Sarah is a first-year pharmacy student who is juggling a lot of personal turmoil

Question

Sarah is a first-year pharmacy student who is juggling a lot of personal turmoil. Between the pressures of school, monetary concerns, the recent loss of her Amazon grey parrot, and her own health issues, she turns to her roommate, Dana, for support. “Dana, I just don’t know how much more I can handle right now! Losing Polly has me so upset! My vet wanted to do an autopsy since Polly died of unknown causes but I can’t afford it. She was always so healthy until we moved to this house. Maybe the stress of moving and me spending less time with her because I’m studying all of the time affected her.” “Don’t be so hard on yourself, Sarah. It was probably just her time to go and it has nothing to do with the move. Besides, think about the great deal we got on this place because it was damaged in the flood a few years ago! It’s so quiet out here in the country and the rent is so cheap. Our student loans are going to be so high when we finish pharmacy school that finding this house was a blessing. Speaking of school, how did you do on the Principles of Drug Action test this morning?” “Terrible! Since Polly died, I just can’t concentrate. My coughing had me up a lot last night too thanks to my asthma. But I also have some chest pain. I often feel breathless and I’ve lost my appetite too. I’ve been more tired than usual lately too. In fact, I really need to study but I think I’ll take a quick nap.” Later that week, Sarah’s condition worsens. She has started to wheeze, has a low-grade fever and chills, feels nauseous, and notices some blood tinged mucus when she coughs. She feels fatigued and wonders if she might be experiencing depression. She decides to go to her primary care physician for help.

Questions

1. Besides asthma, what do you think Sarah might have? List at least two disorders, the etiological agent if it is an infectious disease, and your rationale for choosing each one.

2. What diagnostic tests should be performed to determine the likely cause of her illness?

Explanation / Answer

1. Besides asthma, Sarah might have one of the following illness:

a. Bacterial pneumonia: Streptococcus pneumonia is the common causative agent. Other agents are Mycoplasma pneumonia, Legionella pneumophila etc. Pneumonia is a lung infection. People who have a respiratory disease or having week immune system are prone to this infection. In pneumonia, symptoms such as fever, chills, cough with bloody mucous, loss of appetite, breathlessness, chest pain etc. can be seen which are same as in the given case.

b. Aspergillosis: This is an infectious disease which is caused by Aspergillus fungus. Parrots are also infected by this fungus, which can infect humans also. Invasive aspergillosis occurs in people who already have some illness as in the given case. The symptoms include fever, chills, headache, cough with blood tinged mucus, fatigue, breathlessness, chest pain etc. Most of the symptoms are similar to those in the given case.

2. i. Diagnostic test for Pneumonia:

a. Physical examination and X- ray of chest.

b. Pulse oximetry

c. Complete blood count, blood gases

d. Presence of Streptococcus, Mycoplasma or Legionella etc.

e. Bacterial sputum culture and gram stain.

ii. Diagnostic test for Aspergillosis:

a. Physical examination and X- ray of chest

b. Complete blood count, blood gases

c. Sputum culture for presence of Aspergillus.

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