Defeating Cholera

In January 1991, an outbreak of cholera appeared in Peru and quickly spread to other Latin American countries. Cholera is a major problem for centuries in other parts of the world. In recent years, cholera epidemics have occurred in parts of Asia and in many African countries. Now the problem is in this hemisphere.
Here, in Guayaquil, Ecuador, cholera patients are brought by car or ambulance for treatment. When the patient arrives at the hospital, she had lost 10% of its body weight due to diarrhea and vomiting. In this woman of 50 kg, this is equivalent to 5 liters. She is in shock and can not stand or even sit up. His skin has lost its normal turgor. His eyes are hollow. Except after vomiting, mouth and tongue are dry. This patient is conscious and orientation is normal, but his thoughts are lucid. His radial pulse is absent and brachial pulse is weak. It is possible with cholera arrive at such a state in a few hours, but usually it takes at least 12 to 18 hours. In extreme cases, patients may be unconscious and close to death. If the water and salts lost through diarrhea are replaced quickly, survival is assured. This same young woman is doing well now. If they receive proper treatment, cholera patients recover quickly.
When cholera occurs in areas where practitioners are not familiar with modern treatment methods, many people die. In some populations, the mortality rate was over 30%. This unnecessary loss of life creates panic, seriously disrupting effective control measures. With proper treatment, even severely ill patients can be saved and panic avoided.
Most people infected with the cholera bacterium have mild diarrhea or no symptoms at all. Only 7% of people infected with the bacteria El Tor biotype cholera have symptoms requiring treatment in a health center, but these cases are the biggest challenge for practitioners.
The patients with cholera arrive at the health center, noting that their diarrhea is watery and profuse, they have vomiting, leg cramps are often serious resulting from the disturbance of the electrolyte balance. Patients have signs of dehydration, the skin retracts slowly when pinched, the eyes are deeply sunken, mouth and tongue are dry except after drinking or vomit. The skin of the fingers and toes are shriveled and they are cold. In general, patients were very thirsty and drink eagerly. But severely dehydrated patients may be unable to drink. In general, patients are restless and irritable, but severely dehydrated patients may be lethargic or unconscious. The pulse rate and blood pressure should be measured. The pulse is rapid and low or undetectable in severely dehydrated. Blood pressure is very low or non-measurable. Fast food or liquid salts lost will prevent deaths and is the main objective of treatment. Dehydrated patients who can sit up and drink should immediately receive rehydration fluids by oral route and are encouraged to drink. If a patient has vomiting, oral rehydration solution is still effective general. Even if the patient vomits during treatment, it usually absorbs more solute he vomits.
The oral rehydration solution is obtained by mixing water with a specific mixture of salts and sugar. Salts replace the sodium, potassium and bicarbonate lost by diarrhea. Sugar allows the sodium and water to be absorbed rapidly. If possible, the solute must be prepared with water which has been treated with chlorine or slurry. But a lack of clean water should not prevent a health worker administering this life saving fluid. It is important to frequently offer oral rehydration solution to the patient, to measure the amount drunk, and measure fluids lost in the diarrhea and vomiting.
The drilled bed for cholera in which a hole is drilled in the middle, provides a convenient method for collecting liquid stool by directing them to a container under the bed
In patients suffering from moderate dehydration, hydration should be reassessed after 1 hour of treatment, then every 1-2 hours until rehydration is complete. The patient is properly hydrated when his skin turgor is normal, thirst has gone, he started urinating and his pulse is strong.
Let the patient drink pure water in addition to oral rehydration solution. If kept in a health institution for more than six hours, it must offer food to the patient if vomiting has stopped.
Patients suffering from severe dehydration in a stupor, coma, with uncontrollable vomiting, or extreme fatigue that prevents drinking should be rehydrated intravenously. For patients who can drink a little, give them oral rehydration solution for the implementation of the infusion.
It is sometimes necessary to place a large 18 gauge needle to achieve adequate flow. In rare cases, it is necessary infusion into two veins. The Ringer lactate is the best choice for cases of severe dehydration. If it is not available, normal saline or half-normal saline with 5% glucose are acceptable.
The glucose solutions (dextrose) should NOT be used as they do not contain the necessary salts.
Intravenous therapy should be administered only by trained personnel using sterile needles, tubing, bottles and fluids. For a person who weighs 60 kg, it is often necessary to administer 2 liters of fluid during the first 30 minutes of treatment. It is useful to indicate on the bottle the level at which the liquid should have decreased after a specified time. Patients with dehydration that puts lives at risk should be reassessed after the first thirty minutes of treatment. Rapid intravenous therapy should continue until the radial pulse becomes strong. Patients should then be assessed every 1 or 2 hours to determine if the amount of fluid they receive enough. Do not reuse needles or infusion sets on another patient.
All patients should also receive oral rehydration solution when they can drink without difficulty. After three hours, most patients are fully rehydrated. They are able to drink and no longer need intravenous fluid. Their fluid losses can then be treated by oral rehydration solution. Stopping the intravenous infusion as soon as the patient can drink and is no longer severely dehydrated avoid overhydration, venous thrombosis and sepsis. If the intravenous equipment is not available or if practitioners do not have the training to use it, the patients suffering from severe dehydration can receive oral rehydration solution administered by nasogastric tube by skilled workers . Stool volume and vomiting and liquid volumes of oral rehydration and intravenous administration must be on a single table. Patients with cholera can serve more than one liter of fluid per hour. The characteristic diarrhea of cholera has the appearance of water and rice straw color; it is watery with a fishy smell, not fecal. After starting rehydration, a rectal swab can be taken to establish a laboratory diagnosis. The swab is placed in a Cary-Blair medium and transported at room temperature in the laboratory to be cultured on TCBS.
Antibiotics administered orally will reduce the volume and duration of diarrhea. There is no advantage to using injectable antibiotics which are expensive. Antibiotics may be introduced when vomiting has stopped.
Antibiotics currently recommended include tetracycline, doxycycline, azithromycin, erythromycin and ciprofloxacin. No other medication to treat diarrhea or vomiting should be administered.
In some places, the cholera bacterium has developed resistance to certain antibiotics, so it is necessary to monitor resistance patterns in all affected regions.
It is important to remember that cholera can be successfully treated only by replacing lost fluids if antibiotics are not available.
Hospital employees who care for patients with cholera or handle their fluids or bedclothes should not fear for their health. They rarely contract cholera. The transmission of the cholera bacterium directly from one person to another is very rare. Washing hands with soap after touching contaminated areas will prevent hands contaminate food, which the body can develop. Bedding and equipment used for the patient can be disinfected using normal washing and cleaning procedures. If wastewater from the hospital is not treated, feces can be decontaminated by treating the cresol or Lysol.
Upon restoration of the patient and his family should be educated on how to prevent transmission of cholera and other diarrheal diseases. Everyone should wash their hands after defecating and before preparing or eating food. The water can be made safe by boiling or chlorination at home. Shellfish and other seafood should be well cooked. All cooked leftovers should be heated before being eaten.
In remote areas, field treatment centers can be established. An effective therapy can be administered with a simple and limited equipment. The key to treat cholera consists of the following: a person qualified to judge and replace fluid losses, appropriate solutions to be administered orally and intravenously, and the tubes and needles to administer fluids intravenously.