Diagnosis of cholera

  • Etiology, epidemiology and pathogenesis of cholera
  • The clinical picture of cholera
  • Treatment and prevention of cholera
  • Diagnosis of cholera is based on clinical assessment of the patient with regard to epidemiological history and confirmed by positive results of bacteriological examinations of faeces, vomitus, duodenal contents. When classic (alkidnoj) form of cholera, when the patient clearly identifies the main intoxication symptoms - diarrheaprior vomiting, seizures, temperature drop, anytime, asphyxia, anuria and others, the diagnosis can be made on clinical grounds. Difficulties with atypical and easy flowing cholera (children, the elderly, patients with chronic diseases). The increase in settlement of acute gastrointestinal diseases, deaths from these diseases should alert health workers on the possible emergence of cholera.
    For bacteriological tests for cholera take defecation sick, vomit, which is placed in a sterile vessel and immediately transported to the laboratory.
    Differential diagnosis of cholera spend with foodborne diseases (see), dysentery (see), botulism (see), amebiasis (see), balantidiozom (see), food poisoning (see), severe tropical malaria (see).
    Unlike dysentery, cholera is not observed cramping abdominal pain, of tenesmus; there is an abundant chair and relatively rare admixture of blood and mucus in the feces. The temperature rarely rises, but with cholera caused by the El tor biotype may be low grade fever. For food-related disease characterized by intense pain in the abdomen, often in epigastria; diseases begin often with nausea and vomiting, and then attaches diarrhea to the foul-smelling stools. After a few hours or from the beginning of illness and fever. Mild forms of cholera is very difficult and practically impossible to distinguish with an enteritis of different etiology. Diagnosis is based on bacteriological examination on cholera, epidemiological anamnesis.

    Diagnosis
    Diagnosis of cholera is based on data obtained during the clinical examination of the patient with regard to epidemiological history, and is confirmed by positive results of bacteriological researches on selection of V. cholerae from faeces, vomitus, duodenal contents. When the classic of symptomatology of cholera, when the patient clearly identifies the main symptoms of intoxication, diarrhea, prior vomiting, seizures, temperature drop, anytime, asphyxia, anuria, etc., the diagnosis can be easily installed on clinical grounds. Difficult to diagnose atypical flowing cholera (children, the elderly, patients with chronic diseases).
    Microbiological diagnostics. The main method of diagnosis of cholera is a bacteriological analysis. Without it, only on the basis of clinical observations or data serological surveys diagnosis of cholera cannot be considered reliable.
    Bacteriological analysis used for the diagnosis of typical and atypical cases of cholera, identifying vibrionaceae, particularly among patients, workers of food items and children's institutions, as well as in the study of corpses and objects of environment (water, food, infected objects, and so on).
    Research should be conducted as possible short terms. The success of bacteriological analysis depends primarily on the right of the fence and timely delivery to the laboratory material.
    Bacteriological analysis include: 1) smear microscopy study of material, a gram-stained or divorced carbolic-Magenta; 2) planting material of liquid media enrichment (1% peptone water, bismuth sulfide environment and others) and dense elective environment (alkaline agar, environment diedonne, Aaronson, and others), regardless of the results of the microscopy; 3) identification of the selected culture. Pure culture of cholera Vibrio can be allocated at any stage - from direct seeding material or re-seeding with enrichment. Usually the preliminary diagnosis is through 5-6 hours, final - 24 - 36 hours.
    Diagnosis is delayed in case of allocation of atypical culture, to identify where further research is needed (see Vibrios).
    From among more rapid methods of detection of Vibrio cholerae in the secretions of patients and environmental objects currently recommended: fluorescent-serological, micro - and microagglutination with native material, the reaction growth titer of bacteriophage, dark-field microscopy in the presence of cholera serum and some others. However, accelerated methods should be considered as indicative. For a definitive answer you want to extract pure culture of the causative agent of cholera and its identification by a combination of traits.
    Differential diagnosis of cholera spend with many infectious diseases and various poisonings of chemical poisons. One of the first places are food intoxication (see). The clinical picture may be similar to cholera, especially with its gastroenteriticheskaya phase. However vomiting when diseases are accompanied by nausea and usually precedes diarrhea, expressed pain syndrome (pain in the abdomen). The disease often accompanied feverish reaction; not so sharply expressed dehydration, common and less painful cramps, as with cholera. Diagnostics help examination of smears from the feces and vomit, serological studies.
    The initial period of dysentery, unlike cholera, typical febrile response, tenesmus, colicy pains in the abdomen, scarce and frequent stools with mucus and blood. In botulism onset of acute, with nausea, vomiting, dizziness, hypothermia, and cold sweat. Recognition contributes to the severity of neurological symptoms (paralysis of the muscles, diplopia, anisocoria, mydriasis, dysphagia, hoarseness). Taken into account the data of the anamnesis, laboratory results.
    By clinical cholera in the number of features similar diseases such as severe tropical malaria (see), fever mosquito (see), amebiasis (see), balantidiasis (see) and other Finally, in persons, particularly mental reactivity, in conditions of cholera situation may occur the so-called mental cholera with clinically similar symptom.
    Differential diagnosis of cholera spend with mushroom poisoning, castor (ricin), hellebore (glycosides), new potatoes (solanine), as well as poisoning organic and inorganic poisons (arsenic compound, methyl alcohol, antifreeze, butiphos). The clinical picture of poisoning by mushrooms sometimes similar to Algida with cholera, but in the first case, expressed sharp abdominal pain. The diagnosis help historical data (consumption of mushrooms, the relationship with the cultivation or processing of castor, hellebore, and others), as well as the absence of instructions on contacting the source of cholera infection and negative results of bacteriological researches. In case of poisoning by chemical poisons, as a rule, there is a group character of diseases (processing of cotton by butiphos).
    The results of chemical researches, the lack of V. cholerae in the feces and vomit help in the diagnosis of disease.