Question

questions 1-7 please

Case Study Myalgia A 32-year-old man presents with fever, headache and myalgia. He works as a green-keeper at the local golf course in a semirural district. Questioning reveals that over the last few weeks he has been working to refashion the water hazards at the course, spending much of the day in the water. Clinical examination reveals that he has mild neck stiffness. There is conjunctivitis present and he has a mild jaundice. His abdomen is soft; his liver edge can be palpated and is tender. The preliminary laboratory findings of his full blood count, urea and electrolytes and liver function tests performed in the A&E department are as follows: WBC 14.2 x 10VL, predominantly neutrophils Urea 9.9 mmol/L Creatinine 138 mmol/L AST 150 IU/L 1. What do the initial blood tests show? 2. What specific test would you perform? 3. What is the most likely infectious diagnosis? 4. Are there any additional ways of making the diagnosis? 5. What is the significance of his occupation? 6. What is the significance of poor renal function? 7. What is the first choice of antibiotic?

Answer 1

Blood test, Urea test and Liver test of patient reveals higher values. Based on the symptoms and blood test reports we can infer that there is evidence of a neutrophilia, renal dysfunction and liver dysfunction.

As the patient has a mild jaundice with tender and palpated liver edge, it is suggested to investigate infectious causes of hepatitis. He should also be tested for leptospirosis. An ultrasound should be done to rule out the possibilities of surgical conditions such as acute cholecystitis.

The man has a hepatitis, neck stiffness and conjunctivitis, all three conditions creates a triad for leptospirosis. The occupational history and exposure to contaminated water for the last few weeks add more evidence in favor of leptospirosis. The evidence from renal disorder and neutrophilia are also typical of leptospirosis. This is a classic case of rare infection.

Another way of diagnosis could be achieved through lab culture. Although the success rate of diagnosing Leptospirosis by culture, less and only few laboratories can achieve it.