The clinical picture of cholera

The clinical picture. The incubation period - from several hours to 5 days, usually 2-3 days. There are several clinical forms of cholera: enteritises, gastroenteriticheskaya, echidna. There is also gastritises form of cholera, when the diarrhea precedes vomiting. Onset of acute - with sudden, uncontrollable urges to bottom with copious secretions from the intestines. First, the allocation of fluid, feces, then watery, odourless. Changes and color selections: in the beginning they remind bean, pea, then milk soup, later congee. Feces can sometimes contain mucus, undigested food particles, the blood. This first phase - Vibrio enteritis, cholera diarrheaor diarrhea,- lasts from several hours to 1-2 days. Sometimes the disease may be limited to these phenomena.
Subsequently develops Vibrio gastroenteritis is the second phase. You receive multiple and profuse vomiting without nausea. Diarrhea continues. Huge losses of water (up to 10% or more of body weight of the patient) lead to dehydration, loss of salts of sodium, potassium , etc. the patient's Condition is extremely grave, he wore a continuous vomiting and diarrhea. The tongue is covered with white fur and dry. Painful thirst. Growing phenomena of intoxication. Heart sounds deaf, blood pressure decreases dramatically. There acrocyanosis. Decreases or completely stop the flow of urine. Belly zapasy. Sometimes there mild abdominal pain, often, feeling of heaviness. At a palpation in the intestine is determined by a large number of fluids. This is the period of painful and excruciating cramps clonic, tonic or mixed.
The third phase - ALGID. The patient is in prostration, painful thirst, voice husky (exicosis), up to aphonia. Consciousness is saved. Progresses acrocyanosis. Sharpened features, are the cheeks, eyes sink, sclera fade, inherits. Decreased turgor of the skin, they can easily folds of fat, becomes wrinkled, cold to the touch, covered with sticky sweat. The temperature sharply reduced (to 35-34 degrees and below). Seizures continue. You receive a painful hiccups. Pulse filiform frequent. Heart sounds deaf, blood pressure is not defined. Urination can completely stop (cholera anuria). Due to thickening of the blood, the number of red blood cells increases up to 6-8 million and more than 1 mm3. Leukocytosis to 10 000 - 15 000 and above. Echidna phase becomes evictions (the fourth phase)at which joins shortness of breath. The mind is obscured, enhanced by cyanosis , and seizures. When events progressive shortness of breath and collapse the patient dies.
Described phase (forms) of cholera are observed not in all patients. More frequent lighter (enteritises, gastroenteriticheskaya) form, especially with cholera caused by biotype El tor. Described lightning and "dry" cholera, when death comes from severe intoxication before the development of diarrhea and vomiting.

Clinical presentation and course
The incubation period varies from several hours up to 6 days (usually 2-3 days), rarely longer. Onset of acute, with a sudden urge to bottom, appearing first, often at night. The uncontrollable urge, with copious secretions. Defecation usually proceeds without pain and tenesmus. Highlight the first liquid stool, and then after several bowel movements buy liquid watery consistency, lose the scent. Changes the color of the emitted mass; at first they are like the bean, and then on milk soup, and later on congee. Sometimes stool contains mucous mass, undigested food particles, very, rare admixture of blood.
General condition of the patient in this first phase, Vibrio enteritis, cholera diarrhea or diarrhea,- violated-Malo, the disease is transferred to the feet, which is in epidemiological terms greater threat to others. Patients noted weakness, thirst, loss of appetite. The temperature is increased or a low grade fever. The duration of the first period of 1-2 days (G. P. Rudnev, A. G. Podvarka). Sometimes the disease may be limited to these phenomena.
When the continuation of the disease develop the second phase - Vibrio gastroenteritis. Vomiting, multiple and generous portions, without prior nausea, diarrhea continues. In stool, and vomitus are easily found cholera vibrios (3. Century Ermoleva, N. N. Zhukov-Verezhnikov, L. M. Jacobson). Patient kinda like "the fountain of contagion, very dangerous in an epidemiological sense (G. P. Rudnev). Because of heavy diarrhea and repeated vomiting occurs progressive dehydration.
When a relatively short duration of this period (36-48 hours.) some patients lose up to 7 litres with vomit and 30 l with faeces (N. K. Rosenberg). The fluid is removed from the body of a large number of proteins and some salts (especially sodium chloride).
The patient becomes severe, he wore a continuous vomiting and diarrhea. Vomit, initially containing impurities food, then become watery. The tongue is covered with white fur and dry. Worried thirst. Growing phenomena of intoxication. Muffled heart sounds, blood pressure is reduced, appears acrocyanosis, decreased amount of urine. The abdomen is soft, zapasy. Temperature is normal or greatly reduced. In this period of the disease appear painful and agonizing clonic seizures, tonic or mixed.


Diarrhea, vomiting, dehydration (loss of salts), convulsions are the main symptoms in the clinic cholera gastroenteritis. However gastritises symptoms (nausea, vomiting) with cholera sometimes can anticipate the appearance of diarrhea (I. D. Jonas). It is also mentioned in connection with the widespread use of antibiotics and with cholera, caused by a variant of Vibrio El tor.
The third phase - ALGID with a dominant clinic consequences of the second period (G. P. Rudnev). The patient is in prostration, painful thirst, voice husky (EC - sycosis) to complete aphonia. Consciousness is saved.
Progresses acrocyanosis. Sharpened features, are the cheeks, eyes sink, sclera fade, inherits. Lose turgor of the skin, it easily folds of fat, becomes wrinkled, cold to the touch, covered with sticky sweat. The temperature sharply reduced (to 36-35-34 degrees and below). Convulsions are becoming more common, capturing the muscles of the arms, abdomen, chest, chewing and especially the calf muscle. The diarrhoea stops, but vomiting still possible. You receive a painful hiccups (clonic spasms of the diaphragm).
Pulse filiform frequent. Heart sounds deaf, arrhythmia, blood pressure drastically reduced. When listening to noise of a friction of the pleura, pericardium (exicosis). Urine output is decreased and may completely stop (cholera anuria). Due to thickening of the blood, the number of red blood cells increases to 6-7-8 million and up to 1 mm3. Moderate leukocytosis (10 000-15 000, sometimes above).
Duration alhydrogel period from several hours to 3-4 days.
Echidna phase becomes evictions which causes shortness of breath (up to 40-45 breaths per minute), develop uraemic and izotermicheskie state. The mind is darkened, increase cyanosis, and seizures. When events progressive shortness of breath and collapse the patient dies. Death may occur in agenom period during a seizure. Mortality in alkidnoj form in recent years has reached 90%, although the average mortality from cholera not exceeding 50%, and with cholera El tor is much lower.
Describes the phases are observed in all patients; with timely diagnosis and proper treatment may shift of the disease after the first three phases in the so-called reactive phase.
The division into phases was the basis for developing, P. Rudnev following classification of clinical forms typical of cholera.

Classification of clinical forms of cholera
1. Vibrio enteritis
2. Vibrio gastroenteritis
3. Algeny period
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Reactive phase Efektidega phase
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Recovery Cholera coma
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Death

Possible lighter, atypical forms of cholera and lightning and "dry" cholera. Death in these forms of the disease comes from severe intoxication before the development of diarrhea and vomiting.
From complications, especially developing in critically ill, it should be noted pneumonia, face, cellulitis, abscesses, septicemia, and other
Specific complications of the disease include Vibrio typhoid in the pathogenesis of which is the role of Escherichia coli. In patients with high temperature, the mind is obscured (status typhosus), appear on the skin rash roseolous nature. Characterized by nausea, vomiting and foul-smelling diarrhea, like colitis with ihoroznym chair. This is a difficult and dangerous complication of cholera mortality from which in the past has reached 80-90%.