Cholera in children

Cholera is an acute intestinal infection caused by cholera vibrios, characterized by gastroenteric manifestations with rapid dehydration of the body due to loss of water and electrolytes with vomit and liquid stool.

ICD-10 code

• A00.0 Cholera caused by cholera vibrio 01, biovar cholerae.
• A00.1 Cholera caused by cholera vibrio 01, biovar eltor.
• Cholera, unspecified.

Epidemiology of cholera

The source of infection in cholera is only a sick person or a vibrio carrier. A patient with cholera, which secretes 10 ⁶ -10 ⁹ highly virulent vibrios in 1 g of stool in the acute period of the disease , is most dangerous if uninfected feces fall into open reservoirs used for drinking water supply. However, the greatest epidemiological danger is represented by patients with erased forms of disease and vibrio carriers. Healthy (transient) vibrio-carriers currently represent the main danger of importation of cholera into countries where it was not previously registered. The most important is the waterway of infection. In addition, infection can occur with the use of infected milk, fish, shrimp, meat and other products. The contact-household way of transmission of infection is possible in the case of neglect of sanitary and hygienic norms and is currently of no decisive importance in the distribution of cholera, which is mainly due to the rapid detection and isolation of patients and vibrio carriers. The minimal infectious dose of the pathogen in cholera is 10 ¹¹ microbial bodies.

Classification

There are typical and atypical forms of cholera. Typical forms depending on the severity of toxicosis with exsicosis 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 eltor) do not differ in morphological, cultural and biochemical properties from each other. These are gram-negative, curved or straight polymorphic sticks with a long flagellum providing active mobility. They facultative anaerobes, spores and capsules do not form, grow well on ordinary nutrient media (especially in meat-peptone broth and alkaline agar), forming a film after 3-4 hours on the surface of the liquid medium. Biovar El-Tor differs from the classical hemolytic properties.

Pathogenesis of cholera

The entrance gates of the infection serve only the GI tract, where the pathogen gets 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, responsible for diarrheal syndrome. In addition to exotoxin, other toxic substances and enzymes (mucinase, neuraminidase, proteases, etc.) play an important role in the pathogenesis of the development of the disease.

Causes and pathogenesis of cholera

Symptoms of cholera

The incubation period ranges from several hours to 5 days, more often 2-3 days. In vaccinated, it can extend up to 9-10 days.

At children of the senior school age the clinical picture of a cholera practically does not differ from that at adults. The disease begins acutely, with the appearance of a loose stool, severe weakness and malaise, sometimes - dizziness and easy cognition, a slight increase in body temperature. The first clinically pronounced sign of cholera becomes 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 on the basis of clinical picture, epidemiological situation and laboratory results. Bacteriological method is crucial: microscopy of biomaterial preparations (stool, vomit, etc.) and seeding the material on the accumulation medium (peptone water, alkaline agar). Further studies are carried out according to the instructions. Express laboratory methods are used for accelerated laboratory diagnosis , which have only an approximate value.

Diagnosis of cholera

Treatment of cholera

The treatment is primarily aimed at compensating for body weight deficiency, correction of continuing water and electrolyte losses with stool, vomiting and exhaled air. Rehydration therapy is based on the same principles as in the treatment of other intestinal infections with dehydration.

For oral rehydration glucose-saline solutions (rehydron, "pediatric healer", glucosolan) are also used, and for parenteral - quartz and trisol, isotonic solution of 1.5% reamberin solution. Solutions for oral use are prepared before use, and intravenous preparations are heated to 37-38 ° C. The volume of liquid for oral rehydration (in case of I-II degree exsicosis) is calculated by the conventional method. It is very important to organize an accurate record of all losses of water and electrolytes, which is achieved by collecting feces and vomit, and by weighing the child every 4 hours.

Treatment of cholera

Forecast

With timely diagnosis and early-initiated adequate rehydration therapy, the prognosis is favorable in most cases - the improvement of the condition and recovery is very fast. 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 can be a layering of secondary bacterial infection (most often pneumonia).

Prevention

The basis of prevention is 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 focus of infection presume a system of quarantine measures, including isolation and examination of persons in contact with the patient, and provisional admission of all diarrheal diseases in the outbreak. Inoculation against cholera is also used .

Prevention of cholera

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