Sudden onset of effortless vomiting and profuse watery diarrhoea. Vomiting is a common feature but the rapid dehydration and hypovolaemic shock which may cause death in 12 to 24 hours are related mainly to the profuse 'rice water' stools —watery, colourless with flecks of mucus and distinctive sweet, fishy odour—which contain little protein and are very different from the mucopurulent blood-stained stools of classical dysentery.
Anuria develops, muscle cramps occur and the patient quickly becomes weak and lethargic with loss of skin turgor.
Low blood pressure and absent or thready pulse.
But there are all grades of severity and the milder cases of cholera, which are more common in El Tor infections, cannot be distinguished clinically from non-vibrio diarrhoeas. Symptomless infections are common.
TREATMENT OF CHOLERA
The first and essential requirement in the treatment of cholera is rehydration but chemotherapy plays a useful supporting role. The cholera vibrios are sensitive to the tetracyclines, chloramphenicol, streptomycin, furazolidone and other chemotherapeutic drugs active against most Gram-negative organisms. In practice, dosage with 2g daily of tetracycline or furazolidone for 2 to 3 days quickly eliminates the vibrios from the stools and sharply reduces the duration of the diarrhoea and associated loss of fluid.