Clinical Features of Cholera in Children
Cholera in children presents as profuse, watery diarrhea ("rice-water stools") that can rapidly progress to severe dehydration, shock, and death within hours if untreated. 1
Cardinal Clinical Manifestations
Gastrointestinal Features
- Sudden onset of profuse, watery diarrhea is the hallmark presentation, with stool losses that are more pronounced in cholera than other diarrheal illnesses 2
- The characteristic "rice-water" appearance of stools reflects massive secretory losses from the small intestine 1
- Vomiting frequently accompanies the diarrhea, particularly in children receiving oral rehydration therapy 3
- The purging rate is highest initially but declines with time, especially when appropriate antibiotics are administered concurrently 2
Dehydration and Shock
- Rapid dehydration develops due to massive fluid and electrolyte losses, which can be life-threatening 1, 4
- Dry mucous membranes indicate volume depletion from fluid and salt loss 5
- Tachycardia reflects compensatory cardiovascular response to volume depletion 5
- Circulatory collapse and shock occur in severe cases (cholera gravis), affecting up to 10% of infections 6
Metabolic Disturbances
- Acidosis develops from bicarbonate losses in stool 1
- Muscular cramps are prominent features resulting from electrolyte imbalances 1
- Weakness is common in both volume depletion and associated electrolyte abnormalities 5
Severity Classification
Children with cholera should be immediately assessed for dehydration severity:
- Mild dehydration (3-5% fluid deficit): Early signs of volume loss 7
- Moderate dehydration (6-9% fluid deficit): More pronounced clinical signs 7
- Severe dehydration (≥10% fluid deficit): Shock, altered mental status, requires immediate IV intervention 7
Critical Clinical Pitfalls
The most dangerous aspect of cholera in children is the rapidity of progression to severe dehydration and shock - this can occur within hours of symptom onset 1, 6. Clinicians must recognize that:
- Stool and electrolyte losses are more pronounced in cholera than in other diarrheal diseases, requiring aggressive fluid replacement 2
- Children can deteriorate rapidly despite appearing stable initially 8
- The disease requires immediate fluid replacement before diagnostic confirmation 1
Risk Factors for Severe Disease
Certain factors increase risk for cholera gravis in children:
- High-dose exposure to the organism 6
- Blood group O 6
- Increased gastric pH (e.g., from antacid use) 6
- Underlying conditions worsened by dehydration, such as cardiovascular or kidney disease 6
Key Diagnostic Consideration
Suspect cholera in any child with massive, shock-producing diarrhea, especially with recent travel to cholera-affected areas 1. However, treatment must begin immediately based on clinical presentation without waiting for stool culture confirmation of Vibrio cholerae 1.