Question

Your friend Anna’s husband Jose has not been feeling well for the past 10 days. He has congestion in his lungs and has been very tired. She talked him into going to the doctor a week ago when his fever was 101.3. The doctor gave him some oral antibiotics, which he took faithfully until it was gone. But she still thinks he still looks sick.
Anna, Jose and there 3-year-old daughter have just moved to Ohio from Arizona. Jose is a park ranger and loves his job, even when it is checking on the local bat populations in nearby caves (bats creep him out). However, for the past three days he has felt too sick to work. His respiratory symptoms have not improved. Anna makes an appointment for him with her doctor.

1) As the physician’s assistant in the office, you are the first to examine Jose. What is your tentative diagnosis based on the history?

2) Which components of the history support your diagnosis?


Answer 1

Looking at the above history of the patient, it clearly shows that the antibiotics have not worked for Jose which makes you think that that the underlying infection is not a bacterial infection but could be something else. on reading further history of the patient we realise that he has recently shifted to Ohio, therefore in a new job of a park ranger, since park rangers are close vicinity of forest and animals, they would have something where this could be that. and since the question specifically speaks about bats, we will try to think of something that is related to transmission of flu from bats:

1) either it could be a viral infection like that of SARS/ corona virus which has been directly linked to bats

2) or it could be a fungal infection like histoplasmosis whcih is a type of fungal infection caused by animals and depicts flu like symptoms eventually leading to breathlessness.

therefore to diagnose the disease we will also ask the patient to get a chest X ray done and a blood test done

the differential blood test (WBC test)would help us diagnose if it is a viral infection or a fungal

if it is an allergic or fungal infection : there will be increased eosinophilic count in the blood

while if there is a viral infection: there will be an increase in the lymphocytosis.

based on the above tests we can prescribe them medications, antifungal or antivirals

meanwhile to calm the patient, we can ask the patient to take bedrest and avoid occupational place or an environment away from animals.

i hope i was able to help you with your answer :)