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