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Symptoms
By Mayo Clinic staffMost people exposed to the cholera bacterium (called Vibrio cholerae) don't become ill and never know they've been infected. Yet because they shed cholera bacteria in their stool for seven to 14 days, they can still infect others. Most symptomatic cases of cholera cause mild or moderate diarrhea that's often hard to distinguish from diarrhea caused by other problems.
Only about one in 10 infected people develops the typical signs and symptoms of cholera, which include:
- Severe, watery diarrhea. The incubation time for cholera is brief — usually one to five days after infection. Diarrhea comes on suddenly. Diarrhea due to cholera is often voluminous, flecked with mucus and dead cells, and has a pale, milky appearance that resembles water in which rice has been rinsed (rice-water stool). What makes cholera diarrhea so deadly is the loss of large amounts of fluids in a short time — as much as a quart (.95 liters) an hour.
- Nausea and vomiting. Occurring in both the early and later stages of cholera, vomiting may persist for hours at a time.
- Muscle cramps. These result from the rapid loss of salts such as sodium, chloride and potassium.
- Dehydration. This can develop within hours after the onset of cholera symptoms — far more quickly than in other diarrheal diseases. Depending on how much body fluids have been lost, dehydration can range from mild to severe. A loss of 10 percent or more of total body weight indicates severe dehydration. Signs and symptoms of cholera dehydration include irritability, lethargy, sunken eyes, a dry mouth, extreme thirst, dry, shriveled skin that's slow to bounce back when pinched into a fold, little or no urine output, low blood pressure, and an irregular heartbeat (arrhythmia).
- Shock. Hypovolemic shock is one of the most serious complications of cholera dehydration. It occurs when low blood volume causes a drop in blood pressure and a corresponding reduction in the amount of oxygen reaching your tissues. If untreated, severe hypovolemic shock can cause death in a matter of minutes.
Signs and symptoms of cholera in children
In general, children with cholera have the same signs and symptoms adults do, but they may also experience:
- Extreme drowsiness or even coma
- Fever
- Convulsions
When to see a doctor
The risk of cholera is slight in industrialized nations, and even in endemic areas you're not likely to become infected if you follow food safety recommendations. Still, sporadic cases of cholera occur throughout the world. If you have diarrhea, especially severe diarrhea, and think you may have been exposed to cholera, seek treatment right away. Severe dehydration is a medical emergency that requires immediate care.
- Cholera. World Health Organization. http://www.who.int/mediacentre/factsheets/fs107/en/. Accessed Feb. 19, 2009.
- Cholera. Centers for Disease Control and Prevention. http://www.cdc.gov/nczved/dfbmd/disease_listing/cholera_gi.html. Accessed Feb. 19, 2009.
- Cholera. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec14/ch173/ch173e.html. Accessed Feb. 19, 2009.
- Butterton JR. Approach to the patient with Vibrio cholerae infection. http://www.uptodate.com/home/index.html. Accessed Feb. 19, 2009.
- Menon MP, et al. Vibrio cholerae (Cholera). In: Long SS, et al., eds. Long: Principles and Practice of Pediatric Infectious Diseases. 3rd ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2008:844.
- Seas C, et al. Vibrio cholerae. In: Mandell GL, et al. Mandell, Bennett, & Dolin: Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2005:2536.
