clinical cases from infection diseases hospital part 4

Clinical cases from infection diseases hospital

Part 4Pavlov State Medical University,

St-Petersburg, Russia

Dr. Andrey Dyachkov

E-mail: [email protected]

Botkin's hospital was found in 1882

Clinical case — Just do it!

Case 6: 31 y.o. with haemorrhages in scleras Time of admission: 15 of April 2012 Complains at admission: high fever, moderate pain in

eyes, residual changes in sclearaes of both eyes (minimal haemorraghes around iris).

Anamnesis morbi: at 8 of April 2012 patient noticed fever and pain in eyes which was accompanied by moderate periorbital edema and haemorraghes in sclerae of both eyes. At 9 of April patient visited ophtalmologist who prescribed himt an eye drops with vitamins and told him that his complains were related to stress and adviced him to visit neurologist.

Same day patient had visited neurologist who recommended him to make MRI of a brain. MRI revealed no significant changes.

At the evening of 9 of April fever had reached 40C, patient took 1 gr of paracetamol and call ambulance. By the time doctor arrived fever decrease to 37C, doctor from ambulance service told patient he never saw such significant haemorrages in scleares and recommended patient to visit infection disease spaecialst (IDS).

Patient visited IDS at 10 of April with complains on haemorrages in sclera, moderate muscle pain and fever. Fever raised up to 38-39C and responded to antipyretics for a short time.

Case 6: 31 y.o. with haemorrhages in scleras

IDS ask patient to do a number of tests including tests for herpes simplex infection of the eyes, but patient refused to do tests and went home.

For 3 days he stayed at home with high fever (patient took paracetamol with timely effect), haemorraghes in scleares gradually decreased.

At 5th day of disease patient visit GP and give blood for general blood count. No changes in treatment was made by GP.

Despite of a fever next day he was able to visit his friend wedding ceremony where he felt generally weak and didnt have appetite.

On next slide a photo from this ceremony


Patient' eyes at 5th day of disease

Patient right eye at 10 day of disease

Epidemiological data: 10 days before patient got ill he went for a barbique with his wife, daughter and his friend with bribe. For barbeque they had bought a fresh pork meat in one of the city' supermarket.

2 days after barbeque patient' wife had diarrhea for 2 days.

7 days later patient friend developed high fever, moderate muscle pain and periorbital edema.

Patient' daughter and his friend' bribe had no problem with health.


Physical examination: patient looks generally well, 179cm/82kg, skin was clear.

Blood pressure 120/70 mmHg, pulse 83 per minute, arythmic with few extrasislols

Lungs were clear. No dyspnea. Liver and spleen was normal in size. Palpation of abdomen

was unpainful. 24 hours urine volume and urine color were normal. Meningeal symptoms were negative. Palpation of muscles was unpainful.


General blood count 12 of April: WBC 14,5, RBC 3,45, HGB 13,5 g/dl, EOS 38%,

LYMP 11%, left shift (+) General blood count 15 of April: WBC 20,3, RBC 4,1, HGB 13,9 g/dl, EOS 42%,

LYMP 2%, left shift (+) ALT 35 E/l (N below 40E/l), AST 42 E/l (N below

40E/l), Creatinine phoshocinase 856 E/l (N below 175 E/l), LDH 535 E/l (N below 235 E/l)


What is a diagnosis?

Paget's disease of bone is a chronic disorder that can result in enlarged and misshapen bones. The excessive breakdown and

formation of bone tissue causes affected bone to weaken, resulting in pain, misshapen bones, fractures, and arthritis in the

joints near the affected bones.

- Patient' serology was higly positive for antibody against Trichinella spiralis. Later his friend who made barbeque with him ( look at epidemiology slide) had same result.

- Trichinella spiralis Own — a nematoda worm and 5 species of Trichinella described they are distributed among carnivorous on all continents

- Adult: Female 4 mm*0,06 mm Male 1,5mm*0,03mm

- Adult live in small intestine for around 2 months, lavrae can survive in striated muscles for many years

Case 6: Trichinellosis

Case 6: Trichinellosis• Adult live in small intestine for

up to 2 months and produce handreds of larvaes

• After reaching bloodflow larvae spreaded through different tissues specifically striated muscles (but also heart, lungs, brain) and entering muscle cell where forming a cyst

• Larvae stimulate angiogenesis in the area around it and causing formation of a hyaline capsule

• After 6 months calcification takes place

- GI phase usually developed in 12-48 hours after eating infected meat and accompaning by nausea, vomiting, diarrhea and abdominal discomfort.

- Within a 3 weeks later due to spreading of a lavras from small intestine through bloodflow and lymphatic vessels patient might develope fever, fascial edema, hemorrhages in sclerae, MUSCLE PAIN, heart failure, respiratory symptoms and meningoencephalitis.

- There is usual eventual complete recovery in most patients but mascular pain (60%), fatigue (25%) and heart pain may persist for 1-6 years.


- Diagnosis is based on:

epidemiological data (eating a undercooked meat, especially pork, boar or bear),

high eosinophilia (up to 90%), serological tests (ELISA) muscle biopsy (usually from biceps)

- Treatment: 10 days of albendazole (400 mg bid) or mebendazole (200 mg bid) or thiabendazole (25 mg/kg bid) together with corticosteroids.

- Prevention: trichinelloscopy of meat, hygienic pig farming, apropriate cooking of meat


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More cases - http://www.slideshare.net/drandreyst-p/clinical-cases-from-infection-diseases-hospital

clinical cases from infection diseases hospital part 4

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