Overview of Vibrio cholerae enteritis
Non-01 Vibrio cholerae enteritis is an intestinal infectious disease caused by non-group 01 Vibrio cholerae, with clinical manifestations of gastroenteritis and dysentery type. In recent years, with the decline in the incidence of cholera, non-group 01 Vibrio cholerae infection epidemic scope, intensity and pathogenicity have a rising trend, gradually attracted attention, reported in recent years, the cholera epidemic in South Asia, not by the diagnostic sera of Vibrio cholerae group 01 and non-group 01 Vibrio cholerae diagnostic sera agglutination, this epidemic strain so far for the undocumented new serotypes of Vibrio cholerae, so the name for the Vibrio cholerae 0139. The synonym “Bengal” has also been suggested as the strain was first isolated from the Bay of Bengal coast. It has been suggested that the organism produces a Shiga toxin-like cytotoxin, which may be an important virulence factor, and some strains have been shown to produce cholera enterotoxin or heat-resistant enterotoxin.
Etiology
Non-group 01 Vibrio cholerae can be categorized into serogroups 02 to 0138 according to their O-primary antigens. Flagellar antigens are what they share with Vibrio cholerae, but their bacteriophage antigens are different. Non-group 01 Vibrio cholerae is also different from, serogroup 0139. However, non-group 01 Vibrio cholerae has a distinctive characteristic of being externally resistant.
Some strains have been shown to produce cholera enterotoxin or heat-resistant enterotoxin. Some also believe that the causative agent is likely to be a Shiga toxin-like cytotoxin produced by the bacterium.
Symptoms
Most patients have an acute onset of illness, with a few cases 1 to 2 days before illness; there are prodromal symptoms such as dizziness, lethargy, abdominal distension and mild diarrhea.
1. Diarrhea
(1) diarrhea without acute and severe, not accompanied by abdominal pain, a few times, dozens of times, fecal incontinence; yellow dilute watery stools, rice slop-like stools, washed meat-like stools; ELTOL-type is more common
(2) Vomiting: diarrhea followed by vomiting, mostly without nausea; vomit is gastric contents, rice slop-like material; no vomiting in mild cases.
2. Dehydration
(1) circulatory failure, the manifestations of anhydrous shock, agitation or confusion, cold extremities, pulse is fine, blood pressure drops rapidly, or even can not be measured; shortness of breath, skin and mucous membrane cyanosis; urine output is reduced, blood urea nitrogen is elevated; moderate and severe dehydration.
(2) Uremic acidosis Kussmaol respiration (deep great breathing).
(3) Muscle spasms Large dissipation of salts from the body and severe hyponatremia cause painful muscle; spasms and a state of muscle tonus, most prominent in the gastrocnemius and rectus abdominis muscles.
(4) Hypokalemia Decreased muscle tone, loss of reflexes, abdominal distension, tachycardia, weak heartbeat, arrhythmia and other symptoms, as well as prolonged Q-T time limit of electrocardiogram, the appearance of U-wave, T-wave flattening or inversion and so on.
3.Recovery period
Most of the symptoms disappear after diarrhea stops and dehydration is corrected, with endotoxin entering the bloodstream in a few cases, and fever of 38℃～39℃ lasting for 1～3 days.
Examination
1. Blood test
Due to the loss of fluid blood concentration, the erythrocyte pressure volume increases, hemoglobin increases, white blood cells can reach 10×109～30×109/L. Neutrophils and large monocytes increase. Serum potassium and sodium are mostly in the normal range in the early stage of the disease, and generally decrease after infusion, but chloride is mostly higher than normal, urea nitrogen increases, and HCO3- decreases (<15mmol/L).
2. Urine examination
Most patients’ urine is acidic and may have protein, red and white blood cells and tubular pattern. Urine specific gravity is between 1.010 and 1.025.
3. Fecal examination
(1) Microscopic examination In half of the cases, there is mucus in the feces, and only a few leukocytes can be seen on microscopic examination. If the fecal specimen is taken and examined by direct suspension immediately, Vibrio can be found with strong motility and shuttle-like movement. Dark-field examination reveals characteristic meteor-like movement of the bacteria.
(2) Culturing At the same time of microscopic examination, the specimen should be inoculated with alkaline (pH 8.4) peptone water for bacterial enrichment, and then cultured for isolation.
4. Serologic examination
Commonly used serum agglutination test and sterilization test, generally can not be used as the basis for early and rapid diagnosis, often used for epidemiological investigation or retrospective diagnosis.
Diagnosis
1. Clinical features
Diarrhea, vomiting, watery stool or with fever, abdominal pain, mucus stool.
2. Epidemiology
History of consumption of contaminated food or seafood.
3. Experimental diagnosis
Bacterial culture can be done by alkaline peptone, alkaline plate, blood plate, etc. It must be differentiated from group 01 Vibrio cholerae by serology, gas chromatography and biochemical reaction.
Treatment
1. Principles of treatment
Strict isolation, timely rehydration, supplemented by symptomatic treatment.
2. Strict isolation
Isolate according to Class A infectious disease, and isolate the confirmed and suspected patients until 6 days after symptoms disappear, and culture the feces every other day, and release the isolation if the fecal culture is negative for 2 consecutive times.
3.Timely rehydration
Usually choose the 541 fluid with similar concentration of electrolytes lost by the patient, which contains 5g of NaCl, 4g of NaHCO3, 1g of KCl per liter, in order to prevent hypoglycemia, often add another 50% glucose 20ml, the preparation can be used for 0.9% NaCl 500ml, 1.4% NaHCO3300ML, 10% KCl 10ml, 10% glucose 140ml ratio. Preparation. It should follow the principle of early, rapid, sufficient quantity, salt first, then sugar, fast first, slow first, correct acid and replenish calcium, see urine and replenish potassium. The dose and speed of infusion should depend on the severity of the disease, the degree of dehydration, blood pressure, pulse, urine volume and plasma specific gravity. The feces of children patients contain low sodium and high potassium, the loss of water is more serious, the condition develops faster, and hypoglycemic coma, cerebral edema and hypokalemia are easy to occur, so the loss of water should be corrected in time and potassium should be supplemented.
4. Antibacterial therapy
This is an adjunctive treatment to rehydration therapy. Antibacterial drugs can reduce the amount of diarrhea, and can shorten the period of diarrhea and excretion of bacteria. Ciprofloxacin is often used, twice a day, norfloxacin adults, three times a day. Can choose one of them, usually 3 ~ 5 days for a course of treatment or available quinolones or sulfamethoxazole / methotrexate (compound sulfamethoxazole), etc., the course of 3 ~ 5 days.
5. Symptomatic treatment
Correct acidity. Correct shock and heart failure. Correct hypokalemia.