February 15, 2015 Shannon Heaton, a 24-year-old female (5’4”, 123 lbs.) is compl
ID: 212829 • Letter: F
Question
February 15, 2015 Shannon Heaton, a 24-year-old female (5’4”, 123 lbs.) is complaining of aches throughout her head, back, and neck. In addition, the patient claims to be feeling weak, is suffering from extreme nausea and vomiting, and that bouts of cold-sweats are keeping her from sleeping well at night. Shannon’s bloodwork showed a normal hematocrit and buffy-coat levels; however, her relative proportion of granulocytes was slightly elevated. Shannon was given a subcutaneous IV before leaving the clinic. In addition, the patient was prescribed Emetrol for nausea, and was instructed to rest and remain hydrated. Lastly, Ms. Heaton was told to call the clinic if her symptoms do not subside within the next five days. 1. Based on the information above, what affliction does the clinician think likely Shannon has? Explain. (1 pt.) February 21, 2015 Shannon Heaton (115 lbs.) has returned to the clinic with an increased severity of aches, nausea, cold-sweats, and fatigue. The patient is now jaundiced with a swollen and tender abdominal area, and her bloodwork showed a hematocrit level of 29% and an overabundance of eosinophils. Shannon’s pulse and blood pressure were normal, and she showed no signs of confusion or disorientation. Finally, Ms. Heaton was asked the following questions in an attempt to identify her ailment: Question………………………………………….Patient’s response 1.Are you allergic to any medications?.................................Penicillin. 2.Are you allergic to any foods?...............................................Cheese. 3.Any other allergies?......................................Cat and dog hair. Grass. 4.Any tattoos or piercings within last six months?..........................No. a. Within the last year?.................................Yes, nose piercing. 5.Blood transfusion within the last six months?..............................No. a. Within the last year? …………………………………….No. 6. Travel outside the country within the last six months?................No. a. Within the last year?.........................................................Yes. b. Where and when did you travel? . .......West Africa, from June 2 – 30, 2014 c. Purpose of travel?.....................................Graduation present d. Did you get all appropriate vaccinations?........................Yes. e. Any other medication while traveling?.................Yes, Lariam. Six of eight doses f. Did you drink unfiltered water?.....................................................Yes, but rarely g. Did you eat anything that caused indigestion?.................No. h. Any other relevant or critical information? During her trip, the patient experienced “night terrors”. Shannon also had (protected) sexual intercourse with a tour guide. 2. Based on this new information, what is your diagnosis for this patient? (1 pt.) 3. What symptoms lead you to this diagnosis? (1 pt.) 4. What further tests should be conducted to confirm your diagnosis for this patient? (1 pt.) 5. What type of pathogen caused Shannon’s ailment? Explain how this pathogen affects the blood and overall physiology of humans. (2 pts.) 6. Why is this patient showing jaundice? (0.5 pt.) 7. What most likely lead to this patient’s affliction? Is there anything the patient could have done to prevent herself from getting this sickness? (2 pts.) 8. After fully treating the patient with Doxycycline, Shannon contracted a yeast infection. Explain how/why this secondary infection occurred. (1 pt.) 9. What type of medication would you prescribe to rid Shannon of this secondary infection? (0.5 pt.)
Explanation / Answer
1. Initial symptoms of aches, in head, neck, back, feeling weakness, nausea, vomiting, cold sweats may indicate several disease and conditions like viral infections, food intoxication, thyroid problems, or even anxiety disorder. may indicate pathogen infection. Since the blood test indicated normal haematocrit, but elevated granulocytes, initial indication could be pathogenic infection like intoxication, allergic reactions, gastroenteritis, hepatitis, with a suspicion of hepatitis.
2. Based on further information, the patient may be diagnosed with hepatitis.
3. Persistence and increased symptoms of aches, nausea, cold sweat, fatigue. Further symptoms of swollen and tender abdominal area (due to inflammation of the liver), with jaundice, indicate hepatitis. Also, high haematocrit value, indicate viral infection in blood. Since the patient had a visit to West Africa and drank unfiltered water (though occasionally), the patient may be diagnosed with hepatitis A virus (HAV) infection.
4. Further tests to confirm the presence of hepatitis A virus in blood may be prescribed, as: blood test using antibodies (IgM), immunoassay test to detect anti- HAV, RT-PCR to detect HAV RNA, liver imaging or liver function tests to detect inflammation and liver damage.
5. The pathogen which has caused infection in the patient is a virus. The symptoms and conditions suggest the pathogen to be hepatitis A virus.
Hepatitis A virus is mainly transmitted through faecal-oral route, due to consumption of contaminated food or water, lack of sanitation, handling food and water through contaminated hands, etc.
The incubation period is about 14 to 28 days. The virus, after ingestion enters the stomach, then the intestine. The virus enters the liver through the portal vein, where they replicate. This results in liver infection, causing inflammation and jaundice symptoms of liver. The HAV may be released into the hepatic sinusoids and enter the bile canaliculi. They further enter the small intestine and may be released into systemic circulation and stimulate immune cells. This causes symptoms of fatigue, aches etc.
6. The patient might have gained infection, due to her travel to West Africa, where the sanitary condition may have been poor. The patient should have avoided drinking unfiltered water. Also HAV may gain entry through certain sexual practices with infected person, and the patient could have avoided such interaction.
7. Doxycycline is a broad spectrum antibiotic.Treatment with Doxycycline, may reduce the the normal flora in the body, resulting in secondary yeast infection.
The yeat infectio may be treated with anti fungal medications, like Fluconizole.
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