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Case Presentation. Kevin Urquhart PA-S. Chief Complaint. Fever Chills Nausea/Vomiting Bodyaches. HPI. 30 year old Hispanic male, immigrated from Honduras 2 months ago 10 day hx of fever, chills, N/V, bodyaches Saw PMD4 days ago, dx w/virus, given meds No improvement

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case presentation

Case Presentation

Kevin Urquhart

PA-S

chief complaint
Chief Complaint
  • Fever
  • Chills
  • Nausea/Vomiting
  • Bodyaches
slide3
HPI
  • 30 year old Hispanic male, immigrated from Honduras 2 months ago
  • 10 day hx of fever, chills, N/V, bodyaches
  • Saw PMD4 days ago, dx w/virus, given meds
  • No improvement
  • vomiting worse past 3 days
  • “ can’t hold anything down “
  • Presents to MER
pmx meds
Denies any significant PMHx

Cedax for fever, unsure of dosage

Apap po prn for pain

PMx / Meds
slide5
ROS
  • Gen- Fever/Chills
  • GI-N/V
  • Musculoskeletal- Bodyache
slide7
PE
  • Chest: Symmetrical Inspiration
  • Lungs: CTA bilaterally
  • Heart: S1 S2 no murmurs
  • Abdomen: Soft, NT/ ND, no organomegaly
pertinent findings
Recently in Honduras

Intermittent fever

N / V

Bodyaches

No diarrhea

No Headache

No rash

No bradycardia

No icterus/ jaundice

No organomegaly

No cough

No Pruritis

Pertinent Findings
slide9
DDX
  • Malaria-Thick smear, fever flu-like symptoms, symptoms may come @ intervals
  • Salmonella-fecal leukocytes, rose spots, altered sensorium, organomegaly
  • Hep A/E-Presence of antibodies, antigens, hepatomegaly
pertinent labs
HGB 9.6

WBC 4.7

BC negative

Platelets 58

Thick smear positive for plasmodia

Dx morphologically as P. Vivax

Parasitemia=0.6%

Pertinent Labs
pathophysiology
Transfer of sporozoites from salivary gland to blood stream

Reproduction in liver

Release of merozoites into bloodstream

Attach to erythrocyte surface receptors and invade cell

In rbc’s merozoites mature to trophozoites, then schizonts

Release of new daughter merozoites and new rbc infection

Pathophysiology
key features of malaria
Leading worldwide cause of fever

Parasitic, caused by 4 species: P.Vivax, P.ovale, P.malariae, P. falciparum

organomegaly

Chills, fever, myalgias

Classic paroxysms of fever spikes, chills and rigors at intervals suggest Vivax

In Vivax parasitemia ltd to 1-2%

Key features of Malaria
sources cited
Sources Cited
  • Fauci, A.S., et al.1998. Harrison's: Principles of Internal Medicine.14th Edition. Mcgraw- Hill.
  • Dornbrand, L., Hoole, A.J., Fletcher, R. H. 1997. Manual of Clinical Problems in Adult Ambulatory Care. Third Edition. Lippincott-Raven.
  • Carey, C. F., Lee, H. H., Woeltje, K. F. 1998. The Washington Manual of Medical Therapeutics. 29th Edition. Lippincott-Raven, Philadelphia.