Cholera, treatment

The cornerstone of cholera treatment is fluid replacement. Without treatment, the case-fatality rate for severe cholera is approximately 50%. For cholera, rice-based ORT is better than glucose-based ORT because it reduces the number of stools.21 Patients with significant disease should receive a short antibiotic course, 1 to 3 days, to shorten the duration of illness and decrease the number of stools. Doxycycline 300 mg once daily is the drug of choice. Other antibiotics shown to be effective include erythromycin, azithromycin, trimethoprim-sulfamethoxazole, and ciprofloxacin.2 Antibiotic resistance has been documented in V cholerae since 1977.2 Antibiotic prophylaxis is not warranted. 

For large outbreaks, oral rehydration solutions (ORS) are useful. Standardised World Health Organization (WHO) ORS sachets are available although a home-made version can be produced by adding 8 level teaspoons of table sugar and 1 level teaspoon of table salt to 1 litre of water. Antibiotic therapy can be useful for cholera treatment but does not shorten the disease course. Doxycycline 300 mg p.o. as a stat dose, or ciprofloxacin 250 mg p.o. b.d. for 3 days is recommended. Cryptosporidium infections are self-limiting and effective treatment is strictly supportive. 

Antibiotic LL-E19020a and LL-E19020P are described as useful agents for the treatment of chronic respiratory disease, fowl cholera, and necrotic enteritis in birds (76) and as anthelmintics in monogastric and mminant animals (28). 

Pathogenic organisms Bacteria, viruses or cysts which cause disease (typhoid, cholera, dysentery) in a host (such as a person). There are many types of bacteria (non-pathogenic) which do NOT cause disease. Many beneficial bacteria are found in wastewater treatment processes actively cleaning up organic wastes. 

Cholera toxin and related toxins act as immune modulators, with potential use as adjuvants and as therapeutic agents in the treatment of immunologically mediated human disease. 

After Koch s momentous discovery of the cholera bacillus in 1883, cheap and effective treatment of sewage became possible. The civil engi-... 

The mainstay of treatment for cholera consists of fluid and electrolyte replacement with ORT to restore fluid and electrolyte losses. Rice-based rehydration formulations are the preferred ORT for cholera patients. In patients who cannot tolerate ORT, IV therapy with Ringer s lactate can be used. 

Fig. 4.—Mass Fragmentography (m/e 161) of Methylated Hexose Derivatives from the Disialosy] Ganglioside. [Top, before treatment with neuraminidase bottom, after treatment with Vibrio cholerae neuraminidase. The methylated hexose derivatives identified are (A) 2,4,6-tri-O-methylgalactose (B) 2,3,6-tri-O-methylglucose (C) 2,3,4,6-tetra-O-methylgalactose. The peaks eluting before C are unrelated signals that were also detected in a blank experiment employing the neuraminidase treatment. Conditions 3% of QF-1, at 190°. Reproduced, by permission, from Ref. 80.]...

The typical symptoms begin with the sudden onset of nausea and vomiting and profuse diarrhea without abdominal cramps. The stools produced are characteristically ricewater -like and contain mucus, epithelial cells, and ibrio cholerae bacteria. The dehydration resulting from rapid loss of fluid and electrolytes leads to circulatory collapse and kidney shutdown. Mortality rate without treatment can be as high as 50%.3... 

Treatment — Because of the severe dehydration caused by cholera infection, the most important therapy is fluid and electrolyte replacement. Many antibiotics are effective against V. cholerae, including tetracycline, doxycycline, ciprofloxacin, and erythromycin.3... 

Caveolae can mediate the delivery of CtxB that binds to GM1 ganglioside at the plasma membrane and is delivered to intracellular compartments. Cholera toxin, produced by Vibrio cholerae, consists of five identical subunits B and one A chain. In addition to labeled SV40 and caveolin-1-GFP, CtxB is one of the most commonly used caveolae markers. However, two groups reported that the toxin is internalized by either a clathrin-independent caveolae pathway or a clathrin-dependent uptake, bringing its selectivity/specificity into question (31,81,118). We controlled the suitability of this marker for COS-7 cells pretreated with CPZ, mpCD, and filipin and as expected, the uptake was not influenced by CPZ treatment but was strongly decreased by the latter two (data not shown). 

Enterotoxigenic E. coli (ETEC) is the main cause of TD in Latin America, whereas in Asia it is reported in only 15% of cases. Enteroinvasive E. coli (EIEC) strains are recorded with even less frequency. ETEC is isolated in 0 to 5% of cases. Symptoms of poisoning develop after 16 hours from consumption of contaminated water, salads, cheeses, or meats. The outgrowth of ETEC rods takes place in a patient s gastrointestinal tract, where they produce thermostable and thermolabile toxins that imitate Vibrio cholerae infections. Stimulation of intestinal guanylcyclase and interruption of ion transport leads to watery stools, which do not require medical treatment or only need simple replacement of fluids and salts by means of multielectrolyte solutions. If a co-infection with EIEC strains occurs, the symptoms of enteritis will develop, with the presence of leukocytes, erythrocytes, and mucous in stools due to a cytotoxic influence of bacteria (Butterton and Claderwood, 2001). 

When the diarrhea is not viral (Noro formerly known as Norwalk virus) or protozoal Entamoeba) or caused by a toxin (shell-flsh poisoning) it is often caused by either Salmonella, Shigella, Campylobacter or Yersinia species. In some countries there is a high prevalence of Vibrio cholerae - GTI causing severe watery diarrhea. Clostridium difficile enterocolitis is related to prior antibiotic treatment but also observed during chemotherapy. 

The tetracyclines are still the drugs of choice for treatment of cholera, diseases caused by Rickettsia and Coxiella, granuloma inguinale, relapsing fever, the chlamydial diseases (trachoma, lymphogranuloma... 

The following experiments arc at variance with such a clearance mechanism. Incubation of rabbit erythrocytes with V. cholerae sialidase in the presence of inhibiting concentrations of Neu2en5Ac protects surface sialic acids and, correspondingly, survival of the cells in circulation.142 Treatment of erythrocytes by V. cholerae sialidase immobilized on Sepharose 4B, allowing complete separation of the enzyme from the cells after incubation, resulted in engulfment of these cells by macrophages at a rate similar to that observed with cells treated with the soluble enzyme. 1 1... 

Novobiocin (Fig. 3.9) is a narrow-spectrum antibiotic with antibacterial activity against many gram-positive pathogens. It is frequently used, in combination with penicillin, for treatment of bovine mastitis by intramammary infusion of 200 mg/ quarter in two quarters, and to control fowl cholera and staphylococcal infections in chickens and turkeys at a level of 200-350 g/ton in feed. 

The outbreak of cholera in Latin America that started in Pein in January 1991 was caused in large part by the lack of effective water treatment and disinfection. The result was 1.2 million cases and 12,000 deaths from 1991 to 1998. 

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