt homeostasis in the body.

Since diarrhea is often accompanied by frequent vomiting, fluid loss is exacerbated. Vomiting usually occurs several hours later, sometimes on the next day after the onset of diarrhea. Vomiting is profuse, repeated, begins suddenly and is accompanied by an intense feeling of nausea and pain in the upper abdomen under the sternum. Initially, remnants of undigested food are noted in the vomit, then bile. Over time, the vomit also becomes watery, sometimes taking on the appearance of rice water.

When vomiting, the body rapidly loses sodium and chlorine ions, which leads to the development of muscle cramps, first in the muscles of the fingers, then in all limbs. As electrolyte deficiency progresses, muscle cramps can spread to the back, diaphragm, and abdominal wall. Muscle weakness and dizziness increase to the point of inability to get up and go to the toilet. At the same time, consciousness is completely preserved.

Severe pain in the abdomen, unlike most intestinal infections, is not observed with cholera. 20-30% of patients complain of moderate pain. Fever is not typical; body temperature remains within normal limits, sometimes reaching low-grade levels. Severe dehydration is manifested by a decrease in body temperature.

Dehydration

Severe dehydration is characterized by pale and dry skin, decreased turgor, cyanosis of the lips and distal phalanges of the fingers. Dryness is also characteristic of the mucous membranes. With the progression of dehydration, hoarseness of voice is noted (the elasticity of the vocal cords decreases) up to aphonia. Facial features become sharper, the stomach retracts, dark circles appear under the eyes, the skin on the fingertips and palms wrinkles (the “washerwoman’s hands” symptom). Physical examination reveals tachycardia and arterial hypotension. The amount of urine decreases.

Dehydration of the body differs in stages:

• at the first stage, fluid loss does not exceed 3% of body weight;
• on the second - 3-6%;
• on the third - 6-9%;
• at the fourth stage, fluid loss exceeds 9% of body weight.

With a loss of more than 10% of body weight and ions, dehydration progresses. Anuria occurs, significant hypothermia occurs, the pulse in the radial artery cannot be palpated, peripheral blood pressure is not determined. At the same time, diarrhea and vomiting become less frequent due to paralysis of the intestinal muscles. This condition is called dehydration shock.

The increase in clinical manifestations of cholera can stop at any stage, and the course can be erased. Depending on the severity of dehydration and the rate of increase in fluid loss, cholera is classified into mild, moderate and severe. Severe cholera occurs in 10-12% of patients. In cases of lightning-fast progression, the development of dehydration shock is possible within the first 10-12 hours.

Complications

Diagnostics

Severe cholera is diagnosed based on the clinical picture and physical examination. The final diagnosis is established on the basis of bacteriological culture of feces or vomit, intestinal contents (sectional analysis). The material for sowing must be delivered to the laboratory no later than 3 hours from the moment of receipt; the result will be ready in 3-4 days.

There are serological methods for detecting infection with Vibrio cholerae (RA, RNGA, vibrocidal test, ELISA, RCA), but they are not sufficient for final diagnosis, being considered methods for accelerated tentative identification of the pathogen. Accelerated methods for confirming a preliminary diagnosis can be considered luminescence-serological analysis, dark-field microscopy of vibrios immobilized with O-serum.

Treatment of cholera

Since the main danger with cholera is the progressive loss of fluid, its replenishment in the body is the main goal of treating this infection. Treatment of cholera is carried out in a specialized infectious diseases department with an isolated ward (box) equipped with a special bed (Philips bed) with scales and utensils for collecting feces. To accurately determine the degree of dehydration, their volume is recorded, the hematocrit, the level of ions in the serum, and the acid-base indicator are regularly determined.

Primary rehydration measures include replenishing the existing deficiency of fluid and electrolytes. In severe cases, intravenous administration of polyionic solutions is performed. After this, compensatory rehydration is performed. The introduction of fluid occurs in accordance with its losses. The occurrence of vomiting is not a contraindication to continued rehydration. After restoring the water-salt balance and stopping vomiting, antibiotic therapy is started. For cholera, a course of tetracycline drugs is prescribed, and in case of repeated isolation of bacteria, chloramphenicol.

There is no specific diet for cholera; in the first days, table No. 4 may be recommended, and after severe symptoms subside and intestinal activity is restored (3-5 days of treatment), a diet without any special features. Those who have had cholera are advised to increase potassium-containing foods (dried apricots, tomato and orange juices, bananas) in their diet.

Prognosis and prevention

With timely and complete treatment, recovery occurs after suppression of the infection. Currently, modern drugs are effective against Vibrio cholerae, and rehydration therapy helps prevent complications.

Specific prevention of cholera consists of a single vaccination with cholera toxin before visiting regions with a high incidence of this disease. If necessary, revaccination is carried out after 3 months. Nonspecific measures to prevent cholera imply compliance with sanitary and hygienic standards in populated areas, at food establishments, and in areas where water is collected for the needs of the population. Individual prevention consists of maintaining hygiene, boiling water, washing food and proper cooking. If a case of cholera is detected, the epidemiological focus is subject to disinfection, patients are isolated, all contact persons are observed for 5 days to identify possible infection.

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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 vomits. 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.
Since I was feeling very bad, about 4 hours after the initial symptoms I 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 - the office building was 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 the reality of 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.

• Headache.
• Increased body temperature (up to 37.1-38°C), which is accompanied by mild chills. As the disease progresses, the patient experiences a decreased body temperature (up to 34-35.5 ° C).
• Diarrhea (loose stools, diarrhea) - profuse, watery. The stool may have a greenish, yellowish or brown tint.
• Vomit.
• Minor pain and rumbling in the stomach, feeling of bloating.
• Discomfort in the umbilical region, a feeling of fullness and fluid transfusion in the intestines.
• Dehydration is manifested by dry skin and mucous membranes.
• Pale skin and blue lips.
• Feeling thirsty.
• Muscle weakness.
• Muscle cramps (usually masticatory and calf muscles).
• Low arterial (blood) pressure.
• Tachycardia (rapid heartbeat).
• Hoarseness of voice.

Incubation period

From 4 hours to 5 days.

Forms

The severity of the disease is determined by the degree of dehydration of the body.

• Light form:
  • ​ loose stools (2-5 times a day);
  • dry mouth;
  • increased thirst;
  • muscle weakness;
  • satisfactory general condition of the patient;
  • after 1-2 days, the main clinical signs of the disease disappear.

• Moderate course:
  • ​ loose stools (15-20 times a day);
  • vomit;
  • slight pain in the navel area is possible;
  • Treatment prescribed by a doctor ensures complete recovery in 2-3 days.

• Heavy or extremely severe form:
  • ​ loose and copious stools (25-35 times a day);
  • frequent vomiting;
  • severe muscle cramps;
  • a feeling of fullness and fluid transfusion in the intestines;
  • decreased body temperature and arterial (blood) pressure;
  • disturbance of urination up to its complete cessation;
  • high risk of death.

In addition to the typical course of the disease, there are quite often atypical forms.

• Erased form characterized by a minimal set of symptoms that are expressed implicitly and transient. The general condition of the patient, as a rule, is not disturbed. Patients with this form are especially dangerous for healthy people around them because they do not seek medical help and actively release the pathogen into the environment.
• For "dry" form characterized by a high risk of death; There is no diarrhea or vomiting despite the fact that the intestinal tract is filled with water. This is due to the rapid development of paresis (paralysis) of the intestinal muscles - diarrhea simply does not have time to develop.
• Lightning form characterized by a rapid increase in symptoms; several hours pass from the onset of the disease to the development of hypovolemic shock (a sharp drop in blood pressure, inhibition of all body functions, up to the development of coma). This form is characterized by a high risk of death.

Causes

The source of infection is a sick person or carrier. Patients with erased and mild forms of cholera who remain socially active are especially dangerous.
Infection occurs:

• by nutritional means, that is, by eating contaminated foods: vegetables, fruits, herbs washed with contaminated water; seafood that has not undergone sufficient heat treatment (shellfish, shrimp, dried and lightly salted fish); products contaminated during their preparation, packaging or distribution due to non-compliance with sanitary and hygienic standards (through dirty hands);
• by water: when swallowing water when swimming in polluted waters or while washing;
• through household contact: if the rules of personal hygiene are not followed, the pathogen gets onto household objects through dirty hands and is subsequently transmitted to a healthy person (also through dirty hands the pathogen can get onto food and then into the gastrointestinal tract).
• Outbreaks of the disease usually occur in the summer-autumn period.

Diagnostics

• Epidemiological history: the fact of the patient being in the outbreak of the disease, swimming in natural reservoirs, etc. is established.
• Analysis of complaints and medical history: presence of vomiting, nature and frequency of diarrhea, abdominal pain and other factors.
• Bacteriological method: inoculation of feces and vomit on nutrient media, followed by microscopic examination of the grown colonies and identification of Vibrio cholerae. At the same time, the sensitivity of the microorganism to various groups of antibiotics is determined (antibioticogram), which is important for prescribing adequate treatment.
• Serological methods of testing blood for the presence of antibodies (specific proteins of the immune system, the main function of which is to recognize the pathogen (virus or bacteria) and its further elimination) to the pathogen.
• A consultation with an epidemiologist is also possible.

Treatment of cholera

• Antibacterial drugs, taking into account the identified sensitivity of the microorganism to various antibiotics.
• In case of severe dehydration, intravenous administration of water-salt solutions and glucose is prescribed.
• Probiotics (preparations containing microorganisms related to normal intestinal microflora) to normalize digestion.
• Those who have recovered from cholera are under medical supervision for 1 year.

Complications and consequences

• Hypovolemic shock (a drop in arterial (blood) pressure to low numbers followed by the development of coma).
• Acute renal failure (impairment of all kidney functions, leading to disruption of water, electrolyte, nitrogen and other types of metabolism. This disorder is usually reversible).
• Muscle cramps.
• Changes in the myocardium (myocardial infarction in the elderly).
• Phlebitis (inflammation of the vein walls).
• Pneumonia (pneumonia).
• Respiratory failure.
• Cerebrovascular insufficiency.
• Development of carriage: a state of constant presence of the cholera pathogen in the body of a person who has recovered from the disease, not accompanied by clinically pronounced symptoms of the disease (typical for older people).
• After an illness, the body of those who have recovered develops immunity, but this does not exclude the possibility of infection with other types of bacteria. Vibrio cholerae(For example, cholera-like diarrhea ).

Preventing cholera

• Compliance with sanitary and hygienic measures (washing hands, drinking clean water, heat-treated food, etc.).
• Refusal to visit regions where cholera outbreaks have been reported.
• Storing food in places protected from insects. It is known that flies from landfills and garbage cans carry pathogens of various intestinal infections on their legs.
• Disinfection of an apartment after hospitalization of a patient.
• Hospitalization of persons who had close contact with the patient for medical observation.
• Disinfection of wastewater.
• Study of water for Vibrio cholerae in places of water intakes and mass bathing.
• Vaccination in areas of outbreak (Dukoral or Shanchol vaccine).

Doctors say that infectious diseases have claimed more lives throughout human existence 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.

1. Sensitive to dryness and light.
2. Vibrio cholerae does not feel comfortable in acid and quickly dies under the influence of antiseptics and conventional disinfectants.
3. It does not like high temperatures (it dies almost immediately when boiled) and the effects of antibiotics.
4. It persists for a long time in feces, bed linen, and soil.
5. The causative agent of cholera loves water, that is, it is able to survive there for a long time.
6. 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.
7. 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.
8. Another feature of Vibrio cholerae is that it can exist peacefully in the human body for a long time thanks to antigens (flagellar or H and heat-stable or endotoxin O).

Bacteria are present in the 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.

From the beginning of the 19th century, namely in 1816, 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?

1. Without special treatment, vibrios are stable in the external environment.
2. 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.
3. 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?

1. 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.
2. 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.
3. 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.

1. I degree is characterized by fluid loss in adults from 1 to 3%, in children about 2%.
2. II degree - from 4 to 6%, in children up to 5%.
3. III degree - the total amount of fluid lost does not exceed 9%, for children the upper limit is 8%.
4. 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 attention.

The moderate course of the disease is characterized by:

• 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, the typical appearance of a sick person is characteristic:

• 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.

1. 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.
2. 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.

1. The infection is especially severe in children in the first years of life.
2. Dehydration occurs faster, but its manifestations are not immediately noticeable. Clinical signs of dehydration are difficult to immediately detect even for a specialist.
3. Lack of potassium leads to various cramps, which occur more often.
4. During the height of cholera, children develop symptoms of brain dysfunction, which is manifested by lethargy and impaired consciousness.
5. 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.

1. In weakened sick people, abscesses and phlegmon (purulent melting of tissues) are sometimes observed.
2. One of the rare, but quite possible, complications in modern conditions is sepsis or bacterial blood poisoning.
3. 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.
4. 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?

1. 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.
2. At the next stage, the water-mineral composition of the blood is corrected and the same solutions are prescribed.
3. From the very first days, antibacterial drugs are prescribed, the course of treatment is at least 5 days.
4. 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. There are currently 3 types of them.

1. “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.
2. “Modified WC/rBs vaccine”, which is used in Vietnam.
3. “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.