Download Case presentation in infectious disease

Case presentation in
infectious disease
報告人: I 2 陳師儀
地點:檢驗科會議室
時間: 94/12/26 10:00 AM
Supervisor : 盧章智主任
Chief complain

headache, anorexia, diarrhea, vomiting,
chills, fever, night sweats, and increasing
sleepiness for weeks
Present illness

A 25-year-old woman recently returned to
USA from a 2-week safari vacation in
Tanzania (East Africa)

Visit several game parks during stay in
Africa

ask help to ER complaining of as
mentioned for weeks

experience of many bug bites during her
to game parks
Past and personal Hx

No mentioned in the case
Physical exam


a pale, emaciated woman with a painless,
erythemtous lesion located on shoulder
No adenopathy was noted
Lab data
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B/R : systemic inflammatory response
Platelet :75000 (15*10 3 -40*103 )
CRP: 210 mg/l (<0.3)
Hgb: 8.5 g/dl (anemic ,which type ?)
Blood smear
Stumpy
type
Slender type
A arge number of pleomorphic hemo-fkgellates, some being
slender and some being stumpy, were visible
Differential diagnosis
Hemoflagellates
Leishmania
Trypnosoma
Morphology of hemoflagellate of
human
Single promastigote form
pleomorphism
Differential diagnosis
Hemoflagellates
Leishmania
Trypnosoma
Differential diagnosis

African trypanosomiasis (sleeping
sickness) , which type?
Difference between T .brucei
rhodesiense and gambience
T. brucei
gambience
T. Brucei
rhodesience
Toxicity
Lower to human and
livestock
Higher to human and
livestock
Host
reservoir
Human ,most
Animal ,most
vector
G .palpalis(帕舌蠅)
(tsetse fly)
G.Morsitans(毛舌蠅)
(tsetse fly)
geograph West Africa
ic
location
East Africa
habitat
River
Grassland and park
Clinical
feature
Chancre
Winterbottom”sign
Chancre
Rapid progression
of symptoms (within
several weeks)
Geographic distribution
G
R
Winterbottom ‘ sign
Posterior neck Ln
enlargement
Final diagnosis

Trypanosoma .brucei rhodesience
Treatment


Suramin (germanin)-early stage
Melarsoprol (Mel B -arsenical) –CNS
toxicity
Diagnosis criteria



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Detection parasite in bloodstream
Enlarged lymph node aspirate
CSF fluid study –protein and cell content
Complement fixation test
Fluorescence antibody test
Elevated IgM count conc in blood and CSF

Thanks for your attention!