Question

Infectious Disease DDA

Jim is a 29 year old computer programmer. He presents today c/o feeling badly for 7-10 days. He states that he has had fever of 100-103 degrees, sore throat and body aches all over. He denies cough, shortness of breath, dysuria or frequency.

Jim says that he is healthy, with no chronic health problems. He has never had surgery. He takes no routine meds. He does not smoke. He has no known allergies. He drinks alcohol 3-4 times per week, 3-4 glasses of red wine. He says that he has done some street drugs, smoking and injecting cocaine. Jim states that he has given up the cocaine, has not used any in 4-6 weeks. He admits to recreational use for only a 3 month period earlier this year, with the last episode being 4-6 weeks ago.

Jim is single. He and his girlfriend of 4 years broke up about 6 months ago and he has had unprotected intercourse 3 times since then with different partners.

On his physical, Jim is a well-developed white male in no acute distress. His vital signs are: 99.6-84-18   120/66 72” 180#

His skin, hair and nails are normal. He has some cervical lymphadenopathy and his spleen is one finger breadth below the left costal margin. The remainder of his physical is normal.

What are his medical diagnoses?

What are his differential diagnoses, with rule outs?

What diagnostics are needed?

What prescriptions does he need?

What education does he need?

Answer 1

HIS MEDICAL DIAGNOSES :

He has been suffering from infectious mononucleosis caused by epstein barr virus . classical symptoms and signs are sore throat fever , myalgia and cervical lymphadenopathy and spleenomegaly .It is also called kissing disease spread from saliva of infected person also spreads through sexual contact and kissing . it has incubation peiod of 4 to 6 weeks .epstein barr belong to herpes group of virus family. younger adults are more prone to get this disease .

DIFFERENTIAL DIAGNOSIS RULED OUT ;

• Acute infections with hepatitis A or B is likely suspected because he is an iv drug user for 3 months . had multiple sex partners . but sore throat is less common in hepatitis A or B . and symptoms like nausea , vomitting or abdominal discomfort is not seen and yellow nails or skin is not seen which suggests an jaundice attack due to hepatitis . so hepatitis is ruled out .
• since he had a sore throat and fever respiratory infections can be suspected but he does not have other complications like shortness of breath or cough .
• he had multiple sex partners , so sexually transmitted disease like gonorrhea , chlamydia are suspected , but he donot have symptoms like dysuria or frequency or any genital ulcers etc , so other stds are ruled out .

DIAGNOSTICS NEEDED :

• INITIALLY , COMPLETE BLOOD COUNT IS TAKEN to look for wbc count , incrreased wbc as lymohocytosis suggests an active infection .
• specific test includes for detecting EBV antibodies in serum , it takes longer time , but can be seen in acute stage of the disease . igG and IgM antibodies are detected .
• other include , hetrophile antibody test like paul bunnet test or monopost test but can be done only after 4 weeks of onset of symptoms so mostly not done in early stages .

PRESCRIPTIONS NEEDED ;

• USUALLY THE SYMPTOMS RESOLVE WITHIN A MONTH . There is no specific treaatment . acetaminophen can be given for body aches as analgesic
• other nsaids like ibuprofen can be given to reduce inflammation and swelling of tonsils .
• steroids are given only when there is airway obstruction due to tonsillar enlargement .
• since he has fever advice to take plenty of fluids to remain hydrated.

EDUCATION NEEDED :

• avoid iv drug usage , unprotected sex with multiple partners . reduce alcohol intake all this can affect the liver and can cause serious liver injury .
• education about sexually transmitted disaese and how it will affect our health