What happens in the intestines
Vibrio cholerae does not penetrate deep into tissues. It attaches to the surface of the small intestine and produces cholera toxin, which switches the cells of the intestinal wall to continuously release chlorides, followed by water and other salts. In this case, absorption is slightly impaired, but the volume of fluid released many times exceeds the ability of the colon to return it. Therefore, the stool becomes almost transparent, with whitish flakes of mucus. Sodium, potassium and bicarbonate leave along with water, which causes cramps and acidification of the blood.
- The bacterium remains on the surface of the mucous membrane
- The toxin triggers the release of salts and water
- The mucous membrane is not damaged, there is no blood in the stool
- Sodium, potassium and bicarbonate are lost
- The severity is determined by the volume of losses
How do they get infected?
The main route is water: drinking unboiled water from open sources, using such water for washing dishes, vegetables and fruits, ice from untested water. Less commonly, infection occurs through foods, especially seafood and ready-made meals, contaminated after cooking. Cholera is transmitted from person to person through gross violation of hygiene, because the pathogen is excreted in the stool. The risk is higher in people with low stomach acidity, since acid destroys a significant portion of vibrios.
- Unboiled water and ice
- Vegetables and fruits washed with contaminated water
- Seafood and ready meals
- Poor hand hygiene
- Low stomach acidity as a risk factor
- Travel to outbreak areas
Symptoms and degrees of dehydration
The incubation period often ranges from several hours to five days. The disease begins suddenly with profuse painless diarrhea, which is often accompanied by vomiting without nausea. The temperature is usually normal or even low. Then everything is determined by how much fluid is lost. Mild dehydration causes thirst and dry mouth. With average symptoms, weakness, decreased urine output, and sunken eyes appear. Severe dehydration is manifested by lethargy, cold skin, thready pulse, convulsions and requires immediate help.
- Large, watery stools without abdominal pain
- Vomiting, often without previous nausea
- Temperature is normal or reduced
- Extreme thirst, dry mouth and tongue
- Calf muscle cramps
- Decreased or absent urine
- Cold skin and weak, rapid pulse in severe cases
Diagnostics
The diagnosis at the outbreak site is made primarily clinically, because treatment cannot be delayed until a laboratory response is obtained. To confirm, culture of feces or vomit is taken on special nutrient media, microscopy and rapid tests are used. At the same time, the severity of the condition is assessed: blood electrolytes, acid-base status, creatinine and urea, hematocrit are determined, since the indicators change when the blood thickens. Each confirmed case is subject to mandatory notification to the sanitary-epidemiological service, and contact persons are placed under observation.
- Stool culture for Vibrio cholerae
- Rapid tests and microscopy
- Electrolytes: potassium, sodium, chlorine
- Acid-base state of blood
- Creatinine and urea to assess kidney function
- Complete blood count and hematocrit
Treatment and prevention
The main and vital treatment is to replenish losses. For mild to moderate cases, ready-made solutions for oral rehydration are used, which are drunk in small portions after each episode of bowel movement. Plain water, tea and sugary drinks are no substitute because they do not contain the required salt ratio. For severe dehydration, solutions are administered intravenously in the hospital. An antibiotic is prescribed by a doctor: it reduces the duration of diarrhea and the release of bacteria, but does not replace rehydration. Prevention - boiled or bottled water, hand washing, careful handling of food.
- Oral rehydration solutions from the very first minutes
- Intravenous saline solutions for severe dehydration
- Continue feeding children with breast milk
- Antibiotic only as prescribed by a doctor
- Drink boiled or bottled water
- Wash your hands with soap, especially before eating
- Wash vegetables and fruits with safe water, thoroughly boil meat and fish.