Microbiology Online Case Presentation 3

Fungi/ Parasite/ Arthropod Case Information

Patient’s Name: Ashley Winters Clinical Setting: Clinic Chief Complaint: Fever and Headache

CATEGORY: HPI 1 Chief Complaint Description?

2 3 Onset 4

Pain scale? When did it begin? How did it begin?

5 Progression

Better, worse, same?

Gender: Age: Height: Weight:

Female, W 20 years 5’ 6” 120 lb

BP: T: HR: RR:

110/80 99.9ºF 100/min 18/min

The patient presents at the clinic with a complaint of fever and headache. The patient doesn’t seem to have much energy. She appears “wrung out.” 4 on a scale of 1-10 5 days ago on a Sunday It began with some shaking chills and feeling feverish afterwards for a day. About 5 days ago, I recall getting some shaking chills followed by feeling really warm. I don’t know what my temperature might have been, but I must have been pretty hot, because I was perspiring. I don’t recall ever having a fever that made me sweat before. I am seeing a regular pattern. Every other day, I get a chill followed by high fever and sweat, then, the pattern repeats after a day off. I had the first episode on Sunday and then again on Tuesday and Thursday (today is Friday). I guess I will have another chill/fever/sweat episode tomorrow unless you can do something for me. Two days ago, I started getting sick to my stomach as well, and threw up. This has happened a couple of times now.

6 Mitigating Factors 7

What makes it better? What makes it worse? 8 Associated symptoms? 9 History of previous occurrence (details)? 10 Pertinent Other Allergies to meds? 11 Current medications? 12 Past med. history? 13 Family history? 14 Social history (smoking, alcohol, drugs)?

After having the chills-fever-sweating episode, I have been extremely tired. I will sleep for hours. I also now have a headache – all over my head. I do not feel like eating, and my body just aches. The large muscles in my back and my knees and backbone are aching. Nothing helps. I tried aspirin, but it didn’t help. It is only better on the off days, but then I’m so tired that I just sleep. Any strenuous activity really wears me out. Fever and headache, muscle and joint aches, fatigue, anorexia, nausea, vomiting I have never had this before. None that I know of. Aspirin for the fever, but it has not helped much. Nothing to relate. Not that I know of. I am a student (education major) at Truman State. I am single and live in Ryle residence hall with 3 roommates. My roommates do not appear to be ill; just me. Last week, I returned from a 3-week missionary trip in Africa. I have always been interested in the Peace Corps and I thought that by being a part of this missionary trip it would help me decide whether to apply to the Peace Corps. On the trip, I was part of a group that helped finish building a primary school. Africa was wonderful, strange, unsettling, and dirty. The people were very nice. I really enjoyed meeting new people and the children. It was hot and dry. Everyone on the mission trip was supposed to take a drug called mefloquine. I didn’t take it because it made me sick to my stomach. I -1-

figured that if I used lots of insect spray, and always wore a longsleeved shirt, I would not be bitten by the mosquitoes, and would not need the medicine.

15 Other 16 Skin 17 Neurologic 18 HEENT

19 Chest, Heart & Lungs 20 Abdominal

21 Female Breast & GU (& rectal) 22 Male GU (& rectal) 23 Musculoskeletal General

The patient denied use of alcohol, tobacco, or illegal drugs. Nil No complaints, no abnormal findings Didn’t check Head, eyes, ears, nose, mouth and throat all appeared normal. Palpation revealed lymphatic congestion in front of and behind and along the sternocleidomastoid muscle. Chest sounds seemed normal. With the patient on her back with knees raised, bowel sounds seem normal. Palpation of the abdomen revealed general tenderness. Wiggling the belly did not cause pain. Didn’t check N/A Palpation of back muscles, arm muscles and thighs did not detect tenderness. Didn’t check Didn’t check

24 Upper extremities 25 Lower extremities LAB/PROCEDURE FINDINGS Lab findings CBC Chemistry panel Stain thick and thin blood smears Other diagnostics Radiographic procedures Palpation for Sympathetic sympathetic findings

Patient:

INTERPRET RESULTS

Prediction based on chief complaint

Lab Report: CBC Anemic

BUN

Elevated, 40 mg/dL

Creatine

Elevated, 1.1 mg/dL

LDH

Elevated, 300 IU/L

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Giemsa-stained thick blood smear

Sympathetic findings? What is the best diagnosis of this patient’s disease? Potential Agents Fasciola hepatica Leishmania donovani Rule each In or Out Plasmodium falciparum Plasmodium vivax Schistosoma mansoni Graduate Student Question: What is the vector or method of transmission for each of the agents listed?

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