Caracterización clínica-epidemiológica según la edad de pacientes diagnosticados con cólera / Clinic-epidemiological description according to the age of patients diagnosed with cholera

Introducción: Se estima que 1,4 billones de personas están en riesgo de infectarse por cólera y la mitad de los fallecidos son menores de 5 años. Objetivo: Caracterizar clínica y epidemiológicamente a los pacientes afectados por vibrión colérico según la edad de los enfermos y el tiempo que medió entre la aparición de los síntomas de la enfermedad y la asistencia al Sistema Nacional de Salud. Métodos: Estudio clínico, epidemiológico, descriptivo y prospectivo desde 2013-2017 a los pacientes que se les confirmó por coprocultivo el V. cholerae como causa de enfermedad diarreica aguda en el hospital pediátrico de Centro Habana. Se analizaron variables cualitativas y cuantitativas. Resultados: Se registraron 115 niños mayores de 5 años y 44 menores de 5 años afectados por el cólera. El 54,7 por ciento del total de pacientes estudiados estuvo en la zona afectada, el 94,3 por ciento presentó deposiciones líquidas, el 18,2 por ciento con aspecto de agua de arroz, el 7,5 por ciento con olor a pescado, el 47,2 por ciento presentó vómitos, el 6,9 por ciento fiebre y el 12,8 por ciento dolor abdominal. El valor de la mediana del tiempo que medio entre la aparición de los síntomas y la asistencia al médico fue de 24 horas. Conclusiones: Los pacientes más afectados son los mayores de 5 años y los que más tardíamente acudieron al Sistema Nacional de Salud. En todos predomina la procedencia de la zona afectada, las deposiciones líquidas y los vómitos(AU)

Introduction: It is estimated that 1.4 billion people are at risk of being infected by cholera and half of them are children under 5 years old. Objective: To describe clinically and epidemiologically the patients affected by Vibrio cholerae according to their age and the time passed from the onset of symptoms of disease to their attendance to the National Health System. Methods: Clinical, epidemiological, descriptive and prospective study from 2013 to 2017 in patients with confirmed V. cholerae by stool culture as a cause of acute diarrheal disease in the Pediatric Hospital of Centro Habana municipality.Qualitative and quantitative variables were analyzed. Results: There was a record of 115 children over 5 years and 44 children under 5 years affected by cholera. The 54.7percent of the total number of patients studied was in the affected area, 94.3 percent presented liquid stool, 18.2 percent of those looked like rice water, 7.5 percent with fishy smell; 47.2 percent of the patients presented vomiting, and 6.9 percent fever and 12.8 percent abdominal pain. The value of the mean time between the onset of symptoms and the assistance to the physician was of 24 hours. Conclusions: Most affected patients and that attended late to the National Health System were the ones over 5 years. In all predominated coming from the affected area, liquid stools and vomiting(AU)

Control de foco de un brote de Cólera. Matanzas 2014 / Control of Focus in front of a Bud of Cholera. Matanzas 2014

Se presenta un estudio de control de foco de un brote de cólera, mediante la técnica observacional del tipo serie de casos, en el mes de julio de 2014 en el Municipio Matanzas, donde se describe, según el método epidemiológico, la relación de los casos detectados con el caso índice; se analiza el problema detectado teniendo en cuenta el enfoque de riesgo del cólera. Se realiza una evolución clínico-epidemiológica de los casos detectados y se analizan las medidas de control de foco aplicadas. Se revisan tanto las historias clínicas individuales en el consultorio del médico de la familia, como las encuestas epidemiológicas y el expediente de control de foco en el departamento de Epidemiología (AU).

A study of control of focus of a bud of cholera is presented, by means of the observational technique of the type series of cases, in the month of July of 2014 in the Municipality Matanzas, where it is described, according to the epidemic method, the relationship of the cases detected with the index case; the detected problem is analyzed keeping in mind the focus of risk of the cholera. He/she is carried out a clinical-epidemic evolution of the detected cases and of the applied measures of focus control. They are revised the clinical histories so much in the clinic of the doctor of the family, as the epidemic surveys and the file of focus control in the department of epidemiology (AU).

Cólera en Haití: lecciones aprendidas por la Brigada Médica Cubana / Cholera in Haiti: lessons learned by the Cuban Medical Brigade

El libro relata la experiencia de la Brigada Médica Cubana en Haití, es el resultado del trabajo práctico en el terreno desde una posición científica avalada por toda la experiencia internacional y en Cuba para la prevención y control del cólera, el uso en los servicios de salud y la investigación. Constituye una herramienta de gran utilidad para los profesionales de la salud sobre la actualización del Plan de Prevención y Control del Cólera.

Evaluation of a rapid dipstick test for identifying cholera cases during the outbreak.

Background & objectives: Intermittent cholera outbreaks are major problem in many of the states of India. It is essential to identify cholera at the earliest for timely mobilization of public health responses and to abort the outbreaks. The present study was a part of a diarrhoeal outbreak investigation in Secunderabad, India, during May 2009 where the usefulness of Crystal VC rapid dipstick kit was assessed for detecting the aetiologic agent of the outbreak. Methods: Stool specimens were collected from 15 hospitalized patients with acute watery diarrhoea and analyzed for detection of cholera vibrios using Crystal VC rapid dipstick kit and the usefulness of the kit was determined by comparative analysis of the same set of specimens using both microbiological and real-time PCR (RT-PCR) based assays. Results: Detection of Vibrio cholerae O1 from 10 of 15 specimens was recorded using dipstick assay. Microbiological methods detected V. cholerae O1 positivity among 11 specimens. However, RT-PCR based assay showed all 15 specimens positive for the presence of V. cholerae O1. In addition, the same assay showed that the pathogen load in the dipstick as well as RT-PCR positive specimens ranged from 106 colony forming units (cfu)/ml or more. Interpretation & conclusions: Crystal VC kit had the potential to identify cholera cases in 10 min in field conditions without having good laboratory support. Therefore, dipstick kit may be considered as cholera detecting tool in diarrhoeal outbreak investigations. Specimens from clinically typical cholera cases, if negative by dipstick, should be reanalyzed by culture based methods.

Suspected cholera in Afghanistan

The Ministry of Public Health in Afghanistan [MOPH] has reported small isolated outbreaks of suspected cholera in the east of the Country since early August. The outbreaks were reported from villages and towns in eight of the country's 34 provinces. The Afghan Disease Early Warning and Response System [DEWS] rapidly investigated and responded to these events. Appropriate control measures were put in place and all the outbreaks were contained. In total, some 1636 cases including 5 deaths have been reported from the eight provinces

[ cholera outbreak investigation in Karaj district in 2008]

However outbreaks of cholera are not very common in central area of Iran, in 2008 district health authority reported a cluster of diarrhea cases. We investigated this cluster to identify the etiological agent, source of transmission and propose control measures. We defined a case of diarrhea as occurrence of > or =3 loose/watery stools a day among the residents of Karaj. Fifty four [54] cases were identified in health care centers and 106 healthy individuals as control. We conducted a gender- and age-matched case-control study to identify risk factors. Vibrio cholerae El Tor O1 Inaba was isolated from all cases rectal swabs. during cholera epidemic outbreak in 2007, 54 cases of stool-culture were vibrio cholera, serotype Inaba positive. Using industrial-ice and fruits and vegetables were significantly associated with the illness [OR 4.4 and 3.3 respectively]. This outbreak was due to a contaminated industrial-ice and contaminated vegetables and fruits and V. cholera 01 Inaba was possibly the causative organism. Therefore more prevention program and observation methods should be considered

Epidemie de cholera a Bukavu (R.D.Congo) de 2006-2007: donnees epidemiologiques et de controle

Contexte : Bukavu est une des sept zones sanctuaires du cholera a l'est de la de la Republique Democratique du Congo. Cette etude a examine les aspects epidemiologiques et de controle de l'epidemie de 2006-2007. Methodes : Cette etude descriptive a porte sur les donnees de 3348 malades; collectees dans les registres du centre de traitement de cholera de l'Hopital Provincial General de Reference de Bukavu. Les donnees ont ete traitees par le logiciel Epi Info version 6.04d. Resultats : etalee sur 175 jours avec un taux d'attaque de 5;37 pour mille; l'epidemie a touche les sujets d'une moyenne d'age de 16 ans et un sex-ratio H/F de 1;05. La zone de sante la plus touchee etait celle de Kadutu (50;7). La source probable de contamination a ete hydrique (90;1). La symptomatologie clinique etait dominee par la diarrhee aqueuse (95;5). A l'admission; 63;4des malades presentaient une deshydratation severe. La duree moyenne d'hospitalisation etait de 3 jours. La letalite etait de 0;3. Conclusion : Le cholera a Bukavu a touche principalement les sujets jeunes provenant d'un conglomerat des quartiers populaires au sud de la ville. L'acces derisoire a l'eau potable et l'insuffisance des latrines ont vraisemblablement joue un role capital. La letalite etait faible ce qui denote entre autre d'une bonne prise en charge medicale des cas. Les mesures preventives semblaient etre mises en oeuvre tardivement et timidement. Cette etude fait renaitre la problematique de la rehabilitation du reseau d'adduction d'eau potable et l'hygiene de Bukavu

Cholera in Iraq

On 25 August 2008, the Ministry of Health of Iraq reported, to WHO, the first laboratory confirmed cases of cholera from Baghdad as well as from Missan- a province in the south of Iraq bordering with Iran. This is the first time this year that Iraq reported cases of cholera. As predicted earlier in the year, [please see Weekly Epi Monitor, issue no 31, dated 03 August 2008] the cases came during the month of Autumn [August- September]. By 28 August 2008, Iraq reported a total of 62 cases of cholera including 7 deaths [CFR: 11.2%] out of which 7 cases were laboratory confirmed so far. Of these, 6 cases including 1 death were reported from Baghdad while 56 cases including 6 deaths were reported from Missan province. Vibrio cholerae El-Tor 01 serotype Inaba was identified as the causative strain for both these two clusters of cholera cases in Iraq. The Ministry of Health in Iraq with support from WHO-Iraq has undertaken appropriate public health measures to stop transmission and limit spread of cholera to other at-risk provinces of

L'epidemie de cholera de 2004 a Dakar : aspects epidemiologiques; cliniques et therapeutiques

Ce travail decrit l'epidemie de cholera qui a touche Dakar en 2004; au cours de laquelle 593 cas confirmes ou probables ont ete pris en charge dans notre service. Il se fixe pour objectif de decrire les aspects epidemiologiques; cliniques; bacteriologiques et les strategies de prise en charge de cette epidemie. Pour atteindre cet objectif; nous avons mene une etude prospective a la clinique des maladies infectieuses du 11 octobre au 20 decembre 2004. L'age moyen des patients etait de 30 ans; et le sexe ratio de 1;33. La source probable de contamination a ete alimentaire et/ou hydrique dans 92des cas. La duree de l'epidemie a ete courte (75 jours). Le debut a ete brutal dans 98des cas; et la symptomatologie clinique dominee par la diarrhee aqueuse (95) et les vomissements (78). Le delai moyen d'hospitalisation etait de 11 heures et le nombre de selles emises avant l'admission superieur a 10 dans 23des cas. A l'admission; 119 malades (20;1) ont presente une deshydratation severe. Au total 250 coprocultures ont ete effectuees; dont 145 positives (58); mettant en evidence Vibrio cholerae O1 dans 112 cas (44). Les 36 souches testees aux antibiotiques ont montre une excellente sensibilite a la doxycycline et a la pefloxacine; mais aussi une resistance au cotrimoxazole; a l'amoxicilline et au chloramphenicol. La rehydratation par voie orale a ete la regle (61). La letalite a ete de 0;5. Le cholera est une urgence medicale dont le pronostic peut etre favorable a condition que l'organisation de la prise en charge soit bonne

Hospital-based epidemiology of childhood cholera: a 6-year review in a university hospital in Bangkok, Thailand.

BACKGROUND: Cholera is the cause of severe acute watery diarrhea. Without proper fluid therapy, severe cholera kills half of the affected patients. In terms of epidemiology and surveillance, up-to-date information of this disease in each country is essential. OBJECTIVES: To evaluate 1) prevalence, serogroups, serotypes and antimicrobial susceptibility pattern of V cholerae, and 2) demographic data and clinical manifestation of pediatric patients with cholera. MATERIAL AND METHOD: Microbiogical records of children aged 0-15 years with cholera, who were treated at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between January 1995 and December 2000 were retrospectively reviewed Serogroups, serotypes, and antimicrobial susceptibility of V. cholerae were studied Medical records of children with positive stool cultures for V. cholerae were reviewed in terms of demographic data, clinical manifestation of the patients. RESULTS: Of 11,709 stool culture specimens, pathogenic bacteria were found in 1,745 specimens and 95 specimens (5.4%) were positive for V. cholerae. V. cholerae O1 and non-O1/non-O139 were found in 52.6% and 47.4%, respectively. Common serotypes of V. cholorae O1 were Ogawa. Antimicrobial susceptibility of the pathogens to co-trimoxazole, ampicillin, ceftriaxone, ciprofloxacin and gentamicin were 55.0%, 56.4%, 91.4%, 92.5% and 94.9%, respectively. Age distribution of the patients ranged from 2 months to 15 years with an average age of 2.92 years. Clinical manifestations included acute watery diarrhea (92.8%), vomiting (56.4%), fever (37.5%), hypotension (19.6%) and abdominal pain (3.8%). Stool leukocytes were microscopically detected in 20% of the patients. No patients died in the present study. CONCLUSION: Childhood cholera in Thailand still exists. Most patients presented with acute watery diarrhea. Regarding antimicrobial susceptibility pattern, ceftriaxone and quinolones are appropriate drugs of choice.

Validação do critério diagnóstico clínico-epidemiológico para confirmação da cólera / Validation of clinical and epidemiological diagnosis criterion for confirming cholera

OBJETIVO: Validar o critério diagnóstico clínico-epidemiológico para confirmaçäo de casos suspeitos da cólera. MÉTODOS: Foram estudados pacientes em um hospital público em Maceió, sendo 2.687 do ano de 1992 e 716 de 1997. Nos pacientes admitidos com diarréia, que realizaram pesquisa do Vibrio cholerae O1 (Koch, 1884) pelo cultivo em TCBS-agar, foi aplicado o critério clínico-epidemiológico comparando-o com o padräo-ouro. A análise foi feita por faixa etária - menor que cinco anos e igual ou maior a cinco anos - em 1992 e 1997. RESULTADOS: Foram estudados 833 pacientes, 517 em 1992 e 316 em 1997; 72 com idade menor que cinco anos e 761 com idade igual ou maior a cinco anos. Nos pacientes menores que cinco anos, em 1992, a sensibilidade foi de 40por cento, enquanto a especificidade foi de 84,6por cento. Para a mesma faixa etária, em 1997, a sensibilidade foi de 28,6por cento. Já a especificidade foi de 62,5por cento. Nos pacientes com idade igual ou superior a cinco anos, em 1992, a sensibilidade e a especificidade foram de 99por cento e 1,2por cento; respectivamente. Para a mesma faixa etária, em 1997, a sensibilidade foi de 86,9por cento, enquanto a especificidade foi de 8,7por cento. CONCLUSAO: A elevada sensibilidade do critério diagnóstico clínico-epidemiológico da cólera nos pacientes com idade igual ou maior que cinco anos, nos dois anos estudados, recomenda sua aplicaçäo nos períodos de epidemia. Quando a incidência baixa, todos os casos devem ter confirmaçäo laboratorial

An outbreak of cholera in Karachi following monsoon rains 2003

An epidemic of acute gastroenteritis was observed in the province of Sindh following a heavy monsoon season in July-August 2003. In Karachi, a mega-metropolitan city, large numbers of patients were evaluated for gastroenteritis and many were severely dehydrated and needed hospitalization. This study was carried out to describe epidemiologic features of the epidemic of gastroenteritis and investigate the causative agents responsible. We reviewed the medical records of all the pediatric patients admitted to the Aga Khan University [AKU] Hospital, Karachi, with the diagnosis of "Acute Gastroenteritis" over a 3 month period [1st June 31st August 2003], and analyzed their demographic and stool culture results. Epidemiological and clinical observations were recorded and the findings were correlated with the onset of the monsoon rains. A total of 327 pediatric patients were sick enough to be hospitalized with acute gastroenteritis to the AKU hospital over the 3-month period. A 3-fold increase in the number of patients admitted with gastroenteritis was noted in the period coinciding with heavy rains [mid-July to mid-August] compared to the baseline period before the onset of rains [June 2003]. Of the 327 patients hospitalized, 134 [41%] patients had stool cultures performed. Of these 134 patients, 53 [40%] had a positive stool culture. Vibrio cholerae were isolated from 34 of the 53 [64%] positive stool cultures with an overall isolation rate of over 25% from all stool samples submitted for culture. There was a significant increase in the number of cases of gastroenteritis, specifically cholera following a heavy monsoon season in Karachi. Adequate public health measures to prevent the occurrence of outbreaks of cholera and to educate the public about the dangers of drinking contaminated water are urgently needed

Epidémie du choléra au CHU de Treichville en 2001 : aspects epidémiologiques; cliniques et thérapeutiques

Le choléra sévit à l'état endémo-épidémique en Côte d'Ivoire depuis trois décennies. En 2001 ; des foyers épidémiques ont été signales dans plusieurs villes du pays : Abidjan ; San-Pedro; Divo; Agboville et Aboisso dans le Sud; Touba; Boundiali; Korhogo au Nord; Duekoue et baba à l'Ouest; Abengourou et Bondoukou à l'Est. Notre étude a porté sur la ville d'Abidjan ou les données hospitalières étaient plus complètes. OBJECTIFS : L'objectif de l'étude était d'analyser les caractéristiques épidémiologiques ; cliniques et pronostiques des patients traites pour cholera d'octobre 2000 à novembre 2001 au CHU de Treichville. METHODES C'est une étude prospective portant sur des malades traites pour cholera dans le Service de Maladies Infectieuses. Vibrio cholerae ayant été isole dans les selles des premiers patients ; le diagnostic probable de cholera a été ultérieurement retenu sur les arguments suivants : consommation d'aliments et/ou de jus ; d'eau manipulée ; existence de cas de choléra dans l'entourage proche (famille ; travail ; école ; hôpital); diarrhée aigue avec selles; liquides; riziformes; abondantes mais sans fièvre. RESULTATS : En 14 mois ; nous avons collige 380 cas de choléra. L'épidémie a présente deux pics ; diamétralement opposés en terme d'incidence mensuelle (16 cas pour le 1er vs 47 cas pour le 2eme ; p=0 ; 04) et de mortalité (17pour cent pour le 1er vs 0.6pour cent pour le 2ème ; p 0 ;05). Le sex-ratio H/F était de 1 ;13 ; l'âge médian de 28 ans [15-85 ans]. Le mode de contamination prépondérant était indirect par consommation d'eau en sachets domestiques. Environ 59pour cent des malades ont été admis en état de choc avec collapsus cardio-vasculaire ; contre 27pour cent avec déshydratation modérée et 14pour cent avec déshydratation infraclinique. Cependant ; tous les malades ont été réhydrates avec du Ringer lactate par 2 voies veineuses d'emblée ; puis par une voie après la phase initiale ; l'autre étant relayée par la voie orale. La quantité moyenne de soluté administre était de 12 litres. L'antibiothérapie a été associée dans 49pour cent des cas pour une durée de séjour moyenne de 60 heures. L'évolution clinique a été favorable dans 94pour cent des cas. Le taux de létalité était de 4 ;7pour cent et les facteurs de gravite étaient : la consommation d'eau en sachet ; le plan C de déshydratation et la latence d'hospitalisation 2 jours. Conclusion : L'intérêt de l'enquête est d'avoir montre le caractère endémo-épidémique du cholera avec le risque de survenir à tout moment de l'année dès que les conditions d'hygiène des populations se dégradent. La prévention doit par conséquent être permanente en faisant appel à l'assainissement ; l'accès à l'eau potable et aux mesures d'hygiène

Rapid diagnosis of cholera by coagglutination test.

In this study the coagglutination test for the rapid diagnosis of cholera is evaluated in comparison with the conventional culture method. A total of 553 stool specimens were processed from cases of acute gastro-enteritis. The sensitivity and specificity of coagglutination test was 92.77% and 95.65% respectively. The coagglutination test is found to be simple, reliable and rapid method for the diagnosis of cholera.