**Question:** The characteristic features of El tor cholera are all except

A. Watery diarrhea
B. Acute respiratory distress syndrome (ARDS)
C. Acute renal failure
D. Septic shock

**Correct Answer:**

**Core Concept:** Cholera is a severe diarrheal disease caused by the bacterium Vibrio cholerae, primarily affecting the small intestine. The two main serogroups of V. cholerae are Inaba and Ogawa. El Tor is a variant of the Inaba serogroup, which emerged in the 1960s and is responsible for most cholera outbreaks worldwide.

**Why the Correct Answer is Right:**

El tor cholera primarily presents with watery diarrhea due to the bacterium damaging the intestinal epithelium and producing large amounts of the enzyme toxin-1 (CT), which stimulates the release of chloride ions from intestinal cells, leading to the secretion of water and electrolytes into the bowel lumen.

**Why Each Wrong Option is Incorrect:**

A. Watery diarrhea: This is a key feature of cholera, and El tor cholera is no exception.

B. Acute respiratory distress syndrome (ARDS): ARDS is a severe respiratory complication that is not a characteristic feature of cholera.

C. Acute renal failure: While cholera can lead to acute kidney injury, acute renal failure is not specific to cholera and may occur due to other factors.

D. Septic shock: Although cholera infection can lead to sepsis and its complications, septic shock is not a primary feature of cholera infection.

**Clinical Pearl:**

Cholera is an important cause of severe dehydration, particularly in resource-poor settings. Prompt diagnosis and management of cholera can prevent significant morbidity and mortality.