Global Health Intercession

Small Group Discussion

Emerging Diseases Case #3
History of Present Illness
The patient is a 22-year-old female, Indian medical student who complains of 2
days of high fever, headache, myalgia, productive cough, shortness of breath,
lightheadedness, nausea, abdominal pain and diarrhea that was dark colored.
She is currently in Kampala waiting for a flight home to Pune, after spending the
last 3 months as a clinical observer at Mulago Hospital on the Surgical ward.
She just returned to Kampala from a vacation trip to rural northern Uganda,
where she visited Gulu, Kitgum, Murchisons Falls and Kidepo Valley National
Park (photo below). She reports a history of many insect bites, especially
mosquitos, during her trip to Uganda.

While in the Uganda, she ate excellent local food, but only drank bottled water
purchased in a local market. She had one 3-day episode of mild diarrhea, during
the first week of her trip to Uganda.
While at Mulago Hospital, she attended clinical rounds and conferences, but did
not have any direct patient contact.
Past Medical History: None
Immunizations: Childhood vaccines, including MMR are up to date. She also
has received the Hepatitis B and HPV vaccines.
Family/Social History: Noncontributory

Medications: Tylenol for fever. She was not taking anti-malarial prophylaxis.
Physical Examination
The patient appeared weak and short of breath. Her temperature was 38.5C.
Her heart rate was 110. BP was 100/60. Her respirations were 30 per minute.
Her conjunctiva were injected and jaundiced. Otherwise, her head, ears, eyes,
nose, and throat were all unremarkable. She had no adenopathy. The
cardiovascular system was normal, except for tachycardia. Her lung exam
demonstrated rales in both bases. Her abdomen was diffusely tender to
palpation, without rebound or guarding. Her extremities were non-tender, with no
obvious joint deformities or joint swelling. Her neurologic exam was
unremarkable. She had no rash.
Laboratory Tests
Her total white blood count was normal. She had and thrombocytopenia (Platelet
count was 60,000/mm3). Her creatinine was elevated to 1.9. Her.
Radiology
Her chest radiograph showed bilateral lower lobar infiltrates.
What is your differential diagnosis for this patient? Prepare to discuss and
justify your differential diagnosis with your colleagues who have reviewed
this same case.

What is your presumptive diagnosis for this patient?

(Big Hint: This patient is infected with a single-stranded RNA Flavivirus)