Cholera in children

Cholera is an acute intestinal infection caused by cholera vibrios, characterized by gastroenteritis with rapid dehydration of the body due to the loss of water and electrolytes with vomit and loose stools.

ICD-10 code

• A00.0 Cholera caused by Vibrio cholerae 01, biovar cholerae.
• A00.1 Cholera caused by Vibrio cholerae 01, biovar eltor.
• A00.9 Cholera, unspecified.

Epidemiology of cholera

The source of infection in cholera is only a sick person or a vibrio carrier. A cholera patient, releasing 10 ⁶ -10 ⁹ highly virulent vibrios in 1 g of feces during the acute period of the disease, is most dangerous if undisinfected feces end up in open water bodies used for drinking water supply. However, the greatest epidemiological danger is posed by patients with latent forms of the disease and vibrio carriers. Healthy (transient) vibrio carriers currently pose the main danger of importing cholera to countries where it has not been previously recorded. The water route of infection is of the greatest importance. In addition, infection can occur when consuming infected milk, fish, shrimp, meat and other products. The contact-household route of transmission of infection is possible in case of neglect of sanitary and hygienic standards and at present is not of decisive importance in the spread of cholera, which is mainly due to the rapid detection and isolation of patients and vibrio carriers. The minimum infectious dose of the pathogen in cholera is 10 ¹¹ microbial bodies.

Classification

There are typical and atypical forms of cholera. Depending on the severity of toxicosis with exicosis, typical forms can be mild, moderate, and severe.

Causes of cholera

The causative agents of classical cholera (biovar vibrio cholera) and El Tor cholera (biovar vibrio cholera el tor) do not differ from each other in morphological, cultural and biochemical properties. These are gram-negative, curved or straight polymorphic rods with a long flagellum, providing active mobility. They are facultative anaerobes, do not form spores and capsules, grow well on conventional nutrient media (especially well - in meat-peptone broth and alkaline agar), forming a film on the surface of the liquid medium after 3-4 hours. Biovar El Tor differs from the classical one in its hemolytic properties.

Pathogenesis of cholera

The only entry point for infection is the gastrointestinal tract, where the pathogen enters through the mouth with infected water, food, or from infected hands, household items, etc. The main place of reproduction of the vibrio is the small intestine. The process of reproduction of the vibrio is accompanied by the release of a large amount of exotoxin, which is responsible for the diarrhea syndrome. In addition to the exotoxin, other toxic substances and enzymes (mucinase, neuraminidase, proteases, etc.) also play a significant role in the pathogenesis of the disease.

Causes and pathogenesis of cholera

Symptoms of cholera

The incubation period ranges from several hours to 5 days, most often 2-3 days. In vaccinated people it can be extended to 9-10 days.

In older school-age children, the clinical picture of cholera is practically no different from that in adults. The disease begins acutely, with the appearance of loose stools, pronounced weakness and malaise, sometimes dizziness and slight chills, a slight increase in body temperature. The first clinically expressed sign of cholera is diarrhea, which begins suddenly, more often at night or in the morning. Defecation is painless, abdominal pain is absent or mild.

Symptoms of cholera

Diagnosis of cholera

Cholera is diagnosed based on the clinical picture, epidemiological situation and laboratory test results. The bacteriological method is of decisive importance: microscopy of biomaterial preparations (feces, vomit, etc.) and sowing of the material on an accumulation medium (peptone water, alkaline agar). Further studies are carried out according to the instructions. Express methods are used for accelerated laboratory diagnostics, which have only an approximate value.

Diagnosis of cholera

Treatment of cholera

Treatment is primarily aimed at compensating for body weight deficit, correcting ongoing losses of water and electrolytes with stool, vomiting, and exhaled air. Rehydration therapy is based on the same principles as in the treatment of other intestinal infections with dehydration.

Glucose-salt solutions (Regidron, "Children's Doctor", Glucosolan) are also used for oral rehydration, and Quartasol and Trisol, an isotonic solution of 1.5% Reamberin solution, are used for parenteral rehydration. Solutions for oral use are prepared before use, and drugs for intravenous administration are heated to 37-38 °C. The volume of liquid for oral rehydration (for exicosis of I-II degree) is calculated by the generally accepted method. It is very important to organize an accurate accounting of all water and electrolyte losses, which is achieved by collecting feces and vomit, as well as weighing the child every 4 hours.

Treatment of cholera

Forecast

With timely diagnosis and early initiation of adequate rehydration therapy, the prognosis in most cases is favorable - improvement of the condition and recovery occur very quickly. In severe forms of cholera and decompensated dehydration, especially in young children and newborns, despite timely and adequate therapy, death may occur already in the initial period of the disease. The cause of death may also be the layering of a secondary bacterial infection (most often pneumonia).

Prevention

Prevention is based on a system of measures aimed at preventing the introduction of infection from endemic foci. Of great importance are the identification of patients and vibrio carriers, their timely isolation and sanitation from the pathogen. Localization and elimination of the source of infection involve a system of quarantine measures, including isolation and examination of persons who have been in contact with the patient, and provisional hospitalization of all those suffering from diarrheal diseases in the source of infection. Cholera vaccination is also used.

Prevention of cholera

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