Most people exposed to the cholera bacterium (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 through contaminated water. Most symptomatic cases of cholera cause mild or moderate diarrhea that's often hard to distinguish from diarrhea caused by other problems.
Only about 1 in 10 infected people develops the typical signs and symptoms of cholera, usually within a few days of infection.
Symptoms of cholera infection may include:
- Diarrhea. Cholera-related diarrhea comes on suddenly and may quickly cause dangerous fluid loss — as much as a quart (about 1 liter) an hour. Diarrhea due to cholera often has a pale, milky appearance that resembles water in which rice has been rinsed (rice-water stool).
- Nausea and vomiting. Occurring especially in the early stages of cholera, vomiting may persist for hours at a time.
Dehydration. Dehydration can develop within hours after the onset of cholera symptoms. Depending on how many 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 and 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).
Dehydration may lead to a rapid loss of minerals in your blood (electrolytes) that maintain the balance of fluids in your body. This is called an electrolyte imbalance.
An electrolyte imbalance can lead to serious signs and symptoms such as:
- Muscle cramps. These result from the rapid loss of salts such as sodium, chloride and potassium.
- Shock. This is one of the most serious complications of dehydration. It occurs when low blood volume causes a drop in blood pressure and a drop in the amount of oxygen in your body. 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 are particularly susceptible to low blood sugar (hypoglycemia) due to fluid loss, which may cause:
- An altered state of consciousness
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 develop severe diarrhea after visiting an area with active cholera, see your doctor.
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 regardless of the cause.
April 05, 2014
- Harris JB, et al. Cholera. The Lancet. 2012;379:2466.
- Ferri FF. Ferri's Clinical Advisor 2014: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2014. https://www.clinicalkey.com. Accessed Nov. 18, 2013.
- Cholera — Vibrio cholera infection. Centers for Disease Control and Prevention. http://www.cdc.gov/cholera/index.html. Accessed Nov. 18, 2013.
- Cholera. World Health Organization. http://www.who.int/mediacentre/factsheets/fs107/en/. Accessed Nov. 18, 2013.
- Brooks GF, et al. Jawetz, Melnick, & Adelberg's Medical Microbiology. 26th ed. New York, N.Y.: The McGraw-Hill Companies; 2013. http://www.accessmedicine.com/content.aspx?aID=57032697&searchStr=cholera. Accessed Nov. 18, 2013.
- WHO position paper on oral rehydration salts to reduce mortality from cholera. World Health Organization. http://www.who.int/cholera/technical/en/. Accessed Dec. 30, 2013.