darkhorse
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A 24-year-old male is brought to the emergency department with shortness of breath and
confusion. He recently returned from a retreat in New Mexico, where he stayed in
rodent-infested cabins. For the past 3 or 4 days he has complained of fever, muscle aches,
nausea, and vomiting. Today he became more short of breath and confused. His physical
examination is notable for a temperature of 39°C (102.2°F), blood pressure of 90/60 mmHg,
heart rate of 135/min, and respiratory rate of 28/min. Oxygen saturation on room air is 84%.
His chest has minimal crackles. There are no petechiae or echymoses. Chest radiography shows
bilateral pulmonary edema and pleural effusions. Laboratory studies demonstrate a low platelet
count and atypical lympocytes on blood smear. Which of the following will be most useful in
making a diagnosis?
A. Culture of blood
B. Culture of pleural fluid
C. Flow cytometry of the atypical lymphocytes
D. Measurement of IgM antibodies
E. Silver stain of bronchoalveolar lavage
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| dr.wad
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C
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| drdg
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1. retreat in New Mexico, rodent-infested cabins
2. fever, muscle aches,
nausea, and vomiting. more short of breath and confused.
3. high fever, bp: 90/60
4. pulmonary edema and pleural effusions
5. low platelet count and atypical lympocytes on blood smear
Dx: Hantavirus pulmonary syndrome (HPS)?
I will go for D for the answer
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| titly
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| darkhorse
Forum Elite
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well done drdg!
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| darkhorse
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Posts: 275
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Hantavirus pulmonary syndrome is a rodent-borne hemorrhagic fever caused by a member of
the Bunyaviridae. Other hemorrhagic fevers include Lassa fever, Rift Valley fever, yellow fever,
Ebola, and dengue. Hantavirus may also present with a renal syndrome that is more prevalent
outside the United States. Hantavirus pulmonary syndrome was first recognized in the United
States in 1993; however, serologic studies demonstrate prior episodes. The disease is strongly
linked to rodent exposure in dwellings or during occupational activities, particularly in rural
areas. The disease begins with a viral prodrome and then usually progresses to respiratory
failure within a week. Mortality in those with respiratory failure is 30 to 40%; patients who
survive the first 48 hours of the fulminant illness generally recover without serious sequelae.
The differential diagnosis of a patient in respiratory failure includes rickettsial disease,
meningococcemia, plague, tularemia, and sepsis. IgM testing of acute-phase serum, which may
be positive during the prodrome, is best for making a specific diagnosis. Cultures of blood or
pleural fluid will not be positive. Flow cytometry is useful for the diagnosis of malignancy but in
this case will not be helpful. Silver stain of bronchoalveolar lavage is useful in the diagnosis of
Pneumocystis carazii pneumonia (PCP). Bronchoalveolar lavage in patients with hantavirus
pulmonary syndrome may be consistent with alveolar hemorrhage, but this is a nonspecific
finding
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