Symptoms of cholera

The incubation period of cholera ranges from several hours to 5 days, most often 2-3 days. In vaccinated people it can be extended to 9-10 days.

In older school-age children, the symptoms of cholera are practically no different from those in adults. Cholera begins acutely, with the appearance of loose stools, pronounced weakness and malaise, sometimes dizziness and slight chills, a slight increase in body temperature. The first clinically expressed sign of cholera is diarrhea, which begins suddenly, often at night or in the morning. Defecation is painless, abdominal pain is absent or weakly expressed. In the first hours, stool may be fecal, but very quickly becomes watery, abundant, cloudy-white, with floating flakes and resembles "rice broth" in appearance. Pathological impurities (mucus, greenery, blood) are most often absent. In some cases, the stool may have a greenish, yellowish or even brown tint. In typical cases, the feces are a transudate isotonic with blood plasma, but the bicarbonate content in them is 2 times higher, potassium is 4 times or more than in blood plasma. The frequency of stool varies - from 3 to 10 times a day or more, and in severe cases, the stool cannot be counted, and the liquid constantly flows out of the anus. With cholera, the feces do not have a fecal odor and are very abundant (in adults, sometimes up to 1 liter). Often, after 3-5 bowel movements, pronounced signs of dehydration develop. Pain and convulsive twitching in the calf and chewing muscles appear early, as well as pronounced muscle weakness. Severe weakness and adynamia are among the most characteristic and early signs of cholera. Sometimes weakness is accompanied by dizziness.

Frequent, abundant, watery stools are followed by repeated, abundant vomiting, thirst - the patient asks for a drink, but the liquid drunk does not quench the thirst, but increases vomiting. Vomiting most often begins suddenly, without nausea. At first, the vomit contains food residues, an admixture of bile, but very quickly becomes watery and resembles "rice broth" in appearance, less often - "meat slops".

Abdominal pain in the initial period of cholera is not typical for cholera. Pain syndrome in cholera is associated mainly with convulsive twitching of the abdominal muscles or concomitant gastrointestinal pathology. The abdomen of cholera patients is usually retracted, painless on palpation, bloating is observed with the development of intestinal paresis.

Uncontrollable vomiting and profuse diarrhea very quickly (often already within the first hours from the onset of the disease) lead to dehydration of the body, and then become less frequent and may even stop completely, and the patient's condition progressively worsens. In this case, symptoms associated with exsicosis come to the fore - dry skin and mucous membranes, changes in the patient's appearance, decreased tissue turgor, hoarseness up to aphonia, convulsions, hemodynamic disturbances, cyanosis, hypothermia, dyspnea, anuria (algid state).

The patient's facial features are sharpened, the eyes are sunken, there is blueness around the eyes (the "glasses" symptom), cyanosis of the nasolabial triangle, acrocyanosis or general blueness of the skin, the extremities are cold to the touch, the skin gathers into folds ("washerwoman's hand"), the skin fold on the abdomen does not straighten out.

As dehydration develops, the convulsive twitching of the masticatory and calf muscles becomes more prolonged, generalized, and tonic.

Increasing dehydration leads to increased heart rate, decreased blood pressure, thickening of the blood, hypokalemia and the development of hypovolemic shock with a sharp disruption of hemodynamics and irreversible disruption of the functions of vital organs.

Hypokalemia, blood thickening, hypoxia and metabolic acidosis along with microcirculatory disorders are the main causes of renal dysfunction. Acute renal failure is manifested by a prolonged period of oliguria or even anuria. With timely initiation of rehydration therapy, uremic state (or coma) is rarely observed.

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