Question

MEDICAL HISTORY (Hx) The patient is a female, age 19. She was admitted to the hospital for prolonged diarrhea. The patient is an anthropology major attending school in Madison, WI. She is in a monogamous relationship and is sexually active. She is allergic to wasp and bee venom. She has a family history of Alzheimer’s disease. She lives with one roommate in student housing. She does not own any pets herself; however, she often cares for her roommate’s turtle (a red-eared slider). Over her most recent spring break, she took several short trips. First, she and her boyfriend went camping in the woods for a night. A few days later, she and her roommate spent six days in Cancun, Mexico, with several other friends. During the last few days of her trip, she began to feel unusually tired and occasionally nauseous, with abdominal cramping and increased flatulence. Following her return to the US, the frequency of her bowel movements increased from roughly once every day, to an average of four times a day. In addition, her bowel movements have become loose, off-colored (pale), and occasionally watery. She has lost roughly 5 lbs since returning from her trip. Neither her roommate nor boyfriend has shown any signs of illness. Click here to access Diseases in Focus Tables 25.2, 25.3 and 25.4, and 25.5.

Part B Refine your hypothesis Now that you have narrowed down your selections a bit, you need some more information about what your patient could've come into contact with. The fact that she has recently traveled to Mexico could've exposed her to a number of pathogens; however, you also know of some potential sources of disease she could've encountered at her home. Reviewing her chart, you see that your patient first began feeling ill toward the end of her time in Mexico. You decide to ask her some more questions about the trip. She replies that she and her roommate went to Cancun 22 days ago. They stayed at a beachside resort; however, they did venture out of the city to hike and swim in a cenote (a groundwater pool). She noted that she had tried to be careful about what she ate and drank during the trip, but admitted that on occasion she had eaten salads and consumed beverages containing ice. Part C Which of the following diseases are not very likely candidates for your patient's condition, based upon when your patient first started feeling sick? Remember, you want to consider as many logical possibilities as you can; if you do not have documentation about the time course of the disease, you should not assume that it can be eliminated. Select all choices that are NOT likely based upon the time course of symptoms. View Available Hint(s) Hint 1. The time course of disease opened hint In simplest terms, we can think of the length of time for which a disease is symptomatic as either acute or chronic. An acute disease rapidly becomes symptomatic, and/or does not last very long. Many diseases with an acute onset tend to be "self-limiting" in that they will run their course within a matter of days to a couple weeks. Chronic diseases have much more long-lasting effects. Generally, a chronic disease is one that persists for three months or more. Many diseases fall somewhere in-between these two generalized categories (a given disease may not be chronic, but it has prolonged effects beyond the time course of a self-limiting disease). Hint 2. The time couse of eventsopened hint Your patient went on vacation to Mexico 22 days ago. She was there for 6 days. You do not know when she contracted the disease; however, you do know that she started to feel ill toward the end of her trip. This means that even if she started to develop symptoms on the last day she was in Mexico, the minimum amount of time that she has been symptomatic is 17 days. What does that tell you about the time course of disease your patient has? Select all choices that are NOT likely based upon the time course of symptoms. salmonellosis typhoid fever a form of bacterial gastroenteritis or bacterial-associated diarrhea a form of hepatitis viral gastroenteritis giardiasis Cyclospora diarrheal infection tapeworms

Answer 1

a. Turtle exposure (Red-eared slider turtles) are reptiles that may carry Salmonella and may cause salmonellosis disease

b. eaten salads and consumed beverages containing ice.

c. swimming in a cenote or a groundwater pool

1. Salmonellosis :

Gastroenteritis is the most common clinical presentation of non-typhoidal Salmonella infection.

The incubation period i- typically 6–72 hours

Atypical illness – even after 14 days of exposure. I

Commonly manifested as; acute diarrhea, abdominal pain, fever, and sometimes vomiting.

The illness usually lasts for 4–7 days.

2. Typhoid fever is also known as enteric fever is a septicaemic illness characterised initially by fever, bradycardia, splenomegaly, abdominal symptoms and ‘rose spots’.

Complications are: intestinal haemorrhage or perforation

The incubation period for typhoid fever is usually 8–14 days, but can vary from 3 days to 1 month depends on the infective dose.

3. a form of bacterial gastroenteritis or bacterial-associated diarrhoea:

The symptoms vary depending on the bacteria causing the infection. The symptoms may include:

• loss of appetite
• nausea and vomiting
• diarrhoea
• abdominal pains and cramps
• blood in your stools
• fever
• Usually occurs within 2 days of exposure

4. Hepatitis ( form A)

Prevalent in Mexico, pale coloured stool, fatigue and diarrhoea are symptoms.

Occurs within weeks or days.

5. viral gastroenteritis: Symptoms of gastroenteritis usually begin one or two days after infection and include:

These symptoms can last anywhere from 1 to 10 days.

6. giardiasis:

Symptoms of giardiasis generally show up usually one or two weeks after exposure.

The symptoms include:

• fatigue
• nausea
• diarrhoea or greasy stools
• loss of appetite
• vomiting
• bloating and abdominal cramps
• weight loss
• excessive gas
• headaches
• abdominal pain

7. Cyclospora diarrheal infection:

Cyclospora infection (cyclosporiasis) results in watery, and sometimes explosive, diarrhoea. Fresh produce may contain cyclospora infection.

.The signs and symptoms usually begin within two to 11 days of eating contaminated food or drinking contaminated water.

Symptoms may include:

·         Frequent, watery diarrhoea

·         Bouts of diarrhoea alternating with bouts of constipation

·         Loss of appetite and weight loss

·         Bloating, flatulence and burping

·         Stomach cramps

·         Nausea and vomiting

·         Muscle aches

·         Fever

·         Fatigue — this symptom may last long after the active infection has gotten better

A ·         General feeling of unwellness (malaise)

Diarrhea may end by itself within a few days, or it may last for weeks. If you have HIV or another condition that compromises your immune system, the infection can last for months if not treated.

8. tapeworms:

Common signs and symptoms of intestinal infection include:

·         Nausea

·         Weakness

·         Loss of appetite

·         Abdominal pain

·         Diarrhea

·         Dizziness

·         Salt craving

·         Weight loss and inadequate absorption of nutrients from food

Answer:

Bacterial gastroenteritis

Viral gastroenteritis

Typhoid fever

Cyclospora diarrheal infection

Tapeworms