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Case Presentation

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

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  1. Case Presentation Kevin Urquhart PA-S

  2. Chief Complaint • Fever • Chills • Nausea/Vomiting • Bodyaches

  3. 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

  4. Denies any significant PMHx Cedax for fever, unsure of dosage Apap po prn for pain PMx / Meds

  5. ROS • Gen- Fever/Chills • GI-N/V • Musculoskeletal- Bodyache

  6. Hispanic male sitting upright in stretcher. IV heplock in place right arm. NAD P: 97 BP: 121/62 RR: 22 General Description / Vital Signs

  7. PE • Chest: Symmetrical Inspiration • Lungs: CTA bilaterally • Heart: S1 S2 no murmurs • Abdomen: Soft, NT/ ND, no organomegaly

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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.

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