Question

 

Case Study(1)

A 53-year-old gentleman with a background of asthma on long-term low dose inhaled corticosteroid inhaler had an acute exacerbation of his asthma in February 2020 triggered by a viral upper respiratory tract infection and acute sinusitis and was managed with bronchodilator nebulization and a 7-day course of oral prednisone 30 mg daily. He made an uneventful recovery and proceeded to travel to Austria. During his stay in Austria, he had a high fever, sore throat, dry cough, severe wheezing, worsening dyspnoea and he was not feeling any better and had ongoing fever and cough

According to the above case answer the following questions :

 

1. What is the likely diagnosis of this case? Define it and list its possible causes, mode of transmission, and clinical manifestations?
2. Is this patient has risk factors for the disease? If yes, write them down along with other possible risk factors of the disease?
3. What are the alarming features when evaluating a patient with this disease?

4. What are the protective measures against this disease?

Answer 1

As the case study mentioned here, a 53 year old man who got asthma when get sudden relief from asthma symptoms with a short term therapy of bronchodilators and corticosteroid made him to move to Austria. But within a few days severe symptoms seems to be recurring. From all this informations, I came to a conclusion that the diagnosis will be acute bronchitis.

It's a condition when the tubes that carry air to your lungs, called the bronchial tubes, get inflamed and swollen. More often, the same viruses that give you a cold or the flu cause acute bronchitis. But sometimes, bacteria bring it on.In both cases, as your body fights the germs, your bronchial tubes swell and make more mucus. That means you have smaller openings for air to flow through, which can make it harder to breathe.The main reason for this infection is due to the intake of corticosteroid ,oral prednisone 30 mg daily for Asthma.This drug made the client to immunosuppressive and got this infection easily.

• Weaker immune system
• Older adults are more prone for this diagnosis

The man clinical manifestations include in this diagnosis are

1. Chest congestion, when your chest feels full or clogged
2. A dry cough
3. Shortness of breath
4. Wheezing or a whistling sound when you breathe.
5. Bodyaches and chills
6. Feeling“wiped out”
7. High fever
8. Runny, stuffy nose
9. Sorethroat

Some of the risk factors which cause this condition includes smoking , history of asthma , allergies , weaker immune system and any family history of lung disease.

The alarming features which is notified in this diagnosis that needs immediate medical attention includes

• Brings up blood or mucus that thickens or darkens
• Keeps the client awake at night
• Symptoms lasts more than 3 weeks
• chest pain
• Barking sound and makes it hard to speak
• Unexplained weight loss
• Afoul-tasting fluid in your mouth
• Fever over 100.4 F
• Wheezing or shortness of breath

The preventive measure to avoid this condition to occur in future includes

- No passive smoking

- Ensure that the adult vaccination done as per the schedule

- Hand washing should be done properly

- Wear a mask routine ways

- Drink a lot of fluids

- Get plenty of rest

- Increase the humidity in your home or use a humidifier.

Answer 2

Possible diagnosis is covid-19 or SARS-cov 2 infection.

Covid -19 is the infection caused by novel corona virus, the virus mainly affect the upper respiratory tract and lower respiratory tract and may lead to respiratory pneumonia. Most of the people get infection with out serious complications but in patient with other disease like diabetes ,hypertension and immunity compromised patients get infection with severe complication or even death also.

Causes of covid 19

The corona virus caused by person to person contact and by droplet. The person have resent travel history are more risk for covid 19.from the above scenario traveling to Austria is the cause of getting infection to that patient.

Mode of transmission of Covid 19

The most common mode of transmission of disease is by close contact with respiratory droplet, close contact with infected person and contact with infected surfaces or objects.

Clinical manifestation of covid 19

Most common symptoms include

:fever

:dry cough

:tiredness

Less common symptom include

:sore throat

:loss of appetite

:loss sense of taste and smell

:head ache, body ache

:conjunctivitis

:discoloration of toe and fingers and rash on skin.

:diarrhea

In severe case the symptoms include,

:shortness of breath

:dry cough

:chest pain

:decresed oxygen saturation

:septic shock, multiple organ dysfunction and acute respiratory dysfunction syndrome.

Most of patient get recover without any treatment and some patient with other disease like diabetes and heart disease, asthma ,COPD cause this infection get worsen and need treatment.

From the above scenario the patient has risk factors that is

The most of the recent study shows that patient with corticosteroid treatment is more prone to get this infection. Corticosteriod cause weakened immune function and treatment with corticosteroid fasten the viral replication. This is one of the risk factor for covid 19

Other risk factors include

:kidney dysfunction

:heart disease

:COPD

:sickle cell disease

:immunty compromised patients

:cancer

:diabetes mellitus

:obesity

Alarming feature of covid 19

:recent travel history, loss of sense of smell and taste, dry cough and shortness of breath ,chest pain,discolration of skin.

4)protective measures against covid 19

There is no effective treatments for vivid 19,the prevention is the better way. The protective measure against this disease include.

:wear personal protective equipment such as mask, face shield, aprons and gloves.

:always maintaining hand hygiene. Hand washing with soap and Water or alcohol based sanitizer is useful to prevent the transmission of disease.

:cover the face while sneezing and coughing.

:maintaining social distance. This will help to prevent getting this infection.

:do not touch eyes and mouth with hand and stay at home if possible