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3 Cards in this Set
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A 24 year-old graduate student came into the Health Service complaining of passing 3-5 loose, mushy stools daily for the last 4-6 weeks. The stools seem to float in the toilet and smell pretty bad. She has had no cramps, noticed no blood in the toilet, and has lost about 5 pounds although her appetite is good. She had traveled to South Africa to present a paper on her research 4 months ago, had snorkeled in Belize 3 months ago, and had gone hiking in Estes Park in Colorado 2 months ago. She loves sushi and eats it at least once per week. She has a pet iguana at home. She was under a lot of stress in her work and worked long hours. Her father had a known history of Crohn's disease.
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Giardia picked up most likely from drinking water while hiking
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A 33 year-old woman comes in because of bilateral cervical lymph node swelling. She thinks she has a fever in the evening, has a good appetite, but is tired,which she attributed to taking care of her children. Examination reveals several bilateral 1-2 cm cervical lymph nodes that are soft, non-tender, and freely moveable. There is no other lymphadenopathy, the chest is clear, heart sounds are normal, but she has mild tenderness at the right costal margin on deep inspiration. Laboratory studies reveal Hct 37%, WBC 5,200/uL, ALT 125, AST 140, alkaline phosphatase 210, bilirubin 1 mg/dL.
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Toxoplasmosis
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A 27 year-old graduate student comes in to the ER with fever to 102.7F, chills, and myalgias for 4 days. He thought that they might have been imporving, but then they became worse. He recounts that he had just returned from spending 3 months in Uganda, where he was working on a project on HIV care. He lived in a small village, ate local foods, and swam in the lake that was near the village. On examination, he was afebrile and did not look ill. There was no lymph node enlargement, and heart, lung, and abdominal examinations were normal. WBC was 4100/uL, HCT 37%, platelets 130,00/uL. He was sent home after some lab studies for malaria were negative and studies were drawn for viral infections, and he was told to come back if the symptoms returned.
He returned 4 days later, having had fevers for 3 days and increasing anorexia, myalgias, and fatigue. He looked ill and had a temperature of 103.2F. His WBC was now 3600/uL, Hct 34%, and platelets were 70,000/uL. His abdomen was mildly tender in the right and left upper quadrants. Malaria smears were repeated and further studies for other pathogens were performed. |
Malaria
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