Editing Cholera (section)

== Signs and symptoms ==
[[File:Cholera feces.jpg|thumb|Typical cholera diarrhea that looks like "rice water"]]
The primary symptoms of cholera are profuse [[diarrhea]] and [[vomiting]] of clear fluid.<ref name="Lancet2004">{{cite journal | vauthors = Sack DA, Sack RB, Nair GB, Siddique AK | title = Cholera | journal = Lancet | volume = 363 | issue = 9404 | pages = 223–33 | date = January 2004 | pmid = 14738797 | doi = 10.1016/S0140-6736(03)15328-7 | s2cid = 208793200 }}</ref> These symptoms usually start suddenly, half a day to five days after ingestion of the bacteria.<ref>{{cite journal | vauthors = Azman AS, Rudolph KE, Cummings DA, Lessler J | title = The incubation period of cholera: a systematic review | journal = The Journal of Infection | volume = 66 | issue = 5 | pages = 432–8 | date = May 2013 | pmid = 23201968 | pmc = 3677557 | doi = 10.1016/j.jinf.2012.11.013 }}</ref> The diarrhea is frequently described as "rice water" in nature and may have a fishy odor.<ref name=Lancet2004 /> An untreated person with cholera may produce {{convert|10|to|20|litre|USgal|sigfig=1}} of diarrhea a day.<ref name=Lancet2004 /> Severe cholera, without treatment, kills about half of affected individuals.<ref name=Lancet2004 /> If the severe diarrhea is not treated, it can result in life-threatening [[dehydration]] and [[electrolyte]] imbalances.<ref name=Lancet2004 /> Estimates of the ratio of [[asymptomatic]] to symptomatic infections have ranged from 3 to 100.<ref>{{cite journal | vauthors = King AA, Ionides EL, Pascual M, Bouma MJ | title = Inapparent infections and cholera dynamics | journal = Nature | volume = 454 | issue = 7206 | pages = 877–80 | date = August 2008 | pmid = 18704085 | doi = 10.1038/nature07084 | s2cid = 4408759 | bibcode = 2008Natur.454..877K | hdl = 2027.42/62519 | hdl-access = free }}</ref> Cholera has been nicknamed the "blue death"<ref name="Greenough">{{cite journal|last1=Greenough|first1=William B. |title=The blue death Disease, disaster, and the water we drink|pmc=2171164|journal=The Journal of Clinical Investigation|volume=118|issue=1|pages=4|doi=10.1172/JCI34394|date=2 January 2008}}</ref> because a person's skin may turn [[Cyanosis|bluish-gray]] from extreme loss of fluids.<ref name=McE2009>{{cite book|author1=McElroy, Ann |author2=Townsend, Patricia K. |title=Medical Anthropology in Ecological Perspective|url=https://archive.org/details/medicalanthropol00mcel_718 |url-access=limited |location=Boulder, CO|publisher= Westview|year= 2009|page= [https://archive.org/details/medicalanthropol00mcel_718/page/n395 375]|isbn=978-0-8133-4384-6}}</ref>

Fever is rare and should raise suspicion for secondary infection. Patients can be lethargic and might have sunken eyes, dry mouth, cold clammy skin, or wrinkled hands and feet. [[Kussmaul breathing]], a deep and labored breathing pattern, can occur because of [[acidosis]] from [[Human feces|stool]] [[bicarbonate]] losses and [[lactic acidosis]] associated with poor [[perfusion]]. [[Blood pressure]] drops due to dehydration, peripheral pulse is rapid and thready, and urine output decreases with time. Muscle cramping and weakness, altered consciousness, [[seizures]], or even [[coma]] due to [[electrolyte imbalance]]s are common, especially in children.<ref name=Lancet2004 />