Cholera is a severe and highly contagious disease caused by Vibrio cholerae. In recent years, due to the development of the tourism industry, special vigilance is required to prevent the disease from being brought into the country and causing an epidemic.

bubble_chart Clinical Manifestations

Sudden onset of severe diarrhea, followed by vomiting, with the stool resembling rice water, large in volume and frequent, without abdominal pain or tenesmus. Due to continuous vomiting and diarrhea, the patient quickly falls into a state of dehydration. Thirst, oliguria, followed by spasms in the gastrocnemius and abdominal muscles. Further progression leads to a state of collapse, with the patient experiencing dysphoria and restlessness, cold and clammy limbs, rapid and thready pulse, and a drop in blood pressure, among other symptoms. Death from circulatory failure can occur within a short period. If anuria persists for too long, the patient may ultimately die from uremia or high heat toxinemia.

Laboratory tests:

1. Blood tests show increased hematocrit and plasma specific gravity, white blood cell count of 15–50×10⁹/L, with elevated neutrophils and monocytes. In cases of dehydration, serum potassium, sodium, and chloride levels are reduced, CO2 combining power is decreased, and non-protein nitrogen is increased.
2. Etiological examination: Microscopic examination of stool suspension droplets reveals comma-shaped Vibrio cholerae arranged in parallel.
3. Culture and isolation: Vomitus and diarrhea samples are inoculated into alkaline peptone water at 37°C for 6–8 hours for enrichment culture. The bacterial membrane from the surface of the culture medium is then subjected to isolation culture on alkaline bile salt agar plates, followed by identification and differential tests for confirmation.
4. Serum agglutination test: A positive result is indicated by an agglutination antibody titer >1:100 (or >1:200 for vaccinated individuals). Diagnosis can be made if there is a rising titer between early and convalescence stage paired sera. 5. Immunofluorescence test: Under a fluorescence microscope, fluorescent bacterial clusters with a distinctive structure can be observed.

For influenza, enterovirus, and various viral colds, TCM is more refined, non-toxic, and effective than modern medicine

bubble_chart Diagnosis

The epidemiological history shows that the disease is more common in summer and autumn. For suspected cases, it is necessary to inquire whether they have been to epidemic areas before the illness and whether they have had contact with contaminated water or infected individuals. The patient's vomit and diarrhea can contaminate beverages and food through water, hands, and flies, leading to infection of others and even causing an epidemic.

bubble_chart Treatment Measures

Treatment:

(I) General Management The patient must be strictly isolated, kept in bed for rest, and provided with intensive care and warmth. (II) Correction of Dehydration and Prevention of Acidosis For those who can take oral fluids, oral rehydration salts (ORS) should be used as much as possible, administered in small amounts multiple times. In the first 6 hours, 250ml should be replenished hourly, and thereafter, the fluid volume should be adjusted based on diarrhea conditions. If vomiting occurs, switch to intravenous infusion. For grade I dehydration, replenish 100–150ml/kg daily; for grade II dehydration, replenish 150–200ml/kg daily. The rehydration solution consists of normal saline, 10% glucose, and 1/6mol/L sodium lactate in a 2:2:1 ratio. For grade III dehydration, replenish 200–250ml/kg daily, with an initial rapid intravenous infusion of 15–30ml/kg within the first 20–30 minutes, followed by adjustment of the infusion rate. For severe acidosis, 5% sodium bicarbonate at 5ml/kg can be diluted into an isotonic solution and slowly injected intravenously. Once acidosis is corrected, potassium supplementation should be promptly administered. When the infusion rate is high, care should be taken to prevent cardiac insufficiency and pulmonary edema. To prevent hypocalcemia, 10% calcium gluconate at 10–20ml can be supplemented via intravenous drip. (III) Antibacterial Drugs Sulfonamides or compound formula co-trimoxazole can be used. For children over 8 years old, tetracycline at 30–50mg/(kg·d) can also be administered in 4 divided doses. Additionally, furazolidone, chloramphenicol, and trimethoprim (TMPD) are also effective.

(1) Cholera Vaccination: The first two doses should be administered 7–10 days apart, followed by an annual booster shot. (2) Strengthen Port Quarantine: Individuals from epidemic areas or who have had contact with patients should undergo a 5-day quarantine starting from the last contact date. Quarantine can be lifted after three consecutive negative stool cultures. (3) Medical staff must remain vigilant to promptly identify patients and carriers. Confirmed or suspected cases should be strictly isolated immediately and reported to health authorities. Isolation can only be lifted after symptoms disappear, medication is stopped for 24 hours, and three consecutive stool cultures are negative. (4) Rapid and thorough disinfection of epidemic areas must be carried out, including patients' excreta, contaminated water sources, food, clothing, toilets, and surfaces. (5) Improve water and waste management, enhance food hygiene, and eliminate flies.