- The hallmark clinical feature of cholera infection is rice-water diarrhea, characterized by large volumes of watery stool with a pale, milky appearance containing flecks of mucus but no blood or pus.
- This occurs due to the action of Vibrio cholerae toxin, which stimulates secretion of electrolytes and water into the intestinal lumen without causing intestinal mucosal destruction.
- Unlike inflammatory diarrheas, cholera does not produce bloody stools or significant vomiting in the absence of diarrhea.
- The massive fluid loss leads to rapid dehydration and electrolyte imbalance, which are key concerns in management.

Reference: Davidson’s Principles and Practice of Medicine, 23rd Edition, Chapter: Gastrointestinal Infections, Page 457.