Cholera: symptoms, causes diseases. Full information about pathology

Insanitary

Cholera – an acute anthroponoses bowel disease caused by Vibrio cholerne in which are formed the symptoms of diarrhea with the development of dehydration and demineralization prone to the pandemic, the mechanism of transmission – fecal-oral.

History

Cholera has plagued man since ancient times. Even in the manuscripts describing the campaigns of Alexander the great, find the description of this disease.

A cholera epidemic has decimated the population of Asia, and in the eighteenth century they reached Europe. The reason for this is the active development of trade and diplomatic relations. In the nineteenth century, Europe has experienced five pandemics, and in the XX – two.

First identified and described the causative agent, R. Koch in 1883. In 1905 was found one Vibrio cholerae known as El tor, under the name of the station in which it is detected.

Before antibiotics the treatment was carried out only by the infusion of fluids and was ineffective.

Prevention of cholera for the first time United the country on medical grounds. In 1851 in Paris hosted the First international sanitary conference, which brought together representatives of twelve States.

Etiology

Cause of disease is Vibrio cholerae, there are about 150 strains. They are divided into group A and group B. the first group includes pathogens that cause disease, and the second non-pathogenic microorganisms.

Bacteria of group A in their morphology (appearance) are divided into two biovars of Vibrio eltor and Vibrio asiaticae.

The antigens located on the surface of cells, are divided into subgroups A, b and C, as they behave differently in the experiment with the serum. By combination of these antigens isolated serovar Ogawa (A+B), Inaba (A+C) and Hiroshima (A+B+C). View El tor is able to hemolysate (destroyed) blood.

Vibrio cholerae looks like movable curved wand with a long flagellum. Easily destroyed in acidic environments but can tolerate slightly alkaline. In open water lives up to several months, and in the wastewater is about 30 hours.

The reason for the wide distribution of microorganism – higher survival rate. Easily withstands low temperatures, excess of salts, but is killed by acid, boiling, direct sunlight.

Source of infection – person. The mechanism of transmission – fecal-oral. The way – water and contact. Particularly easy the microorganism is transferred through the water, as it dilutes the acidic environment of the stomach, allowing the pathogen to penetrate this barrier.

Vibrio cholerae is distributed in southern Asia. The variant El tor is common in Southeast Asia.

The cause of the disease in Russia – bringing the microorganism of epidemic areas.

One of the factors of transmission are flies.

Pathogenesis

Bacteria gets into the human digestive tract with contaminated water, food or dirty hands. Most of them are killed in the acidic environment of the stomach. By reducing secretion of hydrochloric acid, for example, when hypoacid gastritis, Vibrio overcome this barrier and enter the intestine. Thanks to the flagellum, it quickly colonizes.

Alkaline environment contributes to their reproduction. Once infected, the microorganisms are attached to the cells of the intestine, where their toxins trigger a cascade of biochemical reactions. The result is the secretion in the lumen of the intestine of large amounts of water and salts. So there are the main symptoms of diarrhea.

Toxins also cause increased peristalsis of the bowel wall. Then, in connection with the loss of potassium ions peristalsis is inhibited first, and then the waves are sent in the opposite direction. This explains the hospital vomiting with the disease.

The reason for the rapid loss of salts and fluids – diarrhea and vomiting. Therefore, decreasing amounts of circulating blood (hypovolemia and haemoconcentration), disturbed nutrition of tissues (hypoperfusion), accumulate acidic decomposition products (acidosis).

Symptom of disease

The incubation period lasts from several hours to five days.

The main symptoms of cholera: profuse diarrhea, vomiting and dehydration.

Cholera starts suddenly, with painless diarrhoea. Gradually, the stool frequency increases and is up to 10 times per day. Due to the large amount of fluid allocation quickly lose their faecal character, becoming colourless, odourless, reminiscent of the murky water with loose flakes (so-called chair of the type "rice broth").Few hours attaches abundant sudden vomiting without qualms.

Occurs and progresses the sense of thirst, weakness, lack of appetite. Large losses of water and electrolytes occurs clinic stun when the patient becomes lethargic, sluggish.

During the illness due to the loss of sodium and chlorine ions appear weakness, cramps in muscles, dizziness. Blood pressure falls,accelerated heartbeat, reduced urination. Lack of potassium is manifested in muscular weakness, disorders of the heart muscle, spasm of the gut wall.

Symptoms of severe dehydration: the skin grows cold and pale, acquires a bluish tinge, facial features sharpened, fingers wrinkled ("washerwoman hands").

With a loss of 10% body weight stops palpable pulse is not determined by pressure, diarrhea and vomiting stops due to paralysis of the bowel.

Symptoms of severe dehydration: the skin grows cold and pale, acquires a bluish tinge, facial features sharpened, fingers wrinkled ("washerwoman hands").

For cholera were characterized by fever. On the contrary, with the increase of dehydration temperature will fall.

Depending on the percentage of fluid loss from a human body, VI Pokrovsky identified four severity of illness:

  • up to 3 % – I degree,
  • up to 6% – II degree,
  • to 9% third degree,
  • more than 9% – IV degree.

The degree of hypovolemia depends on the treatment.

Depending on the fluid loss and clinical picture there are three forms of the disease:

  • In mild stool frequency of up to 10 per day, vomiting up to 3 times the duration of the disease up to two days. Fluid loss is not more than I degree. Bother symptoms are thirst and weakness.
  • Disease of moderate severity is characterized by a chair 20 times a day, which takes on the appearance of rice-water, frequent vomiting. Fluid loss of II-III degree. Reducing the frequency of urination. The patient complains of thirst, cramps in the muscles of the legs. The skin is dry, cyanotic extremities, its elasticity decreases. Blood pressure falls, heart rate moderately high.
  • In severe form of the disease the patient loses more than 9% of the fluid mass body, develop symptoms of hypovolemic shock. Facial features are sharp, "hands of laundress", skin cyanotic. The pressure is reduced, sometimes not detected, tachycardia, pulse is difficult. The body temperature is reduced.

Atypical forms of the flow:

  • "Dry" or hypertoxic occurs in immunocompromised people. Develop severe intoxication and its complications, death occurs before the diarrhea and vomiting, treatment is difficult.
  • Lightning has a rapid formation of a picture of hypovolemic shock.

Complications

  • The development of inflammatory diseases: pneumonia, abscesses, abscesses.
  • Thrombosis of the veins of the extremities, stroke, myocardial infarction and other organs, mechanism of clotting of the blood and its clotting.
  • Because of the hypovolemic shock develops acute renal failure, join cardiovascular complications.

Diagnostics

In severe forms the diagnosis of cholera is based on the clinic and identify ways of transmission, causative agent only confirms the assumption.

With light and erased produce stool cultures on nutrient mass to highlight the culture. It takes up to 48 hours and is crucial to diagnosis.

Express-methods are the application of special serums, toxins which the bacteria form a sediment.

In order to clarify the strain is carried out serological methods of diagnosis.

To determine the degree of severity of a disease control the hematocrit level and pH of plasma.

Treatment

A suspected cholera – indication for emergency hospitalization in infectious diseases hospital.

Goals of therapy – prevention of hypovolemia and the destruction of Vibrio.

When I and II degree dehydration prescribe oral rehydration glucose-salt solutions, for example, "Regidron".

With III-IV degrees intravenously, including inkjet, poligonnye infuse isotonic crystalloid solutions, such as "Kvartasol", "Chlosol" in the amount of 10% of body weight. Once cropped the main symptoms, move on to oral rehydration.

In parallel to the treatment of dehydration begin treatment with antibiotics. Efficient use of doxycycline 200-300 mg/day or a fluoroquinolone for 5 days. Children under 12 years and pregnant prescribe furazolidone 400 mg/day course for 7-10 days.

Our ancestors believed that cholera treatment is not without the red flannel belt.

Prevention

Includes improvement of sanitary-hygienic conditions of life of the population, especially in the areas of spread of the disease. This concept includes control of the transmission, especially water. For example, supplying the population with drinking water, disinfection of wastewater.

Information about disease outbreaks is collected by the who staff, then sent to all countries to take measures to control imported cases.

Who reports, the seventh cholera pandemic started in 1961, continued until today.

Persons from endemic areas who have identified the symptoms of intestinal infections are placed under surveillance.

Prevention in the outbreak of the disease:

  • quarantine or restriction of movement,
  • diagnosis of cholera, the isolation and treatment of cases and carriers,
  • disinfection in the outbreak,
  • prophylactic treatment of contact persons.
Before you travel to the area of infection is recommended to be vaccinated against this disease, this will eliminate the possibility of infection.

Survivors of the disease face for three months under the supervision of medical staff,to exclude the possibility of transmission to uninfected persons. Bacteriological examination is first performed with a frequency of 1 times in 10 days, then 1 times a month.

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