ABSTRACT
Intestinal infection with Vibrio cholerae results in the loss of large volumes of watery stool, leading to severe and rapidly progressing dehydration and shock. Without adequate and appropriate rehydration therapy, severe cholera kills about half of affected individuals. Cholera toxin, a potent stimulator of adenylate cyclase, causes the intestine to secrete watery fluid rich in sodium, bicarbonate, and potassium, in volumes far exceeding the intestinal absorptive capacity. Cholera has spread from the Indian subcontinent where it is endemic to involve nearly the whole world seven times during the past 185 years. V cholerae serogroup O1, biotype El Tor, has moved from Asia to cause pandemic disease in Africa and South America during the past 35 years. A new serogroup, O139, appeared in south Asia in 1992, has become endemic there, and threatens to start the next pandemic. Research on case management of cholera led to the development of rehydration therapy for dehydrating diarrhoea in general, including the proper use of intravenous and oral rehydration solutions. Appropriate case management has reduced deaths from diarrhoeal disease by an estimated 3 million per year compared with 20 years ago. Vaccination was thought to have no role for cholera, but new oral vaccines are showing great promise.
Subject(s)
Cholera , Africa/epidemiology , Asia/epidemiology , Cholera/epidemiology , Cholera/microbiology , Cholera/prevention & control , Cholera Vaccines/therapeutic use , Drug Resistance, Bacterial/genetics , Gene Expression Regulation, Bacterial , Global Health , Humans , Molecular Epidemiology , South America/epidemiology , Vibrio cholerae/classification , Vibrio cholerae/genetics , Vibrio cholerae/metabolismABSTRACT
Aun cuando la mortalidad por cólera ha declinado debido a un tratamiento apropiado, el desplazamiento de esa enfermedad es ahora más intenso que lo que fue a principios del siglo. La esperanza la protección por medio de una vacuna se han visto afectadas por la habilidad del cólera para cambiar su epidemiología. Los programas para el control de afecciones diarreicas han de continuar estimulando la prevención de esas enfermedades por medio de la educación de la comunidad e intervenciones en el campo de la higiene, ya que no hay solución "mágica" inminente o en perspectiva. Estudios de la epidemiología y del comportamiento se requieren aún para entender mejor aquellos factores que puedan continuar iniciando cambios impredecibles en el curso de esta enfermedad y en su distribución epidémica.