Cholera - Symptoms and Signs

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What are cholera symptoms and signs?

The symptoms and signs of cholera are a watery diarrhea that often contains flecks of whitish material (mucus and some gastrointestinal lining [epithelial] cells) that are about the size of pieces of rice. The diarrhea is termed "rice-water stool" (See figure 1) and smells "fishy." The volume of diarrhea can be enormous; high levels of diarrheal fluid such as 250 cc per kg or about 10 to 18 liters over 24 hours for a 154-pound adult can occur. People may go on to develop one or more of the following symptoms and signs:

  • Watery diarrhea (sometimes in large volumes)
  • Rice-water stools (see figure 1)
  • Fishy odor to stools
  • Vomiting
  • Rapid heart rate
  • Loss of skin elasticity (washer woman hands sign; see figure 2)
  • Dry mucous membranes (dry mouth)
  • Low blood pressure
  • Thirst
  • Muscle cramps (leg cramps, for example)
  • Restlessness or irritability (especially in children)
  • Unusual sleepiness or tiredness

Other symptoms that may occur, especially with more severe disease, include the following:

  • Abdominal pain (cramps)
  • Rectal pain
  • Fever
  • Severe vomiting
  • Dehydration
  • Low or no urine output
  • Weight loss
  • Seizures
  • Shock
  • Death

Those infected require immediate hydration to prevent these symptoms from continuing because these signs and symptoms indicate that the person is becoming or is dehydrated and may go on to develop severe cholera. People with severe cholera (about 5%-10% of previously healthy people; higher if a population is compromised by poor nutrition or has a high percentage of very young or elderly people) can develop severe dehydration, leading to acute renal failure, severe electrolyte imbalances (especially potassium and sodium), and coma. If untreated, this severe dehydration can rapidly lead to shock and death. Severe dehydration can often occur four to eight hours after the first liquid stool, ending with death in about 18 hours to a few days in undertreated or untreated people. In epidemic outbreaks in underdeveloped countries where little or no treatment is available, the mortality (death) rate can be as high as 50%-60%.

Picture of rice-water stool from a patient with cholera
Figure 1: Rice-water stool from a patient with cholera; note the flecks of mucus precipitated at the bottom of the cup that resemble rice grains. SOURCE: CDC
Picture of patient with washer woman hands (loss of skin elasticity), a sign of cholera.
Figure 2: Washer woman hands (loss of skin elasticity) are a sign of the dehydration seen in cholera. SOURCE: CDC
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See what others are saying

Comment from: Desmond, Male (Patient) Published: October 30

My first sign of cholera was stomach pain which led to frequent stool and vomiting. While in the hospital I started experiencing cramps from toes, then calf, then stomach.

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