CASE The patient was a 46-year-old male who presented with com plaints of fever.

Question

CASE The patient was a 46-year-old male who presented with com plaints of fever. Ten days previously the patient had return from a holiday trip during which he visited his family i Guatemala. He was both in urban areas and at the Caribbear coast. He received many mosquito bites and did not take malari rophylaxis. He had one episode of diarrhea during his visit, but that resolve vithin 1 day One week prior to presentation he began to develop malaise, headache, and evers with some sweating and chills. Over the 3 days prior to presentation he hac evers throughout the day to 39.0°C with drenching sweats. He also complained of intermittent headaches. He did not complain of stiff neck, diarrhea, or abdonm nal pain. His urine appeared somewhat darker than normal to him. He had nor- al oral intake. On physical examination his temperature was 38.5°C, his blood pressure was 33/85 mm Hg, and his pulse was 145 beats/min. He had no nail bed hemor- hages and no petechial lesions. The remainder of his physical examination was ithin normal limits. He had a white blood count of 13,500 cells/pl with 10,000 eutrophils/ul. A peripheral blood smear is shown in Fig. 55.1. Figure 55.2 shows triple sugar iron (TSI) slant of the organism that was recovered from the atient's blood. 1. Given his travel history, name three organisms that are likely to have been responsible for his fever. How do his peripheral blood smear and the TSI slant in Fig. 552 help to narrow the list? what about his phys- ical examination rules out one of the pathogens? 2. How did this patient likely become infected with this organism? 3. This infection typically occurs in individuals who return from foreign

Explanation / Answer

2. The patient became infected with the organism by traveling to Guatemala, where he had visited the coastal areas. The disease is transmitted through mosquito bites near the urban areas. High fevers and severe headache are a sign of the disease - Dengue.

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