Cholera

Cholera is an acute infectious disease. It is characterized by the development of watery diarrhea and vomiting, disturbed water-electrolyte metabolism, development of hypovolemic shock, impaired renal function. Refers to especially dangerous infections.

Etiology, pathogenesis. The causative agent is a cholera vibrio of two varieties. The effect of exotoxin of cholera vibrio on the epithelium of the mucous membrane of the small intestine is caused by the loss of fluid by the body. Morphological changes in epithelial cells and underlying tissues of the intestinal wall are not available.

Symptoms, course. The incubation period lasts from several hours to five days. The disease begins acutely: with the appearance of diarrhea, which is later joined by vomiting. The chair becomes more frequent, the bowel movements lose their fecal character and smell, become watery. Desires for defecation are imperative, patients can not keep their bowel movements. Discharge from the intestine by form resemble a rice decoction or represent a liquid colored with bile in yellow or green. Relatively often in the secretions there is an admixture of mucus and blood. Vomit has the same chemical composition as the secretion from the intestine. It is a liquid colored in yellow, without an acid sour. Loss of fluid during vomiting and diarrhea quickly leads to dehydration of the body, resulting in changes in the appearance of the patient; Facial features are sharpened, the mucous membranes of the mouth are dry, the voice becomes hoarse, the skin loses the usual tour-mountains and easily gathers into folds, develops cyanosis of the skin and mucous membranes. There are tachycardia, shortness of breath, heart tones become muffled, blood pressure decreases, and the amount of urine decreases. Often there are tonic convulsions, painful cramps of the muscles of the extremities. When palpation of the abdomen, the transfusion of the liquid through the intestine is determined, increased rumbling, and in some cases, the splash of the liquid. Palpation is painless. Body temperature is normal. With the progression of the disease, the patient develops a serious condition characterized by a decrease in body temperature to 34-35.5 ° C, extreme dehydration (patients lose 8-12% of body weight), hemodynamic disorders, dyspnea. Skin coloring in these patients becomes ashen smudge, the voice is absent, the eyes are sunken, the sclera is dull, the look is unblinking. The stomach is retracted, the stool and urination are absent. In the blood due to thickening, high leukocytosis, an increase in the content of hemoglobin and erythrocytes, a hematocrit index, an increase in the relative density of plasma are noted.

Recognition in the outbreak of cholera in the presence of characteristic manifestations of the disease is not difficult. Diagnosis of the first cases of cholera in an area where it was not previously recorded is always difficult and requires mandatory bacteriological confirmation.

The treatment is carried out at the hospital, but in some cases it can be started at home at urgent indications. Patients with extreme dehydration and hypovolemic shock phenomena (blood pressure drop, severe tachycardia or absence of palpable-defined pulse, dyspnea, cyanosis, absence of urine) immediately begin the jet intravenous injection of warm (38-40 g C) sterile saline to compensate for lost fluid and salts Solution of Trisol type (1000 ml of sterile pyrogen-free water, 5 g of sodium chloride, 4 g of sodium hydrogen carbonate, 1 g of potassium chloride). In some cases, if venipuncture is not possible, a venesection is performed. During the first hour, patients with hypovolemic shock phenomena are injected with a salt solution in an amount equal to 10% of the body weight (with a patient weight of 75 kg-7.5 liters of solution), and then transfer to a drip solution at a rate of 80-100 drops per minute . The total volume of injected saline is determined by the amount of liquid lost with bowel movements and emetic masses (for example, if the patient lost 3 liters of fluid 2 hours after the end of the jet infusion, he needs to inject the same amount of saline during the same period). When pyrogenic reaction to the injected saline solution (chill, increase in body temperature), the fluid is injected more slowly, and 1-2 ml of a 2% solution of promedol and 2.5% of a solution of pipolpene or 1% of a solution of diphenhydramine are administered via the IV infusion system. With more pronounced reactions, 30-60 mg of prednisolone is administered IV.

When vomiting is discontinued, patients are prescribed tetracycline orally 0.3 g4 times a day for 5 days. Material for bacteriological examination is taken before the appointment of tetracycline. Cardiac glycosides, prsornye amines, plasma, blood, colloidal solutions apply dpy. Removal of patients from hypovolemic shock in cholera is not recommended.

The prognosis with the timely begun treatment of patients with cholera, including with extremely severe course, is favorable.

Prevention. If suspected of cholera, patients are immediately hospitalized. If such patients are identified at home, in a hotel, in transport, the doctor prior to their hospitalization takes measures to isolate patients from surrounding people and immediately reports the disease to the chief doctor of their institution. The head doctor informs about the sanitary-epidemiological station and the department (city, district) of public health. Simultaneously, they make a list of persons who have come into contact with the patient; After hospitalization of the patient they are placed in the office for contact. In the room where the patient was cholera, after his hospitalization, the final disinfection is carried out.