**Question:** In a patient presenting with diarrhoea due to Vibrio cholera, which of the following will be present: a) Abdominal pain, b) Presence of leukocytes in stool, c) Fever, d) Neutrophilia, e) Occurrence of many cases in the same locality?

**Core Concept:** Vibrio cholera is a Gram-negative bacterium responsible for causing cholera, a watery diarrhoeal disease. Diarrhoea in Vibrio cholera infection is primarily due to the production of a toxin (Vibrio cholerae toxin) that alters the electrolyte and fluid balance in the small intestine, leading to severe diarrhoea.

**Why the Correct Answer is Right:** The correct answer is:

c) Fever
d) Neutrophilia

In Vibrio cholera infection, the body mounts an immune response leading to fever as the body's defense mechanism against the invading bacteria. Additionally, the bacterium causes a significant influx of neutrophils (leukocytes) into the intestinal tract, leading to neutrophilia in the peripheral blood.

**Why Each Wrong Option is Incorrect:**

a) Abdominal pain: While abdominal pain may be present in some cases, it is not the primary symptom of cholera. The main presenting symptoms are watery diarrhoea and dehydration.
b) Presence of leukocytes in stool: While leukocytes might be present in the stool in some cases, it is not a universal finding in all cases of cholera. The primary examination for this would be an endoscopy or a biopsy, not stool examination alone.
e) Occurrence of many cases in the same locality: While the number of cases and their geographical location can be important epidemiological information, it does not directly relate to the clinical manifestations of the disease and is hence not a direct finding in the patient.

**Clinical Pearl:**

Cholera is a significant public health concern, particularly in developing countries. Early recognition of the disease and prompt treatment with intravenous rehydration therapy can prevent severe dehydration and its complications. However, the clinical examination should focus on assessing the severity of diarrhoea, dehydration, and electrolyte imbalances rather than relying solely on examination of stool or leukocytes in stool.