Pathogenic Case Study
Submitted by: LJS
A 34 y/o male who lives and works in London visited Kenya for a
friend’s wedding. Approximately 4 weeks after he returned home, he
began to have flu-like symptoms for which he did not seek medical
attention. Five days after his initial symptoms, he became progressively
worse and began having chills, vomiting and intermittent fevers. He became jaundice and finally
decided to seek medical attention.
His medical history was unremarkable with the exception of an emergency appendectomy 2 years
earlier.
A routine blood exam for parasites revealed a white blood cell count of 7.2 x 10 (9)/L,
hemoglobin of 14.5 g/dl, hematocrit of 42.2 %, and a mean corpuscular volume of 94 %. Manual
differential showed 86% polymorphonuclear leukocytes, 11 % lymphocytes, and 3% monocytes.
The blood film shows normal sized erythrocytes some of which contain small ring form
trophozoites. Some of the erythrocytes show ring forms that have two nuclei. Applique ring forms
and erythrocytes with multiple ring forms are present.
Questions:
1. What is your diagnosis based on the microscopic findings?
2. Can you determine which species from these findings? What other species are associated with
this disease?
3. What other symptoms might he develop if he is not treated immediately?
4. What kind of stain is used to view this parasite?
5. What is the vector of this disease?
6. What treatment would you recommend?
7. What suggestions can you make for prophylaxis for his next visit to Africa?
References:
University of Pittsburgh School of Medicine Department of Pathology
http://path.upmc.edu/cases/case43.html
GlaxoSmithKline
http://www.malariahotspots.co.uk/output/Page48.asp.
The case was adapted from the two sites listed above.
Answers below:
Questions & Answers:
1. What is your diagnosis based on the microscopic findings?
Malaria
2. Can you determine which species from these findings? What other species are associated with
this disease?
Plasmodium falciparum
Plasmodium ovale, vivax & malariae
3. What other symptoms might he develop if he is not treated immediately?
Jaundice, nausea & vomiting, anemia, hematuria, renal & liver failure, seizures & coma
4. What kind of stain is used to view this parasite?
Giemsa stain
5. What is the vector of this disease?
Anopleles mosquito
6. What treatment would you recommend?
Chloroquine (if the origin is not from a chloroquin resistant area) or parenteral quinine. Other
treatments for P.falciparum are atovaquone and proguanil (Malarone), mefloquine, artesunate,
quinine, quinidine, pyrimethamine-sulfadoxine (Fansidar), and doxycycline.
7. What suggestions can you make for prophylaxis for his next visit to Africa?
Prophylatic antibiotics such as Chloroquine, Mefloquine & Doxycycline or Malarone depending
on the region traveled. Mosquito nets are a must, as well as long sleeve shirts and pants sprayed
with permethrin. DEET type repellant. Stay indoors between sunset and sunrise.
Note: This patient was infected in Kenya, which is part of Sub-Saharan Africa, known for a high
incidence of Chloroquine resistant P. falciparum.
a.
c.
d.
1. Choose an organism from the Gallery of pathogens and submit it instructor in the drop box in Lesson 3. You instructor will confirm whether your
choice is acceptable, since only one student may choose each organism. To allow the most benefit for your classmates, please do not share your
case assignment with others.
2. Read all you can about your assigned organism and disease state. This will help you to evaluate any cases you find for suitability.
3. Choose an existing case to adapt, or develop or adapt a specific case to present. If you choose an existing case, you need to make sure that you
present it in your own words.
4. The following are good sources to find existing cases:
Journals: Especially The New England Journal of Medicine, CDC's Morbidity and Mortality Weekly, Clinical Pediatrics, The Lancet, Southern
Medical Journal, and Western Journal of Medicine. b. Textbooks
Internet: There is a wealth of information on the Internet. Use a search engine with advanced search ability, but make sure you draw your
information from legitimate sites.
As an alternative to finding an existing case through research, you can construct your own case using your knowledge of the symptoms, testing
strategies, and disease processes. You can also adapt a case you find, adding or removing details to help it achieve your objective. You will, of
course, need to note the adaptations in your reference.
Warning: Many cases are in the literature because they are unusual. Avoid these cases for this application. Try to present a typical case.
5. Include as many of the following as feasible:
Patient presentation- Demographics, initial complaint
b. Clinical history- Travel, pertinent family history, unusual symptoms
C. Clinical testing- Include specimen collection, results
d. Diagnosis: Include enough information for your classmates to be able to narrow their focus to include one or a very limited range of diagnoses
and causitive organism. Do not include the diagnosis or causitive organism in your case presentation.
Visual aids if you find photographs of symptoms, lab results or other items related to your case, incorporate them into your case. Remember to
conceal any information in the illustration that you do not want revealed to the class.
f. References- Where you found your case. Note whether you adapted the case yourself. Use a variety of reference sources (not just websites),
making sure they are legitimate authorities on your topic. Even if you construct the case yourself, please include the references for the facts you use.
g. Questions - Four to six questions relating to your case. The initial question usually elicits possible diagnoses and causitive organisms. Other
question topics include: additional suggested testing, testing methodologies, etiology, treatment, prevention, specimen of choice, collection protocol,
specimen processing, risk factors.
e.
a.
e.
resenting the case
1. Type up the case you will be presenting. A typical case will require no more than a page using 12 pt font. Please submit your case study document
as an attachment through this assignment drop box, INCLUDING the ANSWERS to your case questions. Make sure your name is included in the text
of the document. Your assignment submitted through the dropbox MUST BE in .doc, .docx, or rtf format.
2. Also post your case study and case questions WITHOUT answers for the class on the designated Discussion Board, using the patient's name and
age in the subject line. Please paste your case as the text of your discussion posting, attaching any images to the posting.
3. Your classmates will have time allotted to read the case and formulate answers to the questions.
4. Monitor and respond to the class's discussion about your case. You may even need to initiate some additional discussion, if your classmates seem
confused or hesitate to respond to your case. Keep in mind that there may be more that one correct answer to some questions. Encourage
classmates to answer even if they are unsure of the correct answer. Avoid criticism of any responses.
5. Be prepared to explain any medical or pharmaceutical terms.
6. Thank your classmates for their participation.
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