III . A 27-year old white female presented her self at her local physician on Au
ID: 50441 • Letter: I
Question
III. A 27-year old white female presented her self at her local physician on August 15. On physical exam, the patient had a fever of 38.5C. She appeared fatigued, had tender abdomen and complained of headache, stiff neck and backache with diarrhea. The physician noted an irregular heartbeat. The patient complained of lack of ability to concentrate. The patient gave the following history: She is a graduate student in the wildlife program at the University in her town. She was in the field for three weeks in Wisconsin during the months of May and June. She tracks small mammals in the field and studies their behavior. It had been a warm, wet spring and she complained of a large number of flies in the area. She felt sick the last day there after eating some canned food, as there was no cooler there. You had no time for culturing, as you need to take action fast.
1. What type of disease she could have based on the symptoms and why? You are not required to name a disease naming a disease means you have answered the question wrong.
2.What features are not critical to your diagnosis from the case & why?
3. What further steps should be taken to precisely identify the case & why?
4. What microbes you will not consider and why [name 4].
5. What steps would you take to ensure that the patient is stable till diagnosis is confirmed; explain why would you do this?
Explanation / Answer
1.
Given below are the suspected diseases the subject is suffering from:
Food poisoning2. Viral fever
As the patient reports of the disease after consuming canned food, it can be suspected to be a bacterial food poisoning. The most probable causes of the poisoning can be as follows:
Listeria monocytogenes2. Salmonella typhi 3. Campylobacter jejuni
The conditions of diarrhaea, stiff neck, malaise or muscle pain, confusion and lack of ability to concentrate, headache, and tender abdomen are all found prominently in Listeria infection.
2.
Headache, backache are not critical to the diagnosis as the patient was on field for the past many days
3.
To further identify the case, rapid diagnostic methods like PCR based detection or serological methods or immunological methods should be done
4.
Escherichia coli, Shigella, Clostridium are the organisms not considered as none of them cause stiff neck and confusion. These infections are further associated with vomiting, cramps, bloody diarrhea in case of Shigella and E. coli infection,