Definition:

Cholera is an acute intestinal infection, severe, characterized by the appearance of abundant diarrheal stools, vomiting and dehydration that can lead the patient to acidosis and circulatory collapse within 24 hours and when untreated can cause death. It is common for mild cases in which only presents diarrhea and it is this characteristic in children.

While cholera is a rare disease in the United States, people at risk of contracting the disease include those who travel to countries where outbreaks are presented and the people who consume raw or inadequately cooked seafood in warm coastal waters, subject to contamination by sewage. In both cases, the risk is small.

The cholera epidemic is presented as if there were poor sanitation, overcrowding, war and starvation. The endemic areas include: India, Asia, Africa, the Mediterranean and, most recently, Central and South America, as well as Mexico. The infection is contracted to ingesting contaminated water or food.

The tests to identify the disease are: Hemocultivo and Coprocultivo.

People can get sick more easily Cholera are those that:
1. They live in overcrowded conditions.
2 . Without clean water.
3. No sanitary facilities.
4. They care inadequate personal hygiene.
5. They have a poor nutritional status.

They are also more susceptible persons who have chronic illnesses, such as gastric ulcer, tuberculosis, AIDS, leukemia; They are operated stomach or consume many antacids.

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Causal Agent:

Cholera is caused by an infectious agent; This is an aerobic bacillus, Gram negative, with only one polar scourge that gives high mobility called Vibrio cholerae. The vibrión cholera survive for periods up to 7 days outside the body, especially in wet environments and temperate; Survive in the water a few hours and a few weeks if it is contaminated with organic material.

Vibrio cholerae 01 includes two kinds of life forms: classic and variant the TOR; The two biotypes are separated into two main serotypes: Ogawa and Inaba, rarely a third serotype the Hikojima may be present. These serotypes may change during epidemics. All serotypes enterotoxins produced similar and also the clinical picture is very similar.

The toxin released by the bacteria cause increased secretion of chloride ions and water in the intestine, which can cause profuse diarrhea. It can occur death as a result of severe dehydration caused by diarrhea.

One type of vibrio bacteria has been associated with seafood, especially raw oysters. Risk factors include the fact reside or travel to endemic areas, as well as exposure to contaminated drinking water or untreated.

Symptoms:

The first symptoms of the disease are presented by Vibrio cholerae 2 to 5 days after infection and are given by the action of cholera toxin that is fixed at the level of the cell membrane bowel causing vomiting, watery stools with abundant remains of intestinal mucosa "rice water" and borborismos with abdominal pain . The loss of water by feces can reach amounts as 15 to 24 liters by day, which causes dehydration so severe that it can kill the patient by hypovolemic shock and electrolyte imbalance and acid base.

The evacuations have virtually no protein, sodium concentrations are equal to the plasma; However, the concentrations of potassium and bicarbonate are five times higher than those in plasma, so that the patients often develop metabolic acidosis and hypokalemia. Mortality in cases hospitalized and treated appropriately based fluids, electrolytes and glucose is less than 1%; However, in cases that do not receive timely and appropriate care, this figure can reach 60% mainly in children under 5 years with malnutrition.

( http://www.bibliotecavirtual.com.do/Biologia/Colera.htm )

Treatments:

The treatment is the replacement of fluids, electrolytes and glucose depending on the status of the person, can be administered orally or fluids through a vein (intravenous). Antibiotics can shorten the time in which the person feels ill.

The World Organization de Of Health (WHO) has developed an oral rehydration solution that is cheaper and easier to use than the typical intravenous fluid. This solution of sugar and electrolytes is now being used at the international level.

It is important to maintain a good level of hydration and adequately replenish sodium bicarbonate and potassium chloride. Under this regime virtually all patients with cholera are saved. The antimicrobial as tetracycline, chloramphenicol and furazolidone among others, can shorten the time of illness and reduce the severity of symptoms but will never be a substitute for hydration and administration of electrolytes and glucose.

Overall evolution is successful if the patient receives a timely basis to hydration; This trend towards the resolution of the infectious process within 4 to 7 days, without any complication.

It may present some complications, such as: severe dehydration, and even death.

It should consult with the physician if there is plenty of watery diarrhea. It should also be consulted if the person has signs of dehydration, including rapid pulse, dry skin, dryness in the mouth, thirst, eyes glassy, "lethargy, sunken eyes, no tears, decrease or absence of urine, and drowsiness or unusual tiredness.

Prophylaxis:

Cholera is spread by contamination of food and water and rarely through contact with infected people or sick unless it is not given basic hygiene measures such as washing hands after evacuating and before eating. Health measures such as the control and storage of food and water under hygienic conditions are more than enough to prevent the occurrence of these outbreaks, and provide the necessary information to the public about modes of transmission and sanitary measures to avoid contagion.

The excreta of carriers and patients should properly handled to avoid further spread of the microorganism. For those people who are in contact with carriers of Vibrio cholerae, suggests making 1g tetracycline every 24 hours for five days. The use of the vaccine with dead vibrios gives partial protection and limited, a situation that has conditioned its inefficiency to limit disease outbreaks from one country to another. (Source: National Epidemiological Surveillance System).

(http://www.drscope.com/privados/consulta/colera/index.html#TRATAMIENTO)

Figures in Chile:

Prevalente in 80 countries in the world and in recent years the Americas region has been affected by an epidemic. The timely and accurate monitoring is a very important tool for disease control in the Americas. In Chile the first case was filed in 1991, reported 147 Cases until 1994 and after that date disappeared. At the end of 1997 there was an outbreak in the town of San Pedro de Atacama, north of the country, which affected 23 people, with a case fatality rate of 8.7%. In environmental samples from 1991 until 1998, have confirmed 88 strains of Vibrio cholerae 01.

In Chile, in the latest outbreak lethality was 8.7%.

(http://epi.minsal.cl/epi/html/public/enftransmisibles.pdf Pag. 37)