Signs and Symptoms of Cholera
Cholera presents as acute watery diarrhea with or without vomiting, ranging from mild illness to life-threatening dehydration that can progress to kidney failure and death if untreated. 1, 2
Primary Clinical Manifestations
Gastrointestinal Symptoms
- Profuse watery diarrhea ("rice-water stools") is the hallmark presentation, resulting from massive fluid and electrolyte efflux caused by cholera toxin 1, 3
- Vomiting commonly accompanies the diarrhea 1, 2, 3
- Abdominal pain and cramping may be present 1
Dehydration and Its Consequences
- Severe dehydration develops rapidly due to massive fluid losses, which is the primary cause of mortality 3, 4
- Kidney failure occurs in severe cases when dehydration is not promptly corrected 1
- The case-fatality rate can exceed 70% in untreated patients but drops below 1% with rapid rehydration 3
Clinical Severity Spectrum
The presentation varies considerably in severity 2, 4:
- Mild cases: Minimal diarrhea with self-limited course
- Moderate cases: Significant fluid losses requiring oral rehydration
- Severe cases: Life-threatening dehydration requiring intravenous fluid resuscitation 1
Critical Timing Considerations
- Incubation period: Ranges from several hours to 5 days, though it can be very short 3
- Rapid progression: The disease can progress from onset to severe dehydration and death within hours if untreated 3, 4
Important Clinical Pitfall
Do not wait for laboratory confirmation to begin treatment—the diagnosis is clinical, and immediate rehydration must be initiated based on symptoms alone to prevent mortality 2. Stool culture for Vibrio cholerae O1 or O139 confirms the diagnosis but should never delay aggressive fluid replacement 2.