Cholera

Cholera-About Cholera:

Cholera is an acute diarrheal disease caused by Vibrio cholerae. The onset of the peak of the summer can cause diarrhea, dehydration and even death within a few hours. Clinical manifestations, after an incubation period of one to two days, sudden and painless watery diarrhea, and then there is often vomiting phenomenon. If you have nothing to add water and electrolytes, can cause shock. Treatment for the additional water and electrolytes and antibiotics. In addition to the improvement of public health prevention, vaccination before traveling to endemic areas. Cholera is one of the World Health Organization quarantine infectious diseases.

Cholera - Introduction
Cholera virus Cholera is an acute intestinal infection caused by Vibrio cholerae, acute onset, rapid spread, spread to a wide range of features, is one of the International Health Regulations, the provisions of international quarantine infectious diseases, the People's Republic of China on Prevention and Treatment of Infectious Diseases Act provided for one of the Group of infectious diseases. Clinically severe painless diarrhea spit Migan-like stool, severe dehydration, muscle cramps, and peripheral circulatory failure characterized. Vibrio cholerae consists of two biotypes, paleontology type and the El Tor biotype. The past, the former caused by the disease known as cholera, the latter caused by the disease known as cholera. 1962 World Health Assembly decided to include cholera in the International Health Regulations, a quarantinable infectious disease "cholera, and the same treatment with cholera.

Cholera - classification
The spread of cholera and symptoms according to the degree of dehydration, blood pressure, pulse and urine, how much is divided into four types.

Light
Only short-term diarrhea, no typical Migan Shui stools, performance was not dehydrated, normal blood pressure, pulse, urine output is slightly less.

Medium-sized
The typical symptoms of the body and typical stool, dehydration significantly, pulse rate, blood pressure, urine output, seldom a day 500ml below.

Heavy
Patients with extreme weakness or confusion, severe dehydration and shock, the pulse rate can not be touched, blood pressure decreased or undetectable in urine with little or no urine may be the occurrence of typical symptoms a few hours after death.

Fulminant
Called dry cholera, abrupt onset, ranging from the typical symptoms of diarrhea spit, due to circulatory failure and death.

Vibrio cholerae in the only way to enter the body through the diet by the oral cavity through the stomach into the small intestine. Acid the bacteria are very sensitive, and therefore the majority killed by stomach acid, and only those who enter the alkaline environment of the small intestine through the gastric acid barrier and a small number of Vibrio adhesion to intestinal epithelial cell surface through the surface of the small intestinal mucus layer, and breeding to produce exotoxin nature of cholera toxin, causing intestinal fluid secretion, resulting in severe diarrhea and vomiting reflex.

Cholera - clinical performance
Cholera patients infected, a larger proportion of latent infection. Dominant infected persons to light cases as much, this is particularly evident in the El Tor cholera. The disease's incubation period can be a few hours to 5 days to 1 to 2 days for the most common. The majority of patients with abrupt onset, no prodromal symptoms. Course of the disease generally can be divided into three:

Diarrhea spit period
Diarrhea spit a period of sudden diarrhea, followed by vomiting. General no significant abdominal pain, no tenesmus flu. Caused by severe diarrhea spit fluid and electrolyte loss, circulatory failure, the performance drop in blood pressure, weak pulse, hemoglobin and plasma specific gravity was significantly increased, and decreased urine output or no urine. The body of organic acids and nitrogen excreted by the disorder, patients are often the early symptoms of acidosis and uremia. Sodium and potassium and other electrolytes in the blood loss in patients with systemic electrolyte imbalance. Lack of sodium can cause the meat cramps, particularly in the gastrocnemius and rectus abdominis is the most common. Potassium deficiency can cause low potassium syndrome, such as generalized muscle hypotonia, tendon reflexes, drum intestine, tachycardia, arrhythmia. Considerable loss of bicarbonate ions, metabolic acidosis, severe confusion, decreased blood pressure.

Dehydration collapse of
Dehydration collapse of the patient's appearance is very obvious, severe cases, sunken eyes, a hoarse voice, dry skin shrinkage, elastic disappear abdominal subsidence was scaphoid, dry tongue, thirst, cold extremities, body temperature often dropped to normal following muscle spasms or convulsions. Patients in critical condition, but if a timely and proper rescue can still save the day, gradually returning to normal.

Convalescence
A small number of patients (more common in children), there may be a febrile response, the body temperature rises to 38 ~ 39 ℃, usually lasts 1 to 3 days to subside on their own, therefore the period, also known as the reaction period. Course of an average of 3 to 7 days.

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Cholera - Medical diagnosis
Differential diagnosis of cholera virus
Cholera diagnosis of the clinical manifestations, epidemiology, history and pathogen check based on three. Serology for retrospective diagnosis after the disease will not help in early diagnosis. The light is not typical of cholera cases differential diagnosis difficult. Generally only mild diarrhea without vomiting, blood pressure, pulse normal, conscious, short course in thirty-two days to heal itself. Fulminant cholera or cholera dry, relatively rare, seen after the onset of vomiting and diarrhea or dehydration, but quickly transferred to a state of shock and severe toxic circulatory failure, high mortality rate.

Activities in the week before the summer and autumn of condensable patients should be asked in detail about the disease, whether from infected areas, the availability of patients and their pollutants touch the history of the disease, and whether or not to accept the vaccination, the combination of epidemiological data the clinical and laboratory examination can make a diagnosis, where clinical diarrhea vomit symptoms or unexplained diarrhea patients should take a stool or vomitus specimens, as soon as possible pathogen diagnosis, including microscopy, culture, separation, the agglutination test and other qualification test.

Diagnostic criteria
, Can be diagnosed as cholera with one of the following conditions:

1, where symptoms such as diarrhea, vomiting, stool culture positive Vibrio cholerae.

Two cholera epidemics in the affected areas with typical symptoms of cholera stool culture negative for no other reason to be investigated.

3, vomiting and diarrhea symptoms, Vibrio cholerae culture negative for 2 serum antibody titers of serum agglutination test was more than four times higher.

Suspected of standard
1, where the typical symptoms of diarrhea spit PFAs Road cases, pathologic examination before diagnosis.

Two cholera epidemics of previous exposure to cholera patients, diarrhea and no other reasons to be investigated.

In the non-affected areas, where there are typical symptoms of diarrhea spit, pathologic examination determined, during the cholera epidemic had come into contact with cholera patients, diarrhea and no other reason to be investigated, should be highly suspected cholera positively at the same time, should be stool culture every other day, 3 consecutive negative, can negate the diagnosis and make the epidemic corected report.

 

Cholera - Treatment
The cholera epidemic caused by the tragic story of a Group of infectious diseases, isolation and treatment. Critically ill patients should be in place to rescue, health care workers, accompanied to designated isolation ward to be in stable condition. Diagnosed and suspected cases should be separately isolated.

2, mildly dehydrated patients, mainly oral rehydration.

3, heavy dehydrated patients, immediate intravenous infusion to rescue, to be in stable condition, reduce the degree of dehydration, vomiting stopped and changed to oral rehydration.

4, while fluid therapy given antimicrobial treatment to reduce diarrhea and shorten the waiting period bacteria. Drug source and cause epidemic Vibrio cholerae antimicrobial susceptibility, selected a commonly used antimicrobial agents, stool culture to check negative.
Cholera - prevention of Note
1, the management of the source of infection: Set intestinal clinic, the timely detection of the isolation of patients, so that early diagnosis, early quarantine and early treatment, early reporting, contacts and observing five days, for 3 consecutive negative stool before the lifting of isolation.

2, cut off the routes of transmission: the strengthening of health promotion, and actively carry out the mass of the Patriotic Health Campaign, manage water, food, deal with feces, the eradication of the flies, to develop good health habits.

3, protection of vulnerable populations: active exercise, and increased disease resistance, can be a cholera vaccination, but the effect is not ideal, the ideal oral vaccine are being studied.