Cazuri Clinice

Heba 1, 10
Cristina 2,11
Lena 3,
Irina 4,13
Andreea 5,14
Marinela 6,15
Ana Maria Lichii 7, 16
Ana Maria Moisei 8, 17
Madalina Valache 9 , 18
Nicoleta 12
Caz 1.EXAMINATION CARD NR. 1

Subject Infectious diseases, practical skills
Faculty of medicine VItd year
1. PATIENT: Age: 30 years; Sex: male; Day of the disease: 3
CBC
Normal values
RBC ( x 106 /ml) 4.0 M 4.0 - 5.0; F 3.7 – 4.7
Hemoglobin (g/L) 146 M130 – 160; F 120 - 140
Hematocrit (%) 43 M 40 – 48; F 36 – 42
Reticulocytes (%) 2 - 10
Platelet (x 109/L) 160 120–500
WBC (x 109/L) 10 4.0–9.0 x 109
Neutrophils (%) 49 47 - 72 %
Bands neutrophils (%) 4 1-6%
Lymphocytes (%) 39 19 - 37 %
Monocytes (%) 8 3%–11%
Eosinophils (%) 0,5 - 5 %
Basophils (%) 0-1%
ESR mm/hr 25 M 2 – 10; F 2 – 15
CSF
Normal values
Opening pressure 260 50 – 180 mm H2O
Total protein 0.66 0.15 – 0.33 g/L
Chloride 128 118 – 132 mmol/L
Glucose 2.5 1.8 – 3.8 mmol/L
L cell count 1200 ≤ 5x106/L
Differential:
Lymphocytes 82 %
Neutrophils 18 %
RBC 12
Gramm coloration No bacteria No bacteria
anti Borrelia Burgdorferi IgM – negativ
anti Borrelia Burgdorferi IgG – poz
Questions:
1. Diagnosis: Boala Lyme (neuroborelioza), durată mai mare de 6 luni.
(DG: IgG în LCR pozitivi + pleiocitoză limfocitară + Clinic-semne neurologice)
2. Diferential diagnosis
diagnosticul eritemului migrator din BL cu alte reacții cutanate
Artrită reumatoidă, b Parkinson, scleroza multiplă
3. Aditional investigations:
metoda serologică: primul ser la momentul adresării, al doilea peste 3-5 săptămâni de la
depistare. ELISA, Western Blot: IgG - primele luni de boală, IgM după 5-7 luni de la debut.
IgG sânge/IgG LCR este supraunitar -> neuroborelioza
PCR
2. CLINICAL CASE
Patient A., 24 years old, shepherd, complains on:
• moderate headache, weakness, fever 38°C,
• difficult respiration,
• abdominal pain.
Objective data:
• pronounced edema of the face and neck, more marked on the right side,
• painless ulcer of 1cm in diameter on the right cheek.
• Pulmonary: brutal breathing without wheezes.
• Abdominal pain in epigastric and paraumbilical regions, hepatomegly +1cm.
What additional epidemiological data you need to determine?
What is the preliminary diagnosis. Tularemie

Establish the plan of investigation and treatment.
3. WHAT INVESTIGATIONS IS NECESSARY TO PERFORM IN CASE OF:

acute viral hepatitis C
EXAMINATION CARD NR. 2

CBC
Normal values
RBC ( x 106 /ml) 3.8 M 4.0 - 5.0; F 3.7 – 4.7
Hemoglobin (g/L) 126 M130 – 160; F 120 - 140
Hematocrit (%) 40 M 40 – 48; F 36 – 42
Platelet (x 109/L) 100 120–500
WBC (x 109/L) 18 4.0–9.0 x 109
Neutrophils (%) 41 47 - 72 %
Lymphocytes (%) 17 19 - 37 %
Basophils (%) 0-1%
ESR mm/hr 35 M 2 – 10; F 2 – 15
CSF
Normal values
Cell count 1600 ≤ 5x106/L
Differential:
Lymphocytes 12 %
Neutrophils 88 %
RBC
Gramm coloration Diplococc Gr neg
Questions:
1. Diagnosis
3. Aditional investigations
CLINICAL CASE
Patient B, 27 years old, pregnancy 30 week, hospitalized in February on the 4-th day of the
diseases with:
• fever 39°C, fatigue,
• cough, progressive dyspnea.
The illness had an acute onset with:
• fever 39°C, chills,
• severe headache, fatigue, orbital pain,
• rhinorrhea, dried cough.
Two years ago she has been treated of pulmonary tuberculosis.
Objective data:
• acrocyanosis,
• respiratory rate 30, Ps – 130/min, BP – 90/50.
• Pulmonary: a lot of wet crackles in medium and low pulmonary area bilateral.
Crackles don't clear after a cough.
• PaO2 - 70%.

What is the preliminary diagnosis.

acute viral hepatitis B

CBC
Normal values
RBC ( x 106 /ml) 4.0 M 4.0 - 5.0; F 3.7 – 4.7
Hemoglobin (g/L) 136 M130 – 160; F 120 - 140
Hematocrit (%) 46 M 40 – 48; F 36 – 42
Platelet (x 109/L) 160 120–500
WBC (x 109/L) 12.0 4.0–9.0 x 109
Neutrophils (%) 66 47 - 72 %
Lymphocytes (%) 15 19 - 37 %
Eosinophils (%) 1 0,5 - 5 %
Basophils (%) 0-1%
ESR mm/hr 35 M 2 – 10; F 2 – 15
1. PATIENT: Age: 30 years; Sex: female; Day of the disease: 10
CSF
Normal values
Cell count 550 ≤5x106/L
Differential:
Lymphocytes 72 %
Neutrophils 28 %
Gramm coloration No bacteria
Questions:
Diagnosis
Diferential diagnosis
Aditional investigations
2. CLINICAL CASE
Patient P, 26 years old, was hospitalized on the 5-th day of the disease.
The illness had an acute onset with:
• nausea, vomiting and non severe diarrhea.
In the next 2-3 days the patient started complained of:
• progressive fatigue,
• blurred vision and diplopia
• distention of the abdomen.
Objective data:
• afebrile,
• bilateral mydriasis, ptosis,
• dysphagia (liquids and hard food),
• swollen abdomen, constipation,
• liver – N
• RR – 28, BP – 90/60
What additional epidemiological data you need to determine the etiology of the disease?
What is the preliminary diagnosis?

acute viral hepatitis D superinfection

CBC
Normal values
RBC ( x 106 /ml) 5.0 M 4.0 - 5.0; F 3.7 – 4.7
Hemoglobin (g/L) 156 M130 – 160; F 120 - 140
Hematocrit (%) 46 M 40 – 48; F 36 – 42
Platelet (x 109/L) 160 120–500
WBC (x 109/L) 12 4.0–9.0 x 109
Neutrophils (%) 53 47 - 72 %
Lymphocytes (%) 39 19 - 37 %
Basophils (%) 0-1%
ESR mm/hr 19 M 2 – 10; F 2 – 15
CSF
Normal values
Opening pressure 260 50 – 180
Chloride 128 118–132mmol/L
Glucose 2.5 1.8 –3.8 mmol/L
Differential:
Lymphocytes 82 %
Neutrophils 18 %
Gramm coloration -
SERUM Normal values
BUN 6.0 2.5–7.5 mmol/liter
Bilirubin, total 36 5.1–17.0 µmol/liter
Bil. direct 26 1.7–5.1 µmol/liter
Glucose 5 3,8 – 5,8 mmol/l
AlAt 80 0 – 49 U/l
AsAt 74 0 – 46 U/l
α- amylase 1600 0 – 90 U/l
Alkaline phosphatase 280 100 – 290 U/l
Protrombin index 98 80 – 100%
Cholesterol 6,0 3,1 – 6,5 mmol/l
Questions:
1. Diagnosis
2. CLINICAL CASE
• Patient B, 21 years old, was hospitalized on the 5-th day of the disease with
complains of
o inappetence, nausea, repeated vomiting,
o pain in the epigastric region and right upper quadrant of the abdomen
o pronounced weakness, sleepiness.
• Objective data:
o apathetic, delay answer to the questions,
o jaundice.
o Ps – 56/min, BP – 90/50,
o swollen abdomen, painful liver + 1 cm, spleen +3 cm.

Lyme disease


CBC
Normal values
RBC ( x 106 /ml) 4.0 M 4.0 - 5.0; F 3.7 – 4.7
Hemoglobin (g/L) 136 M130 – 160; F 120 - 140
Hematocrit (%) 46 M 40 – 48; F 36 – 42
Platelet (x 109/L) 160 120–500
WBC (x 109/L) 18 4.0–9.0 x 109
Neutrophils (%) 41 47 - 72 %
Lymphocytes (%) 15 19 - 37 %
Basophils (%) 0-1%
ESR mm/hr 25 M 2 – 10; F 2 – 15
CSF
Normal values
Opening pressure 400 50 – 180
Chloride 106 118–132mmol/L
Glucose 1.4 1.8 –3.8 mmol/L
Differential:
Lymphocytes 8 %
Neutrophils 92 %
Gramm coloration Diplococc Gr poz
.
Questions:
1. Diagnosis
2. CLINICAL CASE
• Patient A, 30 years old, has an acute onset of the disease with:
o fever, chills, dizziness, fatigue
o nausea, repeated vomiting,
o epigastric pain.
• He addressed to the medical assistance in 3 hours after the onset of the disease.
• Objective data:
o pale and cold skin,
o t°- 36.0°C, Ps – 120/min, BP – 70/50,
o attenuated heart sounds.
o The tongue is dry and covered.
o Abdomen is soft, painful in the epigastrium and para umbilical region.
o Liver and spleen - normal.
• Epidemiological data:
o the patient got sick over 2 hours 30 minutes after eating a cake with cream prepared
in home conditions.

Establish the plan of investigation and treatment
3.WHAT INVESTIGATIONS IS NECESSARY TO PERFORM IN CASE OF:

Chronic viral hepatitis D

1. PATIENT: Age: 28 years; Sex: female, pregnant; Day of the disease: 4
CBC
Normal values
RBC ( x 106 /ml) 3.3 M 4.0 - 5.0; F 3.7 – 4.7
Hemoglobin (g/L) 118 M130 – 160; F 120 - 140
Hematocrit (%) 39 M 40 – 48; F 36 – 42
Platelet (x 109/L) 100 120–500
WBC (x 109/L) 16 4.0–9.0 x 109
Neutrophils (%) 6 47 - 72 %
Lymphocytes (%) 16 19 - 37 %
Basophils (%) 0-1%
ESR mm/hr 29 M 2 – 10; F 2 – 15
Normal values
Creatinine 140 53 – 115 mmol/l
Bilirubin, direct 5 1.7–5.1 µmol/liter
Glucose 3.0 3,8 – 5,8 mmol/l
AlAt 60 0 – 49 U/l
AsAt 50 0 – 46 U/l
α- amylase, serum 60 0 – 90 U/l
GGT 40 F 5 – 42 U/l
B 10 -71 U/l
β- lipoproteins 45 35 – 55 U
Cholesterol 3 3,1 – 6,5 mmol/l
Questions:
1. Diagnosis
2. CLINICAL CASE
• Patient T, 16 years old, was hospitalized on the second day of the disease with the
complains of:
o fever 39°C,
o progressive headache, weakness, fatigue,
o repeated vomiting,
o acrocyanosis,
o hemorrhagic rash on the face, thorax and extremities.
• Ps- 120/min, BP – 50/20,
• liver and spleen are normal.
• Rigidity of the occipital muscles.


Leptospirosis.

1. PATIENT: Age: 19 years; Sex: female; Day of the disease: 7

Acute oncet, fever 38C
Bilateral cervical, supraclavicular, axilar lymphadenopathy
Maculopapular rash on the cest and abdomen
CBC
Normal values
RBC ( x 106 /ml) 4.0 M 4.0 - 5.0; F 3.7 – 4.7
Hemoglobin (g/L) 120 M130 – 160; F 120 - 140
Hematocrit (%) 39 M 40 – 48; F 36 – 42
Platelet (x 109/L) 120 120–500
WBC (x 109/L) 3.4 4.0–9.0 x 109
Neutrophils (%) 60 47 - 72 %
Lymphocytes (%) 17 19 - 37 %
Monocytes (%) 10 3%–11%
Basophils (%) 0-1%
ESR mm/hr 17 M 2 – 10; F 2 – 15
Normal values
AlAt 67 0 – 49 U/l
AsAt 56 0 – 46 U/l
GGT 50 F 5 – 42 U/l, B 10 -71 U/l
AgHBs - neg
Anti-HBs-poz
AgHBe - neg
Anti – HBcor sum-neg
Anti – HCV sum – neg
Anti VCA EBV IgM – neg
CD4 – 360 cells
Questions:
1. Diagnosis
2.CLINICAL CASE
• Patient G, 25 years old, fisherman, was hospitalized on the 7 day of the disease the
disease with:
o fever 380C, chills, headache
o vomiting, loss of appetite,
o back pain
• Objective data:
o moderate jaundice,
o injected conjunctiva,
o hepatomegalia + 3 cm, splenomegalia +1 cm.
o Giordano sign - positive bilateral.
o Oliguria.


Acute viral meningitis

PATIENT: Age: 28 years; Sex: male, pregnant; Day of the disease: 2-nd week; Generalized
lymphadenopathy, oral thrush
CBC
Normal values
RBC ( x 106 /ml) 3.3 M 4.0 - 5.0; F 3.7 – 4.7
Hemoglobin (g/L) 108 M130 – 160; F 120 - 140
Hematocrit (%) 36 M 40 – 48; F 36 – 42
Platelet (x 109/L) 90 120–500
WBC (x 109/L) 3.0 4.0–9.0 x 109
Neutrophils (%) 58 47 - 72 %
Lymphocytes (%) 9 19 - 37 %
Basophils (%) 0-1%
ESR mm/hr 20 M 2 – 10; F 2 – 15
Normal values
Creatinine 140 53 – 115 mmol/l
AlAt 70 0 – 49 U/l
AsAt 57 0 – 46 U/l
α- amylase, serum 60 0 – 90 U/l
GGT 40 F 5 – 42 U/l
B 10 -71 U/l
Cholesterol 2.7 3,1 – 6,5 mmol/l
Questions:
1. Diagnosis
2. CLINICAL CASE
• Patient 25 years old, hospitalized on the 4 day of the disease with complains of:
o fatigue, dizziness, loss of appetite,
o pain in the both hypochondrium,
o distention of the abdomen, jaundice.
• She suffered from viral hepatitis in childhood.
• During the last three years periodically complains of the pain in the right
hypochondrium, fatigue and dark urine.
• Objective data:
o the patient is apathetic, sleepy,
o fever 38°C,
o pronounced jaundice,
o Ps- 68/min, BP- 90/50mm Hg,
o distended abdomen.
o Liver is firm, with sharp edges, painful, +5cm. Spleen + 4 cm.
• The patient had unprotected sex with multiple partners.

What is the preliminary diagnosis?

Meningococcal meningitis

CBC
Normal values
RBC ( x 106 /ml) 4.5 M 4.0 - 5.0; F 3.7 – 4.7
Hemoglobin (g/L) 140 M130 – 160; F 120 - 140
Hematocrit (%) 45 M 40 – 48; F 36 – 42
Platelet (x 109/L) 260 120–500
WBC (x 109/L) 13 4.0–9.0 x 109
Neutrophils (%) 50 47 - 72 %
Lymphocytes (%) 19 19 - 37 %
Basophils (%) 0-1%
ESR mm/hr 17 M 2 – 10; F 2 – 15
Normal values
Total protein 6.2 6.2–8.2 g/dL
albumin 46% 50–60%
Alpha1 4% 4.2–7.2%
Alpha2 13% 6.8–12%
Beta 15% 9.3–15%
Gamma 22% 13–23%
Bilirub. direct 260 1.7–5.1 µmol/liter
AlAt 1800 0 – 49 U/l
AsAt 1100 0 – 46 U/l
GGT 70 F 5 – 42 U/l
B 10 -71 U/l
AgHBs - neg
AbHBs - poz
AgHBe - neg
Ab – HBc IgM-neg
Ab – HBc IgG-poz
Ab – HAV IgM-poz
Ab – HCV sum - poz
Urinalysis:
• Proteinuria
• 40 leukocytes,
• 8 erythrocytes,
Questions:
1. Diagnosis
2. CLINICAL CASE
• Patient 29 years old, hunter, was hospitalized on the 3 day of the disease the disease
with complains of:
o fever 37-38°C,
o headache, weakness,
o sore throat during swallowing.
• Objective data:
o hyperemia of the pharynges,
o on the right tonsils is seen an ulcer with white patch, not exceeding palate pillars,
moderately painful.
o Right submandibular is enlarged, 2.5-3 cm, non adherent, moderately painful.
o Pulmonary - vesicular breathing.
o Abdomen is painful in the epigastrium, liver -N.


Mumps meningitis

1. PATIENT: Age: 55 years; Sex: female;
CBC
Normal values
RBC ( x 106 /ml) 2.9 M 4.0 - 5.0; F 3.7 – 4.7
Hemoglobin (g/L) 108 M130 – 160; F 120 - 140
Hematocrit (%) 34 M 40 – 48; F 36 – 42
Platelet (x 109/L) 90 120–500
WBC (x 109/L) 3.0 4.0–9.0 x 109
Neutrophils (%) 45 47 - 72 %
Lymphocytes (%) 28 19 - 37 %
Basophils (%) 0-1%
ESR mm/hr 10 M 2 – 10; F 2 – 15
Normal values
albumin 37% 50–60%
Alpha1 4% 4.2–7.2%
Alpha2 14% 6.8–12%
Beta 10% 9.3–15%
Gamma 35% 13–23%
AlAt 75 0 – 49 U/l
AsAt 106 0 – 46 U/l
GGT 90 F 5 – 42 U/l
B 10 -71 U/l
AgHBs - poz
AgHBe - neg
Ab HBc IgG-poz
Ab HCV sum - negativ
Questions:
1. Diagnosis: Hepatită virală B (reactivarea infecției: AgHbs pozitiv, AcHbc IgG pozitiv),
din ex lab: sdr citoliză, sdr colestază, sdr hepatopriv
2. Diferential diagnosis: Hepatite de altă etilogie (virale, toxice, etilice, etc.)
3. Aditional investigations: investigăm serologic la supra/co-infecția HVD, investigare
afectare hepatică (fibroscan-grad fibroză, leziunile).
2. CLINICAL CASE
• Patient C, 23 years old, was hospitalized on the 4 day of the disease with complains
of:
o fever 38°C,
o loss of appetite, dizziness,
o diffuse abdominal pain,
o non abundant frequent semi liquid stools with mucus.
• Objective data:
o the patient is apathetic,
o T 36°C, pale, cold sweaty skin,
o Ps – 120/min, BP – 60/40mm Hg,
o abdomen is painful mainly in the left iliac region.


Pneumococcal meningitis

1. PATIENT: Age: 55 years; Sex: male;
CBC
Normal values
RBC ( x 106 /ml) 3.5 M 4.0 - 5.0; F 3.7 – 4.7
Hemoglobin (g/L) 120 M130 – 160; F 120 - 140
Hematocrit (%) 38 M 40 – 48; F 36 – 42
Platelet (x 109/L) 110 120–500
WBC (x 109/L) 9.0 4.0–9.0 x 109
Neutrophils (%) 58 47 - 72 %
Lymphocytes (%) 25 19 - 37 %
Basophils (%) 0-1%
ESR mm/hr 17 M 2 – 10; F 2 – 15
Normal values
albumin 45% 50–60%
Alpha1 4% 4.2–7.2%
Alpha2 14% 6.8–12%
Beta 10% 9.3–15%
Gamma 27% 13–23%
AlAt 180 0 – 49 U/l
AsAt 170 0 – 46 U/l
GGT 90 F 5 – 42 U/l
B 10 -71 U/l
AgHBs - neg
Ab-HBs-poz
AgHBe - neg
Ab HBcor sum-neg
Ab HAV – IgG - poz
Ab HCV sum - poz
Urinalysis:
• Proteinuria
• 10 leukocytes,
• 40 erythrocytes
Questions:
1. Diagnosis
2. CLINICAL CASE
• Patient B, 34 years old, was hospitalized on the 3 day of the disease with complains
of:
o fever 39°C,
o headache, chills,
o abdominal pain,
o frequent liquid stools without blood.
• Objective data:
o pale and dry skin, acrocyanosis,
o low turgor of the skin,
o tonic convulsions of gastrocnemian muscles,
o filiform pulse, BP – 50/10mm Hg,
o distended abdomen,
o painful in the epigastrium and per umbilical,
o stool is liquid, watery and green colored.
• Epidemiological data:
o The patient ate a goose prepared in home conditions.


Acute HIV infection

CBC
Normal values
RBC ( x 106 /ml) 4.0 M 4.0 - 5.0; F 3.7 – 4.7
Hemoglobin (g/L) 135 M130 – 160; F 120 - 140
Hematocrit (%) 42 M 40 – 48; F 36 – 42
Platelet (x 109/L) 120 120–500
WBC (x 109/L) 4.0 4.0–9.0 x 109
Neutrophils (%) 55 47 - 72 %
Lymphocytes (%) 25 19 - 37 %
Basophils (%) 0-1%
ESR mm/hr 17 M 2 – 10; F 2 – 15
Normal values
albumin 45% 50–60%
Alpha1 4% 4.2–7.2%
Alpha2 14% 6.8–12%
Beta 10% 9.3–15%
Gamma 27% 13–23%
AlAt 180 0 – 49 U/l
AsAt 170 0 – 46 U/l
GGT 90 F 5 – 42 U/l
B 10 -71 U/l
AgHBs - neg
AgHBe – neg
Ab – HBs-poz
Ab – HBc sum-poz
Ab – HD sum-poz
Ab – HCV sum - poz
Questions:
1. Diagnosis
2. CLINICAL CASE
• Patient S, 27 years old, was hospitalized on the 3 day of the disease with complains
of:
o fever 39°C,
o pronounced headache,
o repeated vomiting,
o generalized myalgia,
o sore throat.
• The disease had an acute onset.
• Objective data:
o T-39°C, rash – absent,
o in the pharings - herpetiform enantema,
o pulmonary - vesicular breathing,
o Ps – 92/min, BP – 90/60mm Hg.
o Occipital muscles are rigid.

1. Dacă pacientul suferă de fotofobie , fonofobie, accentuarea mirosrilor și hiperestezie
cutanată.
2. La examenul obiectiv se va efectua :
-Semnul redorii de ceafă (flectarea capului spre torace)
-Semnul Kering I , II ( P nu poate flecta trunchiul pe bazin , nu poate sta în poziție
șezând
-S. Brudzinski I ( al cefei)
-S Brudzinski II ( contralateral)
- S. Sărutului
Poziții antalgice în pat:
-Poziția în triplă flexie a trunchiului
-„cocoș de pușcă”
-Poziția „ trepiedului”
3. Examinarea feselor și extremităților inferioare ( erupțiile pot apărea la 6-15 h de la

debutul bolii)

Meningită

1. Puncția lombară :
- se efectuează înaintea administrării de AB ,
- se efect. numai după excluderea unui sdr de HTA intracraniană ( risc de
angajare a creierului)
- P. va fi în decubit lateral , cu genunchii la piept și capul flectat în față.
- Dezinfecția tegumentelor cu betadină, dinspre centru spre periferie
- Se va puncta sub niv L2
- LCR se colectează în 3 eprubete câte 2-3 ml
- După puncție bolnavul trebuie să stea 2 ore culcat pe burtă fără pernă și timp
de 24 h să respecte regimul la pat.
Lichidul transportat la laborator trebuie , mai întâi centrifugat, apoi se însemânțează

sedimentul. Dacă lichidul este tulbure , el se însemânțează fără a fi prelucrat preventiv.
Însămânțarea se efectuază pe mediu sangvin. Din sediment se pregătește un frotiu ce se
colorează după Gram.
2. Examinarea LCR
- se determină presiunea ( în N =70-200mm a coloanei de apă)
- reacția Pandy : metodă calitativă de evidențierea proteinelor din LCR cu
ajutorul acidului frenic. În meningitele acute apare o creștere a albuminorahiei
( apare un nor albicios). Intens pozitivă : în meningita TBC și bacteriană.
- numărătoarea de celule nucleate din LCR ( după o prealabilă liză a hematiilor
cu acid acetic).
- Astfel, LCR poate fi:
- LCR clar, transparent, limpede ca ,,apa de stancă", atunci când numărul de
celule nucleate este <100 /mmc,
- LCR opalescent (cu transparență diminuată) atunci când numărul de celule
nucleate este cuprins între 100-2000 /mmc
- LCR tulbure, ,,purulent", comparat cu ,,zeama de varză", atunci când
numărul de celule nucleate este mai mare de 2000 / mmc.
Ordinul de mărime al numărului de celule nucleate /mme LCR în diferitele
tipuri de meningite acute diferă în funcție de etiologie:
- In meningita TBC: de , ordinul zecilor" până la maxim 500 celule nucleate /
mmc
- In meningita virală: de ,,ordinul sutelor" până la maxim 2000 celule
nucleate/mmc. In majoritatea cazurilor de meningite virale, numărul de celule
nucleate este cuprins între 100-1000 celule nucleate/mmc
- In meningita fungică: de ,,ordinul sutelor"
- In meningita hacteriană deordin miilornână la zeci de mii celule nucleate
-
TRATAMENT:
1. Tratament etiologic:
- Meningită produsă de enterovirusuri: pleconaril , pocapavir
- M. cu virursurile HSV 1 HSV 2 : aciclovir i/v 10-15 mg/kg/8 ore , timp de 10-21
zile
- M. și encefalita produsă de virusul varicelo-zosterian : aciclovir
- Meningoencefalita cu EBV : tratament simptomatic și patogenic
- M cu virusul gripal A sau B : oseltamivir p/o, zanamivir inhalator
- M produsă de HIV : Amfotericină B (0,7-1 mg/kg/zi) + Flucitozină (4 x 25
mg/kg/zi), 2 săptămâni, apoi Fluconazol (400 mg/zi), 8 săptămâni
-
2. Tratament patogenetic:
-Tratamentul antiinflamator (corticoterapie în forme severe de meningite virale cu
HTA intracraniană , pleiocitoza, proteinorahie mut crescută. Dexametazon (0,4-0,6
mg/kg/zi). Durata: nu mai mult de 7 zile.
- Tratament depletiv cerebral : Maitol 20% în perfuzii i/v lent, la interval de 8 h , la
care se poate asocia un diuretic de ansă (furosemid) sau glucoză hipertonă (20%).

Generalized form of salmonellosis

CBC
Normal values
RBC ( x 106 /ml) 4.0 M 4.0 - 5.0; F 3.7 – 4.7
Hemoglobin (g/L) 135 M130 – 160; F 120 - 140
Hematocrit (%) 42 M 40 – 48; F 36 – 42
Platelet (x 109/L) 110 120–500
WBC (x 109/L) 4.6 4.0–9.0 x 109
Neutrophils (%) 48 47 - 72 %
Lymphocytes (%) 25 19 - 37 %
Basophils (%) 0-1%
ESR mm/hr 17 M 2 – 10; F 2 – 15
Normal values
albumin 45% 50–60%
Alpha1 4% 4.2–7.2%
Alpha2 14% 6.8–12%
Beta 10% 9.3–15%
Gamma 27% 13–23%
AlAt 2000 0 – 49 U/l
AsAt 1600 0 – 46 U/l
GGT 70 F 5 – 42 U/l
B 10 -71 U/l
AgHBs - poz
AgHBe - neg
Ab – HBcor IgM-poz
Ab – HD IgM-poz
Ab – HCV sum – neg
Ab – HAV IgG - poz
Questions:
1. Diagnosis
2. CLINICAL CASE
• Patient C, 33 years old, was hospitalized on the 11 day of the disease with complains
of:
o moderate headache,
o fever, chills,
o apathy, insomnia, loss of appetite.
• Objective data:
o fever 39°C,
o patient is apathetic,
o jaundiced sclera,
o dry tongue,
o on the abdomen macula-papular rash
o Pulmonary - attenuated right basal breathing with unique wet wheezing sound.
o Heart noise attenuated, Ps – 68/min,
o abdomen is soft, distended, liver + 3 cm, spleen +2 cm, constipation.
• On the 4-th day of the hospitalization:
o the general state aggravated,
o patient become lethargic, pale,
o has vertigo,
o temperature decreased to normal,
o Ps – 110/min, BP- 70/40mm Hg.


Mononucleosis syndrome

CBC
Normal values
RBC ( x 106 /ml) 4.0 M 4.0 - 5.0; F 3.7 – 4.7
Hemoglobin (g/L) 135 M130 – 160; F 120 - 140
Hematocrit (%) 42 M 40 – 48; F 36 – 42
Platelet (x 109/L) 190 120–500
WBC (x 109/L) 3.6 4.0–9.0 x 109
Neutrophils (%) 48 47 - 72 %
Lymphocytes (%) 25 19 - 37 %
Basophils (%) 0-1%
ESR mm/hr 17 M 2 – 10; F 2 – 15
Normal values
albumin 50% 50–60%
Alpha1 4% 4.2–7.2%
Alpha2 13% 6.8–12%
Beta 10% 9.3–15%
Gamma 29% 13–23%
AlAt 69 0 – 49 U/l
AsAt 76 0 – 46 U/l
GGT 90 F 5 – 42 U/l
B 10 -71 U/l
AgHBs - poz
AgHBe - neg
Ab – HBc sum-poz
Ab – HD sum-poz
Ab – HCV sum - neg
Questions:
1. Diagnosis
2. CLINICAL CASE
• Patient, 30 years old, 15 days before the disease start he worked in the garden and
stepped on a rusty nail, but does not addressed for the medical help.
• Now he is hospitalized with the complains for:
o moderate pain in right foot,
o spastic pain in masseter muscles,
o weakness.
• In hospital the wound was dressed, and indicated antibiotherapy and specific
treatment.
• On the 7 day of the treatment appeared:
o fever 38°C,
o maculopapular rash
o sensation of the chest restriction,
o hyperesthesia,
o generalized myalgia.
o generalized lymphadenopathy + 1 cm

Abdominal fever

CBC
Normal values
RBC ( x 106 /ml) 4.0 M 4.0 - 5.0; F 3.7 – 4.7
Hemoglobin (g/L) 135 M130 – 160; F 120 - 140
Hematocrit (%) 42 M 40 – 48; F 36 – 42
Platelet (x 109/L) 160 120–500
WBC (x 109/L) 4.6 4.0–9.0 x 109
Neutrophils (%) 48 47 - 72 %
Lymphocytes (%) 25 19 - 37 %
Basophils (%) 0-1%
ESR mm/hr 17 M 2 – 10; F 2 – 15
Normal values
albumin 40% 50–60%
Alpha1 4% 4.2–7.2%
Alpha2 16% 6.8–12%
Beta 10% 9.3–15%
Gamma 30% 13–23%
AlAt 2600 0 – 49 U/l
AsAt 1900 0 – 46 U/l
GGT 90 F 5 – 42 U/l
B 10 -71 U/l
AgHBs - poz
AgHBe - neg
Ab HBc sum-poz
Ab HD IgM-poz
Ab HCV sum - poz
Questions:
1. Diagnosis
2. CLINICAL CASE
• Patient 32 years old, was hospitalized on the 7 day of the disease with complains of:
o fever 38°C,
o weakness, sore throat,
o unexplained diarrhea for 3-4 /day .
• Objective data:
o T-37,7°C,
o sore throat,
o tongue and tonsils with whitish deposits, easily removable,
o cervical lymph nodes + 1,5 cm,
o liver + 2 cm,
o generalized maculo-papular rash.
• WBC - moderate leucopenia, lymphopenia
• Epidemiological data: unprotected sex 3 weeks ago


Flu in pregnant women

1. PATIENT: Age: 50 years; Sex: male; Day of the disease 10
CBC
Normal values
RBC ( x 106 /ml) 3.6 M 4.0 - 5.0; F 3.7 – 4.7
Hemoglobin (g/L) 117 M130 – 160; F 120 - 140
Hematocrit (%) 34 M 40 – 48; F 36 – 42
Platelet (x 109/L) 70 120–500
WBC (x 109/L) 19 4.0–9.0 x 109
Neutrophils (%) 33 47 - 72 %
Lymphocytes (%) 15 19 - 37 %
Basophils (%) 0-1%
ESR mm/hr 37 M 2 – 10; F 2 – 15
Normal values
albumin 40% 50–60%
Alpha1 6% 4.2–7.2%
Alpha2 17% 6.8–12%
Beta 15% 9.3–15%
Gamma 22% 13–23%
AlAt 69 0 – 49 U/l
AsAt 60 0 – 46 U/l
GGT 60 F 5 – 42 U/l
B 10 -71 U/l
Urinalysis:
• Proteinuria
• 20 leukocytes,
• 100 erythrocytes,
• hyaline casts, and granular casts
AgHBs - neg
AgHBe - neg
Ab HBc sum - neg
Ab HCV sum - neg
Questions:
1. Diagnosis
2. CLINICAL CASE
• Patient 30 years old.
• Periodically for 2 weeks has:
o feelings of the disorder of the heart rhythm
o moderate pain in the right knee joint.
• In spring, 3 month ago, he has a painless erythema of 2-3 cm on the right leg that
gradually increased in size. At that time the general state remained unaltered.


AIDS

CBC
Normal values
RBC ( x 106 /ml) 4.0 M 4.0 - 5.0; F 3.7 – 4.7
Hemoglobin (g/L) 140 M130 – 160; F 120 - 140
Hematocrit (%) 39 M 40 – 48; F 36 – 42
Platelet (x 109/L) 190 120–500
WBC (x 109/L) 16 4.0–9.0 x 109
Neutrophils (%) 12 47 - 72 %
Lymphocytes (%) 65 19 - 37 %
Monocytes (%) 12 3%–11%
Basophils (%) 0-1%
ESR mm/hr 17 M 2–10
From all lymphocytes - 10% are atypical
Normal values
albumin 40% 50–60%
Alpha1 6% 4.2–7.2%
Alpha2 17% 6.8–12%
Beta 15% 9.3–15%
Gamma 22% 13–23%
AlAt 400 0 – 49 U/l
AsAt 280 0 – 46 U/l
GGT 60 F 5 – 42 U/l
B 10 -71 U/l
AgHBs - neg
Ab-HBs-poz
AgHBe - neg
Ab HBcor sum-neg
Ab HCV sum - neg
Questions:
1. Diagnosis
2. CLINICAL CASE
• Patient 26 years old,
• During the last 6 months started to lose her weight, to have difficulty by recalling and
by knitting.
• Dry cough and fever 38°C for the last 3 weeks.
• Objective data:
o hypopondered,
o fever 38°C,
o pale,
o acrocyanosis,
o generalized lymphadenopathy,
o tongue is whitish coated,
o dyspnea - 28 / min, pulmonary - basal bilateral breathing is attenuated with multiple
wet wheezing sound.
o Blood saturation with O2 – 75%.
o Heart sounds are rhythmic, attenuated, systolic murmur at the apex. Ps – 120/ min.
o Liver + 2 cm.
o Lung X-ray: bilateral in the lower and middle lobes - micronodular interstitial
infiltration.

Tularemia

CBC
Normal values
RBC ( x 106 /ml) 3.0 M 4.0 - 5.0; F 3.7 – 4.7
Hemoglobin (g/L) 112 M130 – 160; F 120 - 140
Hematocrit (%) 34 M 40 – 48; F 36 – 42
Platelet (x 109/L) 138 120–500
WBC (x 109/L) 16 4.0–9.0 x 109
Neutrophils (%) 50 47 - 72 %
Lymphocytes (%) 18 19 - 37 %
Basophils (%) 0-1%
ESR mm/hr 37 M 2–10
Normal values
albumin 40% 50–60%
Alpha1 6% 4.2–7.2%
Alpha2 17% 6.8–12%
Beta 15% 9.3–15%
Gamma 22% 13–23%
AlAt 600 0 – 49 U/l
AsAt 480 0 – 46 U/l
GGT 90 F 5 – 42 U/l
B 10 -71 U/l
AgHBs - neg
Ab-HBs-poz
AgHBe - neg
Ab HBcor sum- poz
Ab HCV sum – neg
Ab-HEV IgG-poz
Questions:
1. Diagnosis
2. CLINICAL CASE
• Patient 25-year-old, rancher, was admitted to ED because of a two-day history of
headache, chills, and fever (40°C).
• The day before admission, he began vomiting.
• The day of admission, an orange-sized painful swelling in the left axilla was noted.
• Within a few hours of admission, he had a cardiopulmonary arrest.
• During resuscitation efforts, he vomited and aspirated his vomitus; a chest X-ray
showed bilateral infiltrate.
• Additionally, the patient bled from several body sites.
• The patient died within 6 hours of admission.
• In the 2 weeks prior to becoming ill, the patient had trapped, killed, and skinned 3 kit
foxes, 4 coyotes, and 1 bobcat. The patient had cut his left hand shortly before skinning the
bobcat.


Acute viral hepatitis E in pregnant women (38 weeks of pregnancy

Cazuri Clinice

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Cazuri Clinice

Uploaded by

Copyright:

Available Formats

Heba 1, 10

Caz 1.EXAMINATION CARD NR. 1

1. PATIENT: Age: 30 years; Sex: male; Day of the disease: 3

What additional epidemiological data you need to determine?

What is the preliminary diagnosis. Tularemie

3. WHAT INVESTIGATIONS IS NECESSARY TO PERFORM IN CASE OF:

EXAMINATION CARD NR. 2

1. PATIENT: Age: 30 years; Sex: male; Day of the disease: 3

What additional epidemiological data you need to determine?

3. WHAT INVESTIGATIONS IS NECESSARY TO PERFORM IN CASE OF:

EXAMINATION CARD NR. 3

3. WHAT INVESTIGATIONS IS NECESSARY TO PERFORM IN CASE OF:

EXAMINATION CARD NR. 4

1. PATIENT: Age: 18 years; Sex: male; Day of the disease: 3

What additional epidemiological data you need to determine?

EXAMINATION CARD NR. 5

1. PATIENT: Age: 65 years; Sex: male; Day of the disease: 6

What additional epidemiological data you need to determine?

3.WHAT INVESTIGATIONS IS NECESSARY TO PERFORM IN CASE OF:

EXAMINATION CARD NR. 6

1. PATIENT: Age: 28 years; Sex: female, pregnant; Day of the disease: 4

What additional epidemiological data you need to determine?

4. WHAT INVESTIGATIONS IS NECESSARY TO PERFORM IN CASE OF:

EXAMINATION CARD NR. 7

1. PATIENT: Age: 19 years; Sex: female; Day of the disease: 7

What additional epidemiological data you need to determine?

3. WHAT INVESTIGATIONS IS NECESSARY TO PERFORM IN CASE OF:

EXAMINATION CARD NR. 8

What additional epidemiological data you need to determine?

3. WHAT INVESTIGATIONS IS NECESSARY TO PERFORM IN CASE OF:

EXAMINATION CARD NR. 9

What additional epidemiological data you need to determine?

3.WHAT INVESTIGATIONS IS NECESSARY TO PERFORM IN CASE OF:

EXAMINATION CARD NR. 10

1. PATIENT: Age: 55 years; Sex: female;

What additional epidemiological data you need to determine?

3.WHAT INVESTIGATIONS IS NECESSARY TO PERFORM IN CASE OF:

EXAMINATION CARD NR. 11

1. PATIENT: Age: 55 years; Sex: male;

What additional epidemiological data you need to determine?

3.WHAT INVESTIGATIONS IS NECESSARY TO PERFORM IN CASE OF:

EXAMINATION CARD NR. 12

1. PATIENT: Age: 50 years; Sex: male;

What additional epidemiological data you need to determine?

3. Examinarea feselor și extremităților inferioare ( erupțiile pot apărea la 6-15 h de la

What is the preliminary diagnosis.

Establish the plan of investigation and treatment

Lichidul transportat la laborator trebuie , mai întâi centrifugat, apoi se însemânțează

3.WHAT INVESTIGATIONS IS NECESSARY TO PERFORM IN CASE OF:

EXAMINATION CARD NR. 13

1. PATIENT: Age: 50 years; Sex: male;

What additional epidemiological data you need to determine?

3.WHAT INVESTIGATIONS IS NECESSARY TO PERFORM IN CASE OF:

EXAMINATION CARD NR. 14

1. PATIENT: Age: 50 years; Sex: male;

3.WHAT INVESTIGATIONS IS NECESSARY TO PERFORM IN CASE OF:

EXAMINATION CARD NR. 15

1. PATIENT: Age: 50 years; Sex: male;

What additional epidemiological data you need to determine?

3.WHAT INVESTIGATIONS IS NECESSARY TO PERFORM IN CASE OF:

EXAMINATION CARD NR. 16

1. PATIENT: Age: 50 years; Sex: male; Day of the disease 10

What additional epidemiological data you need to determine?