Case history
Case history #1
A 3-year-old boy is brought to the health post in a rural Zimbabwean village by his distraught mother. The child started to have diarrhoea 20 hours ago, and the volume has increased rapidly until now there is almost a continuous passage of thin, yellow stools into the bed. Initially, the child was taking fluids, but he is now drowsy and unresponsive. On examination, the patient's radial pulse is impalpable, his blood pressure is unrecordable, and his eyes are sunken. The capillary return is 5 seconds and skin turgor is poor. The mother notes that the child has not urinated for 12 hours. The mother also reports that several members of her family and others in the village are also ill with a similar illness and that three children have already died.
Case history #2
A 37-year-old Indian woman is referred urgently to the local accident and emergency room, having collapsed in the toilet during a flight she had taken from India, where she had been visiting relatives in a rural village. Other passengers state that she returned to the toilet 3 to 4 times per hour initially and then locked herself in there for the remainder of the flight. On arrival she is talking but is mildly confused, with a pulse of 130 beats per minute and blood pressure of 90/50 mmHg. Her mucous membranes are dry and skin turgor is poor. She is almost continually passing thin, pale, cloudy yellow stools without blood or mucus.
Other presentations
Less severe diarrhoeal disease can occur in cholera, especially in older adults who may have some pre-existing mucosal immunity, but diarrhoea remains loose, pale, and bloodless. About 70% to 80% of all those infected remain asymptomatic. The most striking feature of patients with cholera is the high-volume diarrhoea and loose rice-water stools. [Figure caption and citation for the preceding image starts]: Cup of typical 'rice-water' stool from a cholera patient shows flecks of mucus that have settled to the bottomCDC/Dr William A. Clark [Citation ends].
Vomiting is a common early feature. Pregnant women with cholera have an increased risk of adverse pregnancy outcomes, in particular fetal death.[7][8] Patients living with HIV are likely to have a poorer outcome. This is probably a reflection of pre-existing malnutrition and decreased mucosal immunity.
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