Entre o Carlo R. e o Orleannais: a saude publica e a profilaxia maritima no relato de dois casos de navios de imigrantes no porto do Rio de Janeiro, 1893-1907 / Between the Carlo R. and the Orleannais: public health and maritime prophylaxis in the description of two cases of ships transporting immigrants arriving in the port of Rio de Janeiro, 1893-1907

Aborda as mudanças ocorridas nas práticas da profilaxia marítima brasileira. Por meio de dois casos de navios de imigrantes, que chegaram ao porto do Rio de Janeiro com epidemias a bordo, são analisados a compreensão sobre a etiologia, a forma de prevenção e o combate às três doenças com regulamentação portuária internacional: febre amarela, peste bubônica e cólera. Até o final do século XIX, uma das principais práticas de profilaxia era a quarentena. No início do XX, identificamos a emergência do ideário da microbiologia e dos vetores no serviço sanitário dos portos. A quarentena, que já vinha sendo criticada como antiquada e ineficaz, é limitada a alguns casos, e novos métodos e tecnologias da higiene passam a ser aplicados na defesa sanitária dos portos.

We address the changes in Brazilian maritime prophylaxis by studying two cases of immigrant ships arriving at the port of Rio de Janeiro with epidemics onboard. The objective is to understand the etiology, means of prevention and methods used to combat the three diseases subject to international port regulations: yellow fever, bubonic plague and cholera. Until the late nineteenth century, quarantines were one of the main disease prevention practices. In the early twentieth century, microbiology and the concept of vectors in ports sanitation services emerged. Quarantines, which were already being criticized as antiquated and ineffective, were limited to a few cases, and new hygiene methods and technologies began to be applied in port sanitary defense.

A De in the life of cholera.

The 50-year commemoration of S.N. De’s seminal 1959 publication in Nature provides an opportunity to reflect on scientific discovery, recognition, and public health. De’s paper marked the first major conceptual advance in cholera research since 1884, when Robert Koch definitively identified Der Kommabazillus as the aetiological agent of cholera. Unfortunately, Koch reported that systemic toxinosis and multi-organ failure led to severe dehydrating diarrhoea, thereby mistaking cause for effect. As a consequence, while work on other microbial pathogens advanced into the development of vaccines and therapeutics, cholera research languished as scientists injected animals parenterally in decades of futile effort to develop an animal model of diarrhoea. This fundamental misconception in cholera pathogenesis was swept away when S.N. De used ligated loops of rabbit ileum to demonstrate lumenal fluid accumulation in the presence of Vibrio cholerae culture filtrates. After some delay, De’s observation of a diarrhoeagenic exotoxin became the founding principle of modern cholera research, vaccination, and treatment; and a burst of discovery saw V. cholerae transformed into the enteric pathogen best understood at the molecular level. The scientific basis for orally administering vaccines to induce mucosal immunity was established, and the success of oral rehydration, what has been described as one of the 20th century’s most important medical advances, was explained.Nobel laureate Joshua Lederberg wrote of De’s iconoclastic creativity, experimental skill, and observational mastery, and many other leaders in the field concurred. De was nominated for the Nobel Prize in Physiology or Medicine more than once. But despite the passage of half a century from De’s work, cholera remains a frustrating problem: we are clearly missing something. In reviewing the scientific and programmatic impact of S.N. De on cholera, it is clear that a defining victory against the disease is achievable, but only if basic scientific discoveries are relentlessly driven towards progress in public health.

cholera outbreak associated with drinking contaminated well water

Cholera has been a significant public health challenge in many communities. An outbreak of acute diarrheal illness occurred among participants in a wedding ceremony in a village in Qazvin, Iran, in 2008. We conducted an epidemiological, environmental and microbiological investigation to determine the causative agent, source and extent of this outbreak. Clinical and environmental samples were collected and analyzed for the presence of diarrhea-causing bacterial organisms, which included Vibrio cholera. The relationship between the strains was determined using enterobacterial repetitive intergenic consensus poly-merase chain reaction [ERIC-PCR]. The attack rate was 21.8%. Clinical and environmental samples were positive for V. cholerae serotype Inaba. All tested isolates had a similar ERIC-PCR pattern, which indicated that a single clone of V. cholerae was responsible for this outbreak. Our findings demonstrated that well water was the source of this outbreak

Coping with Cholera: the Importance of Coordinated Planning

Cholera epidemics in Zimbabwe; Haiti; and Nigeria have grabbed worldwide headlines in the last couple of years as beleagured health agencies battled to contain a rising tide of patients. Is this resurgence a pathological issue; or simply the consequence of poor public health provision? Superficially there should be little excuse for the epidemics of the size we have witnessed recently (more than 1500 died in the outbreak in Nigeria in 2010); cholera is not a mystery illness; and measures to contain an outbreak are known. But the logistics can be daunting and if health systems are weak; they can quickly become overwhelmed. Can one prepare? Of course. and in fact it is a must. As with all infectious diseases; lessons from one campaign will educate and illuminate actions for another. Hospitals and communities should be undertaking regular risk assessments; and providing quality training and resources to enable swift and decisive action the moment a problem is identified. Until the 1980s most outbreaks were managed at the local level using the best available common sense. Apart from in the most densely populated areas; this was largely successful. Slowly; public health experts started comparing notes and the compilation of guidelines for the control of cholera outbreaks started to emerge with epidemiologists from WHO helping to `join up the dots' between experiences in different continents and countries

Cholera in Iraq

During the period between 14th of September, 2007 and 13th of January, 2008 a total of 4,697 laboratory-confirmed cases of cholera were reported from 46 districts in eleven provinces of Iraq [Kirkuk, Sulaimaniyah, Erbil, Dahuk, Tikrit, Ninewa, Baghdad, Basra, Wasit, Anbarand Diyala]. Twenty-four of these cases were fatal [CFR = 0.51%.]. V. Cholerae biotype Inaba was isolated in 99% of all samples tested. The outbreak was first reported from Kirkuk, Sulaimaniyah and Erbil provinces in the Northern part of the Country. The three provinces account for 98% [4,520] of the total reported cases of cholera in the Country. However, in the last few weeks the number of cases has been slowly coming down in these three provinces. In the last six weeks, most of the cases were reported from the capital city, Baghdad. Contaminated water was identified as the commonest vehicle of transmission of this outbreak. In response to the outbreak, Ministry of Health, Iraq, with the support of WHO Country and Regional offices and in collaboration with other partners have put in place control measures to contain the spread of the outbreak

El cólera en la Nueva Granada / Cholera in Nueva Granada

Presenta los usos y abusos biopolíticos de la epidemia de cólera como medio de dominación, control e higienización de las clases pobres. Muestra que la clase dominante, al abrazar el partido del anticontagionismo, atribuyó a la pobreza el carácter de foco de infección y causa de la enfermedad. Señala la importancia del debate entre contagionistas y anticontagionistas en la judicialización del espacio público y privado.

Rice-ORS versus glucose-ORS in management of severe cholera due to Vibrio cholerae O139 Bengal: a randomized, controlled clinical trial.

This study examined the comparative efficacies of rice-based oral rehydration solution (R-ORS) and glucose-based oral rehydration solution (G-ORS) in the management of severe cholera due to Vibrio cholerae O139 Bengal that causes epidemic cholera in many developing countries. Stool culture-proved adult male patients with severe cholera due to V. cholerae O139 Bengal were randomly assigned in a 1:1 ratio to receive either R-ORS or G-ORS after their initial rehydration with intravenous (i.v.) fluid and subsequently four hours of observation. They also received the usual hospital diet and tetracycline capsules (500 mg 6 hourly for three days) immediately after their enrollment in the study. The primary outcomes for observation were stool output during the first 24 hours after intervention and treatment failure as measured by the incidence of re-institution of i.v. fluid after initiation of trial therapy and duration of diarrhoea. Of 113 patients finally included in the study, 57 received R-ORS and 56 G-ORS. The admission characteristics of the two treatment groups were comparable. No significant differences in the first 24 hours of median (inter-quartile range) stool output [179 (67-206) g/kg in R-ORS group vs 193 (80-237) g/kg in G-ORS group; p = 0.52], incidences of unscheduled i.v. fluid requirement [21% (12/57) in R-ORS group vs 25% (14/56) in G-ORS group; p = 0.78], and median (inter-quartile range) duration of diarrhoea [32 (24-48) hours in R-ORS group vs 32 (24-56) hours in G-ORS group; p = 0.64] were observed. It is concluded that rice-based ORS is effective but not superior to standard glucose-based ORS in the management of adult males with severe cholera due to V. cholerae O139 Bengal.

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

Vibrio cholerae diarrhoea in a three-day-old breastfed neonate.

A confirmed case of cholera in a 3-day-old neonate is being reported. Possible source of infection could be by holy water (Chamamrit) given to the baby, which is common ritual in India. Mother's milk has never been reported to transmit cholera, even though mother herself may be suffering from cholera. Contaminated water can transmit the disease as there is no maternally transmitted immunity.

outbreak of cholera in Ajdabiya-Libya

During an outbreak of cholera in Libya, 15 [79%] out of 19 diarrhoeal samples from non-Libyans yielded V cholera 01 strains of E1 Tor biotype and Ogawa serotype. Isolates were [BETA]-haemolytic on blood agar, grew on CLED medium and were positive for VP test. The organisms were resistant to cotrimoxazole chloramphenicol, tetracycline and to the vibriostatic compound 0/129. However, they were sensitive to nalidixic acid, norfloxacin, ofloxacin, carbenicillin and ampicillin. The possible source of infection was attributed to polluted well drinking water

Manejo hospitalario del paciente con colera. Brote en la parroquia de Cangahua. Cantón Cayambe, 1995. Hospital Raúl Maldonado Mejía

En mayo de 1995, el Hospital Raúl Maldonado Mejía de Cayambe recibió a 43 pacientes del brote colérico de la parroquía de Cangahua (cayambe), el cual resultó por la compartición de comidas y bebidas durante el velorio de la primera infectada fallecida. El 35 por ciento llegaron con deshidratación grado 3 y 16 por ciento en shock. La media del tiempo de hospitalización fue 3.63 días de los 43 casos ninguno falleció ni presentaron complicación alguna...

Efectos de la expansión endovenosa rápida con solución Hartmann y con cloruro de sodio al 0.9 por ciento, sobre el medio interno de pacientes con deshidratación severa por diarrea aguda coleriforme / Effects of fast intravenous expansion with Hartmann's solution and sodium chloride at 0.9 per cent on the internal milieo, in patients with cholera like diarrhea

Objetivo: comparar el efecto de la expansión endovenosa rápida con ClNa al 0.9 por ciento y solución Hartmann, sobre la acidosis metabólica y los niveles de electrolitos plasmáticos en pacientes con deshidrataciónn severa por diarrea coleriforme. Material y métodos: se evaluaron prospectivamente 13 pacientes con deshidratación severa por enfermedad diarreica aguda compatible con cólera, que acudieron al Hospital Nacional Cayetano Heredia en febrero de 1994. Los pacientes fueron adultos entre 14 y 60 años, 7 pacientes fueron expandidos con ClNa al 0.9 por ciento y 6 con solución Hartmann a un flujo de 50 cc/Kg/hora endovenoso hasta recuperar diuresis. Resultados: las condiciones basales de ambos grupos fueron iguales, los resultados postmicción, cuando eran expandidos con ClNa fueron: el Na+: 148ñ1.60 mEq/L, el Cl-: 118ñ2.99 mEq/L, la osmolalidad: 299ñ3.97, el pH: 7.23ñ0.07, el HCO3-: 13.3ñ3.10 mEq/L; y cuando eran expandidos con solución Hartmann fueron: el Na+: 142ñ2.29 mEq/L, el Cl-: 109ñ2.74 mEq/L, la osmolalidad: 290ñ4.33, el pH: 7.37ñ0.07 y el HCO3-: 16.1ñ1.36 mEq/L. Se muestra las diferencias y los beneficios de usar la solución Hartmann en la fase de expansión rápida

Modern trends in the biomedical sciences

This work presents some aspects of modern biomedical science that particularly contribute to its application to conquer disease. Two examples are used to show developments in methodology may contribute toward this end .The knowledge about the mechanisms of disease in the case of cholera on the one hand, and of cystic fibrosis, on the other, are leading to new possibilities of prevention and treatment of these diseases. In both cases, membrane transport defects are the underlying cause of their pathology. The nature of these defects has been investigated by in vivo and in vitro studies of ion transfer across the involved epithelia (intestinal and airway), including electrophysiological and single channel studies. The nature of the involved membrane transporters (in cystic fibrosis) as well as of the toxins that cause the symptoms of cholera has been determined by molecular biology methods, which have also detected the genetic defects responsible for the anomalous transporters. In addition, the genes responsible for the production of different main and accessory cholera enterotoxins have been defined, allowing the elaboration of vaccines that may prevent the effect of infection by Vibrio cholerae.This new knowledge may lead, in the future, to improved ways to detect, treat and prevent these and other diseases.