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.
Recommendations for the Use of Antibiotics for the Treatment of Cholera
First-line drug choice
Alternate drug choices
Drug choices for special populations
|World Health Organization 21||Antibiotic treatment for cholera patients with severe dehydration only||Doxycycline||Tetracycline||Erythromycin is recommended drug for children|
|Pan American Health Organization 22||Antibiotic treatment for cholera patients with moderate or severe dehydration||Doxycycline||Ciprofloxacin Azithromycin||Erythromycin or azithromycin recommended as first-line drugs for pregnant women and children Ciprofloxacin and doxycycline recommended as second-line drugs for children|
|International Centre for Diarrhoeal Disease Research, Bangladesh 23||Antibiotic treatment for cholera patients with some or severe dehydration|
Ciprofloxacin Azithromycin Cotrimoxazole
Erythromycin recommended as first-line drug for children and pregnant women
|Medicins Sans Frontieres 24||Antibiotic treatment for severely dehydrated patients only||Doxycycline||Erythromycin Cotrimoxazole Chloramphenicol Furazolidone|
* Please note, due to space constraints, dosage information is not included in this table. Dosage guidance can be found by following the website links to the treatment guidance documents provided in the references section below 21-24.