Answer
a) No The rashes, dry cough, fever, retro-ocular
pain and even the thrombocytopenia symptoms are very similar to the symptoms
of measles. However, the patient does not show anything remarkable in the
oral mucosa besides the gingival bleeding. In measles, spotty enanthem that
blisters and ulcerates deep in the cheek mucosa near the openings of the
Stenson's Ducts are diagnostic (Koplick's Spots). They were not seen.
b) Possibly, Again the boy's symptoms are very similar. Leptospira species is a spirochete which can be cultured from the blood or cerebral spinal fluid within 10 days of infection. However with a generation time of 6-16 hours, a positive or negative result could not be known at this time from cultures. Blood smears will be non-specific since the spirochete is very tiny, and can be confused with cellular debris. The Microscopic Agglutination Test (MAT) which is very specific and sensitive for Leptospiral antibodies tested negative.
c) This is the most correct answer. A positive
tourniquet test, along with the presented symptoms, generally increases
the chances that this is Dengue fever. Yet, this is a relatively non-specific
test, and a diagnosis of Dengue cannot be done by clinical symptoms alone.
Additional serology tests must be performed.
d) No. There were no plasmodium found in the
blood smears.
e) No. Typhoid Fever can also present symptoms very similar to Dengue, but at different chronological order. "Rose Spots" which looks similar to a rash usually happens in week 2 of the infection, along with leukopenia. The symptoms also gradually appear to get worse, compared to this patient's abrupt appearance of symptoms. Also, the blood smears are negative for organisms
Answers for 2
a-d) Not quite the right answer
Answer
e) Co-infection of 2 or more serotypes seem to
increase the likelihood of severity of the disease course.
Answeres for 3
a-d) There's a better answer than this
Answers to 4
a) Not exactly, this is only the first stage,
with a lot of fluids most people don't even get admitted into the hospital.
b) Absolutely, this one is the final stage even
though in hospitals that commonly treat this death rate is 0.2%.
c) Sorry, this is the second stage of Dengue which
if not properly treated turns into Dengue Shock Syndrome
d) Just kidding, I made this one up.
Answers to 5
c) Perfect, you are awesome. There are four serotype
which are the majority of the cases, but it is thought that more may be
subject or surface without adequate control of the Aedes mosquito population.
Answer to 6
a) Absolutely. This is the one closely associated
with the people in the regions where Dengue is found.
b) No, this is associated with St. Louis encephalitis
in North America.
c) Sorry, this is associated with Western Equine
Encephalitis.
d) Too bad, this is a tick associated with
Lyme's disease.
e) No, this is associated with Malaria
Answer: of 7
a) True. Common clinical presentations include
high fever, severe arthralgia, and petechiae.
b) Ataxia could happen during Dengue Hemmorhagic
Fever, when the patient is about to go to shock, but this is a rare occurrence.
c) Actually, bradycardia can be seen in late Dengue Shock Syndrome, but again, it is a rare occurrence
d) Non-productive cough happens when pleural effusion
occurs, which does not happen very commonly
e) Jaundice is presented rarely
Answer: 8
a) True, but not the best answer
b) True, but not the best answer
c) No, IgM maybe detected on the onset of symptoms,
and 90% of patients with Dengue has IgM detectable by the 6th day after
onset.
d) No, IgM ELISA test for Dengue is very specific,
and is a drawback to detect acute Dengue infections. However, the test does
not differentiate between the 4 serotypes.
Answers to 9
a) No, this drug regimen is the CDC's recommendation
for prophylaxis against malaria.
b) Not yet. Hopefully, soon. There are a couple
of vaccines in development that will cover for all 4 serotypes.
c) No. However, it may take the edge out of the
anxiety when traveling to Dengue endemic areas.
d) This is the best answer. Any actions to prevent
mosquito contact would be the best strategy to prevent Dengue.
e) No. The mosquito, Aedes aegypti is the primary
vector of Dengue fever, and it mostly attacks during the day. Staying in
a nice 5 star hotel will help, if you can afford it, but the mosquitoes
will find you when you get out during the day <which most vacationers
do>
Answer:
a) Texas is currently not an endemic area. In
1995, there were only 7 locally acquired cases near the Texas-Mexico border.
b) No, but it is within the rage of the Aedes
aegypti.
c) No, but it is within the rage of the Aedes
aegypti
d) No, but it is within the rage of the Aedes
aegypti
e) Yes, A total of 14,828 cases of DF/DHF have
been reported since the beginning of 1998 with 133 cases being DHF only.
Five deaths have been reported. Serotypes 1, 2, 3 and 4 have been confirmed.
