Case Conclusions — Mosquito-Borne Illness May 11, 2014
Posted by Andy Jagoda, MD in: Infectious Disease , trackback
Recap of Case 1: A 50-year-old man presents with fever for 3 days. He is an immigrant from Nigeria, but has resided in the United States for a decade. Ten days ago, he visited his family in a rural part of his homeland. He complains of fever, chills, and vomiting. His only medication was chloroquine, which was prescribed by his primary care physician prior to his trip. You recall reading something about increased resistance to one of the antimalarial medications in certain countries, but you can’t remember the specifics. A nurse brings you an ominous-looking ECG from EMS, just as you’re attempting to recall where to look up that information…
Recap of Case 2: A 35-year-old woman presents with fever and malaise for 1 day. While taking her blood pressure, she is noted to have petechiae on the ipsilateral arm. She says she recently returned from a trip to Puerto Rico. You have heard that there is a current outbreak of dengue on the island, but you have never seen the disease before, so you need to quickly assess whether your patient has dengue and how to manage her disease…
Case Conclusions: For your 50-year-old patient from Nigeria, you checked the CDC malaria website and called the CDC malaria hotline ( 856-4713), and they were able to assist you in navigating the case. The patient was well appearing and did not meet any criteria for complicated malaria. In your discussions with the patient, he felt safe going home with a prescription for atovaquone/proguanil, pending the results of the thick and thin smears.
You examined the 35-year-old female patient with petechiae who recently visited Puerto Rico, and after evaluation of the WHO Clinical Criteria for suspected dengue, you were comfortable that she did not have any warning signs for dengue. You sent off the appropriate tests (dengue virus PCR and dengue IgM antibody testing). You asked her to either return to the ED or be seen by her primary care doctor in 48 hours once her fever resolved. You carefully explained why reevaluation was so crucial, given the natural history of dengue. You made sure she understood the return precautions prior to discharging her from the ED.
Thank you to everyone who participated in this month’s challenge!
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