What are the key clinical features to consider when diagnosing cholera in a patient presenting with acute diarrhoea?

Key clinical features to consider when diagnosing cholera in a patient presenting with acute diarrhoea include:

• Sudden onset of profuse, watery diarrhoea, often described as 'rice-water stools'.
• Signs of severe dehydration such as sunken eyes, dry mucous membranes, decreased urine output, pale or mottled skin, cold extremities, and altered responsiveness (irritability or lethargy).
• Rapid progression to clinical shock characterized by tachycardia, tachypnoea, weak peripheral pulses, prolonged capillary refill time, reduced skin turgor, and hypotension.
• History of recent travel to or residence in endemic areas or exposure to contaminated water or food sources.
• Absence of blood or mucus in stool, which helps differentiate cholera from other causes of infectious diarrhoea.

Laboratory confirmation through stool microbiological investigations is important if cholera is suspected, especially in the context of outbreaks or travel history.

Early recognition and assessment of dehydration severity are critical to guide prompt rehydration therapy.

These features align with the general approach to diagnosing severe gastroenteritis with dehydration, as outlined in UK guidelines, adapted to the clinical presentation typical of cholera ¹.