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    Pbl-Case SVGB Y2020

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    An SV. Lê Bảo

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    © All Rights Reserved
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    Pbl-Case SVGB Y2020

    Uploaded by

    An SV. Lê Bảo
    7 views18 pages

    Original Title

    PBL-CASE_SVGB_Y2020

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    Copyright:

    © All Rights Reserved
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    Download as pdf or txt
    7 views18 pages

    Pbl-Case SVGB Y2020

    Uploaded by

    An SV. Lê Bảo

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 18

    Module

    SINH VẬT GÂY BỆNH & BỆNH NHIỄM

    PBL CASE
    Y2020
    Brainstorm…

    (Hình ảnh chỉ mang tính chất minh họa)


    Administration

    ● Patient’s full name: Nguyen Thi H, 42-year-old


    ● Address: Tan An - Long An
    ● Occupation: fashion business
    ● Reason of admission: High fever for two weeks
    History of Present illness
    Two-week history:
    - On the first week, she had fever with mild muscle tenderness and headache. Her fever was
    continuous, accompanied by chills with no aggravating or relieving factors. Body temperature was
    38°C-39°C. Paracetamol had relieved pain and fever for up to eight hours. She still had fever and
    frontal headache, feel a burning sensation when urinate. High-grade fever reaching 40°C. She
    denied cough, chest pain, shortness of breath, diarrhea, abdominal pain or back pain. She came to
    the local hospital on the 7th of illness and was prescribed nitrofurantoin (antibiotic) for urinary tract
    infection.
    - Five days later, she returned to the hospital as her fever and headaches had not ceased. These
    headaches were not associated with changes in vision, dizziness, weakness, or photophobia. She
    then also complained of bone and muscle pain, abdominal discomfort and constipation.
    DISCUSSION

    ◦ Identify the key words and relevant information to ask for.


    ◦ Broaden the learned mechanisms.
    ◦ Generate the hypotheses.
    ◦ Have additional knowledge to learn.
    Past history ???
    Past history
    Individual:
    - No previous history of diseases and not on any medication.
    - No high-risk sexual behaviour or sick contacts.
    - No weight changes, eating uncooked food or any contact with animals.
    - One month ago, she has just joined a 1 week-pilgrimage tour in Delhi, India and
    returned 3 weeks before the onset of illness.
    - Not a consumer of tobacco or alcohol, or any known stimulants.

    Family
    No other family member developed similar symptoms.
    DISCUSSION

    ◦ Identify the key words and relevant information to ask for.


    ◦ Broaden the learned mechanisms.
    ◦ Generate the hypotheses.
    ◦ Have additional knowledge to learn.
    Clinical examination ???
    Clinical examination
    On examination, she was well-orientated but lethargic and in obvious distress.
    - Vital signs: Temperature was 40°C; blood pressure was 100/60 mmHg; pulse was 90 beats per
    minute, respiratory rate 25 breaths/minute, and oxygen saturation of 97% on room air. Glasgow
    coma scale (GCS) score was 15/15.
    - On chest examination, no detected heart murmurs, no wheezes or crackles, and her breath sounds
    were clear and equal, bilaterally.
    - Her abdomen was slightly tense with reduced bowel sounds. There was no liver or spleen
    enlargement.
    - Her neck was soft and there was no focal neurologic signs.
    - There was no lymph node swelling, edema or skin rash. Her sclera were white and without
    suffusions.
    - Other examination: normal
    DISCUSSION

    ◦ Identify the key words and relevant information to ask for.


    ◦ Broaden the learned mechanisms.
    ◦ Generate the hypotheses.
    ◦ Have additional knowledge to learn.
    Investigation ???
    Investigation
    WBC (µL) 6400 Sodium (mEq/L) 131
    Neutrophils 66.6% Potassium (mEq/L) 3.6
    Lymphocytes 27.5%, Chloride (mEq/L) 98
    Monocytes 5.5% BUN (mg/dL) 3
    Eosinophils 0.0% Urea (mg/dL) 6.42
    Basophils 0.4% Creatinine (µmol/L) 45
    RBC (M/µL) 4.1 AST (U/L) 106
    Hemoglobin (g/dL) 12.6 ALT (U/L) 60
    Hematocrit 36.8 CRP (mg/L) 142
    Platelets (x103/µL) 109 Random glucose
    87
    (mg/dL)
    Investigation
    ● Chest X-ray: normal
    ● A urinary tract infection was ruled out.
    ● Rapid malaria test and the peripheral blood smear: negative
    ● HIV test: not be detected.
    ● Stool microscopy and culture were negative.
    ● Brain CT-scan and CSF: within normal limits
    ● Heart and abdominal ultrasound were unremarkable
    Investigation
    Blood culture: positive

    100x, oil immersion MacConkey agar


    Investigation

    Hektoen enteric agar


    Investigation
    Widal test:
    - on the first day of admission:
    + O and H antigens, cutoff 1:160
    + AH and BH antigens: negative
    - on the 10th day of admission:
    + O and H antigens, cutoff 1:640
    + AH and BH antigens: negative
    Diagnosis

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