RESUMEN
In 1959-1961, two major international centers for the study of cholera were established in Calcutta and in Dacca, Bangladesh. As the result of collaborative work in these centers, a simple effective oral therapy for cholera, using ingredients available in virtually every part of the world, was defined. Through the well-coordinated efforts of the World Health Organization (WHO), knowledge of how to prepare and administer oral rehydration therapy has now been disseminated throughout most of the world. With this background, when Peru was attacked in 1991 by a massive and totally unanticipated outbreak of cholera, a remarkably well-organized national response to the epidemic achieved a survival rate greater than 99% in greater than 300,000 cholera patients during the first year of the epidemic. Thus the results of clinical research on the Indian subcontinent, widely disseminated through educational programs by the WHO, have resulted in unparalleled success in the treatment of the largest epidemic outbreak of cholera in the 20th century.
Asunto(s)
Cólera/terapia , Fluidoterapia , Animales , Bangladesh/epidemiología , Cólera/epidemiología , Cólera/historia , Cólera/fisiopatología , Brotes de Enfermedades , Fluidoterapia/historia , Historia del Siglo XIX , Historia del Siglo XX , Humanos , India/epidemiología , Perú/epidemiologíaRESUMEN
A pool of colostrum from Guatemalan mothers (Guatemalan colostrum)) obtained 2-4 days post partum inhibited the induced fluid accumulation in rabbit ileal loops when incubated with Vibrio cholerae or Escherichia coli enterotoxin. There was a linear relationship between the quantity of colostrum used and the protection achieved. Pools of Guatemalan breast-milk obtained 15-30 days post partum and North American breast-milk had the same effect when tested with E. coli and V. cholerae enterotoxins, respectively. The antitoxic activity of a given pool correlated with its IgA content but not with the concentration of IgG or IgM. Guatemalan colostrum globulins were precipitated by ammonium sulphate. The globulins were filtered through a 'Biogel A5' column and fractions obtained. When tested in rabbit ileal loops the antienterotoxin activity in these fractions closely paralleled their IgA but not their detectable IgG or IgM content. We hypothesise that IgA antibody to enterotoxin, present in breast-milk of normal mothers, is probably a manifestation of natural immunity. The passive transfer of these antibodies to the infant may explain why breast-milk prevents E. coli diarrhoea in the neonate.