Symptoms of Cholera

cholera symptoms
© Verywell, 2018 

The majority of people infected with cholera—around 75 percent—won't have any symptoms at all. For those who do, they will feel a lot like they have food poisoning, complete with diarrhea, nausea, and vomiting.

In most cases, symptoms (while unpleasant) are typically mild, though severe dehydration and other complications from cholera can be fatal if treatment isn't obtained quickly enough.

Frequent Symptoms

Cholera can cause physical discomfort in a number of ways, but there are a few symptoms characteristic in nearly all symptomatic cases: diarrhea, nausea, and dehydration.

Watery diarrhea 

Often the very first sign of cholera is painless diarrhea that occurs within a day or so of becoming infected. The diarrhea is extremely watery and has a sort of pale murkiness that resembles water after rinsing rice, which is what gives it its nickname "rice water stool."

Because toxins produced by the cholera bacteria prompt the body to expel pretty much everything in the intestines—including fluids—the amount of diarrhea can be substantial. The diarrhea can last anywhere from a day to a week, depending on the person and course of treatment.

Nausea and Vomiting 

In the early stages of cholera, the bacteria can cause gastrointestinal discomfort like nausea and, in some cases, vomiting. Waves of vomiting can last for hours at a time and—when combined with the watery diarrhea—can further the risk of dehydration.

Unfortunately, dehydration can also lead to more nausea, prompting a vicious cycle that, unless broken, can quickly spiral into severe complications.

Dehydration 

Cholera forces a lot of fluid from the body through spells of diarrhea and vomiting, making it easy to become dehydrated if those fluids and electrolytes aren't replaced.

When this happens, some signs of dehydration will start to appear, such as: 

  • Thirst
  • Dry mouth and eyes
  • Rapid and/or weak heart rate 
  • Mild muscle cramps 
  • Tiredness or lethargy
  • Headaches

Rare Symptoms

In about 5 to 10 percent of cases, people can experience severe symptoms of cholera—most notably, very large quantities of watery diarrhea. The massive amount of fluid lost in such a short amount of time can quickly lead to severe dehydration and electrolyte imbalance—two complications that can be severe, if not life-threatening.

Other symptoms of severe disease can include low blood pressure, persistent vomiting, rapid heart rate, and muscle cramps.

Complications 

The greatest risk posed by cholera is severe dehydration. The swift and significant onslaught of watery diarrhea, and sometimes vomiting, can quickly drain the body of fluids and electrolytes. If they aren't replaced in time, people can die within a matter of hours.

Worrisome signs of severe dehydration and electrolyte loss include:

  • Low blood sugar 
  • Fever and chills 
  • Changes in breathing patterns
  • Altered mental state
  • Skin that, when pinched, doesn't immediately go back into place
  • Kidney failure
  • Loss of consciousness 
  • Shock 
  • Coma 
  • Death

In cases of severe disease, these complications can develop quickly—within a matter of hours—and are particularly dangerous for individuals that can decline fast if they lose too many fluids and electrolytes, including small children and pregnant women.

This is why promt attention to the manner is necessary.

Young Children 

Smaller bodies need proportionately more fluids than adults to stay hydrated because of the limited amounts of fluids they can store and how quickly they need to be replaced. Compared to healthy adults, it's far easier for young children and infants to become dehydrated or experience a drop in blood sugar as a result of cholera—and subsequently, go into shock or die as a result.

In places where cholera is common, kids are also less likely than adults to have built up an immunity against the bacterium. For this reason, children under 5 years old account for more than half of new cases and a sizable portion of cholera-related deaths worldwide.

Children who are already malnourished are particularly vulnerable to complications from cholera. Not only are kids with poor nutrition less able to fend off the bacteria, but also physical ailments caused by a lack of good nutrition can sometimes mask symptoms of the disease and lead to a dangerous delay in diagnosis.

Pregnant Women 

Like small children, pregnant women need more fluids than the average adult to stay hydrated, making it easier for them to become dehydrated. If that happens, it can reduce the blood flow to the placenta and limit the amount of cushion and nutrients available to protect and sustain the growing unborn baby.

If a woman becomes infected with cholera in her third trimester especially, it can increase her risk of going into labor too early.

Other At-Risk Groups 

Because of how cholera affects the body's cells and digestive system, there are a number of individuals who could be at risk for worse outcomes if they become infected. These groups should be aware of the risks and potential complications. They include individuals who: 

  • Lack hydrochloric acid in their digestive stomach juices
  • Have blood type O
  • Live with chronic medical conditions
  • Don't have ready access to medical help, including rehydration therapy

When to See a Doctor 

Most individuals—especially adults—can easily manage cholera at home by continuing to rehydrate and replace electrolytes lost from diarrhea and vomiting. That being said, if you spot any signs of severe dehydration, you might want to call your doctor or seek immediate medical attention.

These warning signs can include: 

  • Wrinkled skin 
  • Decline (or absence of) urination, especially in young children and infants 
  • Fast heart rate
  • Low blood pressure
  • Severe muscle cramps
  • Restlessness or irritability 

While you might be able to manage cholera just fine at home, it's important to note that cholera is a reportable disease in the United States in part because of its great potential for outbreaks. If you've visited a country where cholera is common or have any other reasons to believe you've been exposed to the bacteria, you should see a doctor to confirm a cholera diagnosis so that he or she can alert public health officials to conduct an outbreak response, if necessary.

Sources:

Centers for Disease Control and Prevention. Cholera - Vibrio cholerae infection: Illness & symptoms.

UNICEF. Cholera toolkit. 2013.

World Health Organization. Cholera: Fact sheet.