cholera in adults

This infection in just a few hours can lead to a critical level of dehydration, resulting in failure of all organs and systems.

What is cholera

This is a particularly dangerous infection that affects the entire body. Particularly pathogenic cholera vibrios affect the digestive tract at the level of the stomach and small intestine, provoking severe gastroenteritis, severe dehydration, which leads to the formation of dehydration shock.

Cholera is an extremely contagious infection, it provokes epidemics, has a high percentage of deaths, therefore it is classified as quarantine and highly pathogenic worldwide.

To date, cholera outbreaks occur in Africa, Southeast Asia or Latin America. Up to 5 million people are ill with this infection every year, and about 100 thousand people die.

Causes of cholera in adults

The main cause of cholera is infection with pathogenic vibrio cholerae in case of non-compliance with sanitary and hygienic rules. Most often affected are the poorest countries, where the level of water supply is extremely low, there are problems with nutrition, quality food preparation and its storage.

The causative agent of cholera

This infection is caused by the enteropathogenic vibrio cholerae (Vibrio cholerae). To date, more than 150 different strains of this bacterium have been discovered, which differ in their microbiological characteristics. They are divided into two groups – option A or B. The causative agent of cholera are strains of type A. This is a mobile gram-negative bacterium that, when it enters the lumen of the digestive system, releases toxins – a thermostable endotoxin and a thermolabile cholerogen (enterotoxin).

The bacterium is quite resistant to adverse environmental conditions, can easily survive in running water for several months, and lives in wastewater for up to 30 hours or more. The nutrient medium for vibrio is meat or milk. But the bacterium dies under the action of boiling, disinfectants, sunlight, and drying. Sensitive to antibiotics from the group of fluoroquinolones and tetracyclines.

Ways of transmission of cholera in adults

The main source of pathogens are sick people or carriers of bacteria. A lot of cholera vibrios are excreted by a person during the first days with vomiting and stool. It is especially difficult to identify those people who carry cholera easily, as they are especially dangerous in terms of spreading the disease. Therefore, in the foci where the infection is detected, all people who have been in contact with the patient are examined, even if they do not have a single symptom. The degree of contagiousness of patients gradually decreases, by the third week of infection, the body is cleared of bacteria and the person recovers. But in some people who have been ill, the carriage of the bacteria lasts for about a year or more. This is usually facilitated by existing diseases.

Cholera pathogens can be transmitted through utensils and household items, dirty hands, as well as through contaminated water and food. In addition, these bacteria actively spread flies.

People of any age are susceptible to the disease, but it can be especially difficult for children, people with anemia, people who take alcohol, and have parasitic diseases.

Forms of cholera

Doctors distinguish several forms of cholera depending on a key classification criterion.

According to the features of the clinical picture, the following forms can be distinguished:

• typical cholera with lesions of the gastrointestinal tract;
• atypical form (possible in those suffering from alcoholism, during pregnancy, against the background of immunodeficiencies, taking antibiotics, vaccination against cholera, starvation).

With atypical forms, one can distinguish:

• fulminant course – begins quickly, vomiting and stools are very frequent, shock from dehydration can occur in the first 3 – 6 hours of illness;
• dry form with a violent onset and the onset of coma and toxicosis even before the onset of diarrhea;
• erased form – begins smoothly, gradually, diarrhea 1-3 times a day with mushy stools, mild weakness and malaise (in this case, it is possible to make a diagnosis only according to laboratory data, or during an epidemic based on data on contact with a sick person);
• asymptomatic form – there are no clinical signs of infection, but cholera vibrios are determined in the analyzes.

Separately, the carriage of cholera vibrios is distinguished. It can be in several versions:

• convalescent carriage is typical of people recovering from cholera;
• transient – typical for healthy individuals who are in the focus of infection, but the body successfully suppresses the pathogen at an early stage (lasts up to 3 months);
• chronic carriage – vibrio is determined in the body for more than 3 months.

According to the severity of the course of the disease, 4 degrees of cholera are distinguished. The condition is assessed based on three key criteria – damage to the digestive tract, severity of dehydration and complications.

Easy degree. With a little intoxication, minimal weakness, lethargy. Diarrhea and vomiting occur no more than 4-5 times a day, last no more than 3 days. There are no signs of visible dehydration, complications are not noted. This infection lasts up to 5 days.

Medium severity. Intoxication is moderate, vomiting with diarrhea is recorded up to 15 times per day, they last at least 3 days. The degree of dehydration is within 1-2 degrees, complications may occur, the infection lasts within 5-7 days.

Severe degree. It is typical for 10% of all patients – severe intoxication, diarrhea with vomiting occur up to 20 times a day, last more than 3 days. Dehydration is defined as 2-3 degrees, serious complications are formed, the infection lasts more than a week.

Extremely severe. With a sharp, sudden onset with indomitable diarrhea and vomiting literally in the first hours of illness, a state of shock quickly develops.

The severity of dehydration also determines the general condition and plans for treatment. Therefore, it is important to know the signs of dehydration that are typical for each degree.

• I degree – fluid loss is about 1 – 3% of body weight, patients have dry mucous membranes, thirst, variable pulse;
• II degree – loss of fluid in the range of 4 – 6%, thirst is expressed, the skin is pale and very dry, cyanotic, elasticity, elasticity are reduced, the voice is hoarse, the heartbeat is frequent, the pressure is lowered, cramps of the calf muscles occur;
• III degree – fluid loss within 7 – 10%, skin and all mucous membranes are bluish, dry, facial features are pointed, eyes sink, the skin of the hands is wrinkled, the voice is lost, convulsions, palpitations are typical, pressure is reduced, there is practically no urine;
• IV degree – fluid loss of more than 10%, symptoms develop at lightning speed, pressure drops sharply, temperature is below normal, the skin of the body turns blue, eyes are sunken, with dark circles, convulsions occur, dehydration shock develops.

Symptoms of cholera in adults

Basically, the symptoms of cholera are manifested by signs of dehydration, as well as dyspeptic manifestations.

The disease begins acutely, in the early morning or at night. First of all, there is an indomitable urge to defecate, which leads to extreme soreness in the abdomen. At first, the stool may be liquefied, with fecal masses, but rather quickly becomes watery and colorless. The frequency of stool discharge increases to 5-10 times a day, and in severe condition up to 20-40 or more.

The stools are odorless, increasing the release of water into the lumen of the small intestine leads to the loss of a large volume of fluid with the stool. In 40% of patients, the stool looks like “rice water”, or it is a greenish liquid with white flakes. There is a seething and rumbling of the abdomen, fluid transfusion. The constant loss of fluid leads to signs of dehydration. These are dry mouth, intense thirst, cold hands and feet, ringing in the ears, dizzy spells.

Due to frequent vomiting, fluid loss progresses rapidly. Vomiting usually occurs after a few hours or the next day after the onset of diarrhea. It is repeated and profuse, develops suddenly, with severe nausea and pain in the pit of the stomach. First, there are food particles in the vomit, then only liquid and bile impurities. Gradually, the vomit becomes watery, similar to rice water. Due to the loss of salts, cramps are formed in the muscles, initially in the area of ​​​​the fingers, then the arms and legs as a whole. If salt loss intensifies, convulsive contractions capture the diaphragm, back, and anterior wall of the abdomen. Weakness and dizziness lead to the fact that the patient cannot get up, go to the toilet, but the mind remains clear.

With cholera, there is no severe abdominal pain, about a third of patients report slight discomfort. There is also no high temperature, and against the background of dehydration, it generally decreases.

Severe fluid loss leads to signs of dehydration. The skin is very dry, turns pale, its tone decreases, lips and fingers and toes turn blue. The mucous membranes of the mouth and eyes are also very dry, the voice becomes hoarse or completely sits down due to the dryness of the vocal cords. Facial features become sharp (Hippocratic mask), the stomach is drawn in, circles form under the eyes. The skin on the hands wrinkles – the “washerwoman’s hands” develop, one of the typical signs of cholera. There is a frequent heartbeat and severe hypotension, urine almost ceases to stand out.

Treatment of cholera in adults

In view of the special danger of cholera, treatment is necessary for all patients with the introduction of quarantine measures and the isolation of all contacts until they are fully examined.

Patients with signs of cholera are placed in infectious boxes, isolating from all other patients.

Diagnostics

In severe cholera, the diagnosis can be made on the basis of typical symptoms and physical examination. But the final diagnosis is made after bakposev stool and vomit with the release of cholera vibrio.

Serological diagnostic methods with the determination of antibodies to cholera vibrios have a retrospective value. Rapid methods for the detection of antigens of cholera vibrios (latex agglutination reaction, coagglutination, PCR) are guidelines before starting therapy

Modern treatments

One of the main dangers in the development of cholera is the loss of fluid, so the main goal of treatment is to adequately replenish the losses. The patient for the period of treatment is in the intensive care unit in an isolated box, where there are special Philips beds with weighing capabilities and dishes for collecting stool and vomit. This is necessary for accurate accounting of the volume of losses, and an adequate calculation of the injected solutions.

If the condition is not very severe, the introduction of electrolyte solutions is prescribed to make up for the lack of fluid and salts. If it is severe cholera, polyionic solutions are simultaneously injected into both cubital veins, and sometimes into additional veins (subclavian, etc.), the loss of salts and fluids is corrected by the volume of vomit and diarrhea, taking into account the patient’s weight.

After stopping vomiting and restoring fluid balance, tetracycline antibiotics and fluoroquinolones are used.

As the condition improves, the patient needs to eat right, a treatment table No. 4 is prescribed, and as the condition improves, a gradual transition to normal nutrition. After cholera, you need to consume more foods with potassium.

Prevention of cholera in adults at home

In the foci of the possible spread of cholera, specific immunization is carried out according to epidemiological indications.

Among non-specific preventive measures, one can single out strict adherence to all sanitary norms and rules for cooking and storing food, fighting flies, boiling water for drinking, and proper washing of food before eating.

Popular questions and answers

We discussed with infectious disease doctor Tatyana Kovaleva danger of cholera, risks of complications and important nuances of its treatment.