Problem 19 (1) A 35-year old man with fever, malaise, & weight loss. Final diagnosis was Fever of...
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Transcript of Problem 19 (1) A 35-year old man with fever, malaise, & weight loss. Final diagnosis was Fever of...
![Page 1: Problem 19 (1) A 35-year old man with fever, malaise, & weight loss. Final diagnosis was Fever of Unknown Origin (FUO). Q. What is FUO ?](https://reader035.fdocuments.in/reader035/viewer/2022070402/56649f225503460f94c3b6a9/html5/thumbnails/1.jpg)
Problem 19Problem 19
(1) A 35-year old man with fever, malaise, & weight loss. Final diagnosis was Fever of Unknown Origin (FUO).
Q. What is FUO ?
![Page 2: Problem 19 (1) A 35-year old man with fever, malaise, & weight loss. Final diagnosis was Fever of Unknown Origin (FUO). Q. What is FUO ?](https://reader035.fdocuments.in/reader035/viewer/2022070402/56649f225503460f94c3b6a9/html5/thumbnails/2.jpg)
A. It is a fever of 38.5°C or higher for more than 3 weeks & aetiology was unknown despite thorough investigations .
Q. What investigations you may carry out ?
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A. @ Blood culture
@ Urine microscopy+culture for TB, etc
@ Serology for infectious mononucleosis ,
Mycoplasma, Chlamydia, influenza,
typhoid, adenoviruses, Legionella, syphilis
brucellosis, leptospirosis, toxoplasmosis,
@ Skin test: TB, hydatid disease, Histoplasma
Q. Give the infective causes of FUO?
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A.@ Hidden abscess (liver)
@ Endocarditis @ Hydatid disease @ Query fever @ Tuberculosis @ Enteric fever @ Histoplasmosis @ EB virus (Infectious mononucleosis) @ Leptospirosis @ Syphilis
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@ Listeriosis @ Toxoplasmosis @ Influenza @ Legionellosis @ Rabies @ Brucellosis @ Mycoplasmosis @ Chlamydiosis @ Lassa fever @ Leishmaniasis
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Problem 20Problem 20
(1) A 20-years old student with fever, malaise , headache , difficulty in sleeping , & healed scar on his arm due to dog bite. Final diagnosis was rabies .
Q. What is the aetiology?
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A. Rabies virus .
Q. How do you confirm diagnosis ?
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A.@ Virus detection by immunoflurescence in
corneal scraping & skin biopsy. @ Viral culture from saliva @ Antibody serology . @ detection of Negri bodies
in brain biopsy after death . @ Animal inoculation. Q. What is the reservoir of rabies ?
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A. Bats, birds, dogs, foxes , other warm-blooded animals.
Q. How is rabies prevented ?
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A.@ Rabies vaccine
from tissue culture.
@Passive immunization.
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Problem 21Problem 21
(1) A 30-years old woman c/o nausea , vomiting , swelling of fingers, malaise, fatigue ,anorexia, upper abdominal pain , & dark urine. She was found to have hepatomegaly & tender liver .Lab. tests showed positive urine bilirubin , high serum bilirubin ,& raised ALT test. Final diagnosis was viral hepatitis .
Q. Which viruses are to blame ?
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A. Hepatitis A, B , C, D viruses – EB virus – CMV– yellow fever virus
Q. Which tests you perform to establish the aetiology of viral hepatitis ?
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A. *HAIgM antibody
*HBcIgM
*HBsAg
*HBsAb
*HCV IgG antibody
*Serology for other viruses .
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(2) Results of serology were
:
*HAIgM-negative *HBsAg-positive , *HBcIgM-positive , *HBsAb-negative *HCV IgG – negative *Other tests negative.
Q. What is the diagnosis ?
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A. Acute hepatitis B Q. What is the diagnosis if: *HAIgM –negative *HBsAg-negative *HBcIgM-positive *HBsAb-negative *Other tests negative ?
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A. Acute hepatitis B (Recent infection ).
Q. What is the diagnosis if: *HAIgM-negative *HBsAg-negative *HBcIgM-negative *HbsAb-positve *Other tests negative ?
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A. Past infection or immunity to hepatitis B
Q. How did the patient acquire infection?
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A. May be blood transfusion, sexually, intravenous narcotics,
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(3) Patient improved , & tests one year later showed positive HBsAg & HbsAb was negative
Q. What is the diagnosis?
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A. Chronic carrier of HBV
Q. What test you do to show if she is infectious to others ?
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A. HBeAg
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Problem 22Problem 22
(1) An 18-year old woman c/o painful sore throat , malaise, anorexia, fever, & headache . She had DPT vaccine in childhood O/E : tonsils swollen & full of exudates, no membrane in pharynx , liver tender & enlarged
Q. Which lab. test you do to
reach a diagnosis ?
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A. Throat culture for S. pyogenes + Monospot test.
(2) Throat culture revealed alpha hemolytic streptococci , Monospot test was negative , ALT & AST were raised , WBC 16000.
Q. So , what is your diagnosis ?
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A. Early infectious mononucleosis (IM) with negative Monospot test. (supported by LFT)
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(3) Several days later Monospot test was positive and lymphocytosis was detected (15% of lymphocytes were atypical ) . So final diagnosis of infectious mononucleosis was made .
Q.What is the causative agent ?
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A. EBV. Diagnosis is confirmed by EBV IgM antibody .
Q.How is Infection transmitted?
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A. Kissing (EBV is found in
saliva)
Q. In what age group is it more common?
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A. Young adults.
Q. What are the heterophil antibodies?
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A.They are nonspecific antibodies formed during EBV infection .
Q. Do you need to isolate EBV in tissue culture?
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A. No, culture not done routinely.
Q. Can IM be contracted more than once?
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A. No , only once – it gives life –long immunity .
Q. Is there any way of prevention ?
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A. No vaccine or drug to prevent infection.
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Problem 23Problem 23
A 45-year old man c/o behavioral changes & impaired consciousness . Final diagnosis was viral encephalitis
Q. What viruses involved ?
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A. H.simplex types 1&2 , Mumps, Measles, Varicella-zoster, Polio, ECHO, Coxackie, Influenza , Rubella, Rabies, arthropod –borne viruses (St.Louis,Japanese B). Q. What are the human Herpes viruses ?
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A.HSV-types 1 & 2 Varicella-zosterEBVCMVHerpes virus types 6 & 7 .
Q. Describe the lab. diagnosis of viral encephalitis.
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A.* Brain biopsy in which virus is detected by IF * Electron microscopy * Tissue culture. *Serology for herpes. * CSF for herpes antibodies. *Throat swab for viral culture. * Stool for Enterovirus culture
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Problem 24Problem 24
(1) A 32-year old woman with fever, headache ,shivering, cough, muscle pain, & painful eyes. Final diagnosis was influenza .
Q. What are the causative agents ?
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A. @ Influenza viruses A & B
@ RSV (elderly )
@ Adenovirus
@ Parainfluenza viruses
@ Mycoplasma pneumoniae
@ Chlamydia spp.
Q. Give influenza serious complications?
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A. Pneumonia : Viral or bacterial
Q. What specimens to collect ?
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A. @ Throat swab or nasopharyngeal
aspirate for viral culture
@ Blood for serology
@ Sputum for both bacterial &
viral culture
@ Blood culture for bacteraemic
pneumonia
Q. What are the virological tests you perform ?
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A. @ Tissue culture
@ Immunoflurescence for antigens of :
*Influenza viruses A,B
*RSV
*Parainfluenza viruses
*Adenoviruses
*Chlamydia spp.
Q. How are influenza viruses classified ?
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A. @ Influenza A virus, divided into
many subtypes according to
neuraminidase (N) molecule &
haemaglutinin (H) molecule
@ Influenza B
@ Influenza C (not serious )
Q. Is influenza preventable ?
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A. Yes, by :
@ An inactivated vaccine containing the 3 viruses 70% effective for one year only . Vaccine is recommended for people at risk e.g. those c/o asthma , heart diseases , renal failure, diabetes, old age , immunosuppression.
@ Amantadine drug for prophylaxis .
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Problem 25Problem 25
(1) A 27-year old man attended the lab. for HIV test.
Q. How is HIV transmitted ?
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A. @ Sexual
@ Mother to baby
@ Blood transfusion
@ Sharing of needles among
drug addicts
@ Needle stick injuries
Q. What is the basis of HIV test ?
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A. Detection of HIV antibodies by Ag-Ab reaction Q. When does this test become positive?
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A.3 months after exposure “window period “
(2) Following this period HIV test became positive. Q. How do you confirm the diagnosis ?
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A. @ PCR @ Western blot
Q. What is the family of HIV?
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A. Retroviruses
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Problem 26Problem 26
(1) A 4-years old boy with skin rash , fever, running nose , cough , & Koplik's spots . Final diagnosis was measles.
Q. How can the diagnosis be confirmed ?
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A.@ Collect throat swab for virus
culture
@ Collect blood for serology
Q. Is measles preventable?
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A. By a live attenuated vaccine incorporated in MMR (measles-mumps-rubella)
Given at 12-18 months
of age
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Problem 27Problem 27(1) An 8-year old girl with itchy skin rash , vesicles,& mild fever. Final diagnosis was chicken-pox.
Q. Give the aetiology & how can you confirm diagnosis ?
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A. @ Varicella-zoster
virus (VZV)
@ Confirmation by isolation of virus from vesicles fluid or by serology
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(1) A 48-year old man with painful skin rash localized on back & chest. Final diagnosis was herpes zoster (shingles – الحزام that involves ( الناريthoracic nerve roots. Q. What is the aetiology of this condition ?
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A. Same VZV, in adults
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Problem 28Problem 28(1) A 23-year old pregnant lady with fever, skin rash, & swelling of wrists. Final diagnosis was rubella .
Q. What investigations should you carry out ?
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A. Two sera for virus serology
Q.How would you interpret the following :
1)Rubella IgG negative & IgM negative?
2)Rubella IgG negative & IgM positive?
3)Rubella IgG positive & IgM positive?
4)Rubella IgG positive & IgM negative?
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A.1.No infection + No immunity2.Acute infection + No immunity 3.Acute infection + Past exposure 4.No infection + Immunity
Q. How may rubella be prevented ?
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A. Live attenuated vaccine with MMR vaccine , given in 2nd.year of life.
Q. What other viruses causing skin rash in pregnancy ?
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A. Parvovirus B19
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