Transcript plasmodium falciparum: case study 3

ATTACK OF THE KILLER
MOSQUITOS
Diane Eckert
Rebecca De La Torre
Jaimi Schuck
David returned from Africa 12 days prior to his admission to the
hospital. He had been in Africa for 6 months working as a civil engineer on
road building projects in Rwanda, Zaire, and Uganda. Seven days prior to
admission to the hospital, he began suffering from fevers with chills, cough,
and myalgia. Three days ago he had episodes of fevers and chills, three
times a day. On admission, the patient was stuporous and showed mental
changes. Blood work showed lowered white cell and platelet counts. He also
had a hematocrit of approximately half that of normal levels with grossly
prolonged bleeding times. A parasite was recovered from the blood (refer to
blood smears below). Despite treatment, the patient eventually went into a
coma and died.
Determine a differential diagnosis. List the
possible causes of this condition. Consider all
infectious agents we have studied thus far
including allergic responses. You should have at
least 5 possible etiologies in your list.
Plasmodium falciparum transmitted by an insect vector, the Anopheles
mosquito (Leboffe, Pierce 160).
All possible etiologies that David could have contracted are, in the order of
relevance:
1.
2.
3.
4.
5.
Plasmodium falciparum
Plasmodium malariiae
Plasmodium vivax
Plasmodium ovale
Trypanosoma brucei
What further information do you need to make a
diagnosis?
1.
2.
3.
4.
5.
6.
7.
What is his past medical history?
Did he take a prophylaxis for malaria?
If he had taken a malaria prophylaxis – we would want to know if it was
chloroquine, which is resistant to Plasmodium falciparum in some
African countries mainly Uganda, Zaire, and Rwanda (CDC).
Did he use mosquito precautions, such as screens, nets, DEET skin
repellent, permethrin spray on clothes and nets (Gilbert 97)?
Has he ever been an intravenous (IV) drug user (Nurse’s Quick Check
– 492)?
Did he have a blood transfusion while working in Africa?
Did David notice any insects or insect bites?
Identify the etiological agent that you feel is
most likely.
- Plasmodium falciparum -
What was wrong with David? What led you to
this diagnosis? You should be able to
identify this organism to the species level.
David was admitted to the hospital 12 days after he left
Africa. The disease has now moved onto the organic
hallucinosis stage, which is untreatable. David then
died from the Plasmodium falciparum. We must
contact the local health agency and inform them of his
diagnosis.
Why is the observation of mental changes
significant?




The mental changes tell us approximately how long the disease has been
active in his system.
The bursting of the RBC’s causes clogging of the capillaries which
impedes circulation to the brain.
He could have a pre-existing mental health diagnosis which could be
exacerbated by the Plasmodium falciparum.
There could be an interaction with the drugs chloroquine or mefloquine.
Could David’s condition have been prevented?
If David would have followed the following proper precautions he could have
prevented this disease from killing him.






Preventing the mosquitoes from entering the house
Preventing the mosquitoes from hiding
Protective Clothing
Mosquito Repellents
Insecticide vaporizers
Mosquito coils
Most importantly, David’s life could have been saved had he sought medical
attention as soon as his symptoms developed.
Drugs the medical staff would have used to treat David at the onslaught of
his illness would have been chloroquine, oral quinine, pyrimethamine,
sulfadiazine, and leucovorin.
WORKS CITED
Garcia, L. Plasmodium falciparum. 24 February 2003. MicrobeLibrary.org.
14 October 2006.
<http://www.microbelibrary.org/ASMOnly/details.asp?id=1256&Lang=English>.
Gilbert, M.D., David, et al. The Sanford Guide to Antimicrobial Therapy 2006.
36th ed. Sperryville: Antimicrobial Therapy, Inc., 2006.
Kakkilaya, M.D., B. Malaria Site – all about malaria. 14 April 2006.
14 October 2006.
<http://www.malariasite.com/malaria/africa.htm>.
Leboffe, Michael J., and Burton E. Pierce. A Photographic Atlas for the Microbiology
Laboratory. Colorado: Morton Publishing Company, 1999.
Nurses Quick Check Diseases. Philadelphia: Lippincott, Williams & Wilkins, 2005.
Malaria: Topic Home 24 August 2006. National Center for Infectious Diseases, Division of
Parasitic Diseases, Centers for Disease Control and Prevention.
. 14 October 2006.
<http://www.cdc.gov/malaria/features/diagnosis_tool.htm>.
Statistics and Malaria’s Public Health Impact 23 April 2006. National Center for Infectious
Disease, Division of Parasitic Diseases. Centers for Disease Control and Prevention.
18 October 2006
<http://www.cdc.gov/malaria/impact/statistics.htm>.