Eng / Cholera_2023
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Сholera pathogenesis
The A subunit binds to the G protein and activates the enzyme adenylate cyclase, which acts on ADP molecules, resulting in increase in cAMP production.
The cAMP molecule provides the energy needs of the cell. As a result of an increase in the content of cAMP in the cell, all functions of the enterocyte increase. One of the main functions of the enterocyte is the secretion of intestinal juice.The production of intestinal juice increases many times, which leads to the release of water, sodium, potassium and bicarbonate into the lumen of the small intestine and rapid dehydration.
Features of cholera pathogenesis
Cholera is a localized infection
Vibrio cholerae remains in the intestinal lumen, never invades the intestinal wall and does not enter the blood
Cholera toxin (cholerogen) contacts only with the outer membrane of the enterocyte, triggering a cascade of enzymatic reactions, resulting in hyperproduction of fluid and salts by enterocytes.
There are no inflammatory changes in the intestines,
There are no enteritis phenomena,
There is only a hyper enhancement of the enterocytes function
Toxin, as well as vibrio, remains in the intestinal and does not enter the bloodstream,
so there is no intoxication with a rise in temperature and other symptoms of inflammation.
The severity of the condition is associated with loss of fluid and electrolytes
Features of the pathogenesis of 
cholera
There is a decrease in circulating blood volume (BCC), which is compensated by the flow of tissue fluid, extracellular, and then intracellular fluid
Microcirculation is disturbed due to an increase in blood viscosity
In the distal tubules of the kidneys, the reabsorption of primary urine increases, which leads to oligoand anuria.
Shock mechanisms are triggered, aggravating microcirculation disorders and contributing to hypoxia
Dystrophic disorders develop in parenchymal organs, point cell necrosis
Loss of potassium salts contributes to heart rhythm disturbance, intestinal atony
Loss of calcium salts leads to the development of spasms of striated muscles
Signs and symptoms
Acute onset with profuse diarrhea
Rapidly developing dehydration
Signs of desalination
No intoxication
Body temperature is normal or low
No pain syndrome
Diarrhea precedes vomiting
Stool and vomit in the form of rice water
The rapid development of dehydration shock - cholera algid
Stages of dehydration according to V.I. Pokrovsky
fluid loss:
I degree - no more than 3% of body weight;
II degree - up to 6% of body weight;
III degree - up to 9% of body weight;
IV degree - more than
9-10% of body weight.
I degree (loss of body weight up to 3%)
Weakness
Thirst
Dry mouth (in 2/3 of patients)
Liquid watery (rarely mushy) non-bulky stools from 3-4 to 10 times a day
Vomiting 1-2 times a day in about half of patients
II degree (loss of body weight 4-6%)
Marked weakness
Dizziness, fainting
Dry skin, mucous membranes
Cyanosis of the lips in 20-25% of patients (less often acrocyanosis)
Rare muscle spasms
Tachycardia in 50% of patients
lower blood pressure to 90/60 mm Hg. (up to 25% of cases)
III degree (loss of body weight 7-9%)
Severe weakness, adynamia
Dry mucous membranes
Skin turgor is reduced
Facial features are pointed
Eyeballs sunken, a symptom of "dark glasses“
Facial cyanosis
acrocyanosis
Prolonged painful spasms of the muscles of the extremities
Hoarse weak voice
III degree (loss of body weight 7-9%)
Body temperature 36-36.5 ° C, subnormal in a one third of patients
Blood pressure 90/60 mm Hg and below
Pulse up to 120 per minute, weak filling
Multiple stools like rice water
Profuse vomiting more than 20 times a day
Oliguria (in 75% of patients) or anuria (25% of cases)
IV degree (weight loss of 10% or more)
Sharp weakness
Sometimes prostration, but consciousness is preserved
Sunken eyes, a symptom of "dark glasses“
Facial features are pointed
The skin is cold to the touch, covered with sticky sweat
General cyanosis of the skin
Skin turgor is sharply reduced
Wrinkling of the skin of the trunk and face
Symptom of "washerwoman's hands“
Cramps in the muscles of the limbs and abdomen