[Cholera--once and nowadays].

HISTORY: Cholera is an acute intestinal infection which raged in India in the nineteenth century and it broke out in six great pandemics out in Europe.

ETIOLOGY: Cholera is caused by bacteria Vibrio cholerae, which produce an enterotoxin causing massive diarrhoea. There are two biotypes--classic and El Tor.

EPIDEMIOLOGY: The source of Vibrio cholerae is a man. Cholera is a typical faecally-oral infection.

PATHOGENESIS: Ingested by contaminated water and food, Vibrio cholerae comes to the intestinal wall. The tightness is intermediated with toxin-coregulated pilus. There it produces enterotoxin and activates adenilate cyclase which accumulate intracellular cyclic adenosine monophosphate. The result is isotonic watery diarrhoea.

CLINICAL FEATURES: Cholera can occur as asymptomatic infection, then enteritis and deathly classic cholera. Patients suffer from explosive, unremitting, watery diarrhoea (known as "rice water"). DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS: The diagnosis is based on clinical features, epidemiological data and laboratory diagnostic methods. The most important is to isolate Vibrion cholerae from the stool.

THERAPY: The most important treatment for cholera is fluid containing minerals. The best antibiotics available are tetracycline.

PREVENTION: The best preventive measures are water supply, sanitation, food safety and community awareness. The importance of vaccines comes second. CHOLERA NOWADAYS: Cholera has been known since ancient times, but it is present even nowadays. It has been developed as a biological weapon.

CONCLUSION

Cholera is a dreadful intestinal disease with severe clinical features. One thing is known for certain: hygienic and sanitary measures are the main prevention.