Case Discussion
Posted: 08 Oct 2012, 15:22
11 years old from almnagil nefidia by tribe
C/O fever 2month
Joint pain 2month
The pt quite well until 2 month PTA when developed fever high grade on & OFF phenomena mainly at night ass with sweating relief by paracetamol and cold compressed not ass with convulsion or rigors
There is good appetite.No marked loss of weight,vomiting,diarrhea, constipation,abd distension,epistaxis
Also there joint pain mainly in knee increase with fever. No
Joint swelling ,skin rash or itching
Systemic Review:
Cardiopulmonary system No S.O.B,cough,orthoapenae,P.N.D,L.L swelling ,history of contact of chronic cough.
Genitourinary system fregencey 2/1.No change in colour and amount , frequency,loin pain,burinig micturtion
CNS: normal higher function. No symptoms of increase ICP.No symptoms and sign of crainail palsy
PM H:
NO similar condition
Hospital admission
Blood transfusion
Jaundice
Chorinc illness
D.M, HTN, asthmatic
Pregnancy History
Her mother on regular ANC no skin rash or fever during pregnancy not D.M or HTN & did not received medication during pregnancy
Outcome of normal vaginal delivery no intrapartum or postpartum complication cried and breast feed immediately
Vaccination:
Family History
4th class in primary school
O/E:
Looks ill Pale not jaundice not cyanosed
Anthropometric measurement:
Wt 31
Height 139cm
h.c.c 53
head&neck
there anterior cervical lymphadenopathy
posterior cervical lymphadenopathy
pulse 100 min regular good volume synchronous no radio-femoral delay peripheral pulse intact
Hand no clubbing ,there is pi trocheal lymph adenopathy,axillary lympadenopathy
C VS AND
Chest clear
Abd
Inspection
Normal counter
Umbilical is inverted
No dilated veins
No Surgical scars
Hernial orifice intact
Move freely of respiration
Superficial soft no tenderness or rigidity no palpable mass
Deep
Spleen 15cm below costal margin
Liver 6cm below costal margin span 17 cm
Muscluskeletal and skin NAD
Summary:
11 years old female complain of fever high grade mainly at night ass with sweating and joint pain for 2 month There is good appettite.No mareked loss of weight,vomitting,diarrheoa, constipation,abd distension,epistaxis
Also there joint pain mainly in knee increase with fever. No
Joint swelling ,skin rash or itching
No symptoms related to other systems
O/E:
Pale not jaundice hepatosplenmegly plus genrelized lympadenopathy
D.D of hepatospelnomegly general
Infectious Parasitic v.leishmania malaria schistoma
Bacterial brucellousis TB
Viral infectious mononuclosis HB
Liver disease cirroshsis p.HTN
Metabolic gausher disease
Neoplasm leukemia lymphoma
C.T disease
D>D of huge splenomegly
v.leishmania
tropical splenomegly
CML
D.D related to case
Visceral leishmania
Fever good appetite heptospelnomegly epitrcheal lymph node high grade against
Night fever sweating lymphadenopathy TB no cough no Hs of contact against
Fever joint pain sweating brucellosis cow milk
Joint pain c.t diseaese
Leukemia cml
Investigtion
Type On admission 1week 2week 3week on D
HB 5.6
TWBCs
PLT
ESR 133
RFT normal
LFT
Urine clear
BFFM+ICT negativ
Widal for brucellosis negative
Widal for typhoid negative
Sputum for af bacilli negative
DAT for leishmania Positive
Lymph node positive
U/S
Chest x ray
Ttt
Sodium stibogluconate 20 mg Sb/kg/day (maximum 850 mg) IV/IM x20-28 days
S/E
phlebotoxic. One of the practical problems is that after a few doses it can become exceedingly difficult to find a vein in which to inject the drug. The insertion of a PICC does not prevent the problem and can instead make it worse: the entire vein along the course of the PICC line can become inflamed and thrombose. The most practical way of administering a large dose of sodium stibogluconate is to dilute it in a large amount of fluid which then runs through over half an hour or so.
Pancreatitis is a common problem and the serum amylase or lipase should be monitored twice weekly; there is no need to stop treatment if the amylase remains less than four times the upper limit of normal; if the amylase rises above the cut-off then treatment should be interrupted until the amylase falls to less than twice the upper limit of normal, whereupon treatment can be resumed.
Cardiac conduction disturbances are less common, but ECG monitoring while the medicine is injected is advisable and changes quickly reverse after the drug is stopped or the infusion rate is decreased.
Sodium stibogluconate can also cause a reduced appetite, metallic taste in mouth, nausea, vomiting, diarrhoea, headache, tiredness, joint pains, muscle aches, dizziness, and anaphylaxis.
Raised liver enzymes
Coughing and substernal pain
Others:
Fever
Sweating
Flushing
Vertigo
Bleeding from nose or gum
Jaundice
Rash
Litrea ture review
Leishmaniasis is transmitted by the bite of female phlebotomine sandflies. The sandflies inject the infective stage, promastigotes, during blood meals.
Promastigotes that reach the puncture wound are phagocytized by macrophages.
They transform into amastigotes.
Amastigotes multiply in infected cells and affect different tissues.
Sandflies become infected during blood meals on an infected host when they ingest macrophages infected with amastigotes.
In the sandfly's midgut, the parasites differentiate into promastigotes. Migrate to RES
TYPES:
VISCERAL LEISHMANIASIS (Bangladesh, Brazil, India, Nepal and Sudan)
• CUTANEOUS LEISHMANIASIS (Afghanistan, Brazil, Iran, Peru, Saudi Arabia and Syria)
• DIFFUSE CUTANEOUS LEISHMANIASIS
• MUCO CUTANEOUS LEISHMANIASIS (Bolivia, Brazil and Peru.
Post kala azar dermal leishmaniasis (Endemic to India and the Sudan
Clinial presentation:
Variable - Incubation 3-100+ weeks
Low grade fever
Hepato-splenomegaly
Bone marrow hyperplasia
Anemia, Leucopenia & Cachexia
Hypergammaglobulinnemia
Epistaxis , Proteinuria, Hematuria
The following symptoms were found in eight visceral leishmaniasis patients returning from Desert Storm
• Fevers: 6 of 8
• Weight loss: 2 of 8
• Nausea, vomiting, low-grade watery diarrhea: 2 of 8
• Lymphadenopathy: 2 of 8
• Hepatosplenomegly: 2 of 8
• Anemia: 3 of 8
• Leukopenia or thrombocytopenia: 0 of 8
• Elevated liver enzymes: 6 of 8
• No symptoms: 1 of 8
C/O fever 2month
Joint pain 2month
The pt quite well until 2 month PTA when developed fever high grade on & OFF phenomena mainly at night ass with sweating relief by paracetamol and cold compressed not ass with convulsion or rigors
There is good appetite.No marked loss of weight,vomiting,diarrhea, constipation,abd distension,epistaxis
Also there joint pain mainly in knee increase with fever. No
Joint swelling ,skin rash or itching
Systemic Review:
Cardiopulmonary system No S.O.B,cough,orthoapenae,P.N.D,L.L swelling ,history of contact of chronic cough.
Genitourinary system fregencey 2/1.No change in colour and amount , frequency,loin pain,burinig micturtion
CNS: normal higher function. No symptoms of increase ICP.No symptoms and sign of crainail palsy
PM H:
NO similar condition
Hospital admission
Blood transfusion
Jaundice
Chorinc illness
D.M, HTN, asthmatic
Pregnancy History
Her mother on regular ANC no skin rash or fever during pregnancy not D.M or HTN & did not received medication during pregnancy
Outcome of normal vaginal delivery no intrapartum or postpartum complication cried and breast feed immediately
Vaccination:
Family History
4th class in primary school
O/E:
Looks ill Pale not jaundice not cyanosed
Anthropometric measurement:
Wt 31
Height 139cm
h.c.c 53
head&neck
there anterior cervical lymphadenopathy
posterior cervical lymphadenopathy
pulse 100 min regular good volume synchronous no radio-femoral delay peripheral pulse intact
Hand no clubbing ,there is pi trocheal lymph adenopathy,axillary lympadenopathy
C VS AND
Chest clear
Abd
Inspection
Normal counter
Umbilical is inverted
No dilated veins
No Surgical scars
Hernial orifice intact
Move freely of respiration
Superficial soft no tenderness or rigidity no palpable mass
Deep
Spleen 15cm below costal margin
Liver 6cm below costal margin span 17 cm
Muscluskeletal and skin NAD
Summary:
11 years old female complain of fever high grade mainly at night ass with sweating and joint pain for 2 month There is good appettite.No mareked loss of weight,vomitting,diarrheoa, constipation,abd distension,epistaxis
Also there joint pain mainly in knee increase with fever. No
Joint swelling ,skin rash or itching
No symptoms related to other systems
O/E:
Pale not jaundice hepatosplenmegly plus genrelized lympadenopathy
D.D of hepatospelnomegly general
Infectious Parasitic v.leishmania malaria schistoma
Bacterial brucellousis TB
Viral infectious mononuclosis HB
Liver disease cirroshsis p.HTN
Metabolic gausher disease
Neoplasm leukemia lymphoma
C.T disease
D>D of huge splenomegly
v.leishmania
tropical splenomegly
CML
D.D related to case
Visceral leishmania
Fever good appetite heptospelnomegly epitrcheal lymph node high grade against
Night fever sweating lymphadenopathy TB no cough no Hs of contact against
Fever joint pain sweating brucellosis cow milk
Joint pain c.t diseaese
Leukemia cml
Investigtion
Type On admission 1week 2week 3week on D
HB 5.6
TWBCs
PLT
ESR 133
RFT normal
LFT
Urine clear
BFFM+ICT negativ
Widal for brucellosis negative
Widal for typhoid negative
Sputum for af bacilli negative
DAT for leishmania Positive
Lymph node positive
U/S
Chest x ray
Ttt
Sodium stibogluconate 20 mg Sb/kg/day (maximum 850 mg) IV/IM x20-28 days
S/E
phlebotoxic. One of the practical problems is that after a few doses it can become exceedingly difficult to find a vein in which to inject the drug. The insertion of a PICC does not prevent the problem and can instead make it worse: the entire vein along the course of the PICC line can become inflamed and thrombose. The most practical way of administering a large dose of sodium stibogluconate is to dilute it in a large amount of fluid which then runs through over half an hour or so.
Pancreatitis is a common problem and the serum amylase or lipase should be monitored twice weekly; there is no need to stop treatment if the amylase remains less than four times the upper limit of normal; if the amylase rises above the cut-off then treatment should be interrupted until the amylase falls to less than twice the upper limit of normal, whereupon treatment can be resumed.
Cardiac conduction disturbances are less common, but ECG monitoring while the medicine is injected is advisable and changes quickly reverse after the drug is stopped or the infusion rate is decreased.
Sodium stibogluconate can also cause a reduced appetite, metallic taste in mouth, nausea, vomiting, diarrhoea, headache, tiredness, joint pains, muscle aches, dizziness, and anaphylaxis.
Raised liver enzymes
Coughing and substernal pain
Others:
Fever
Sweating
Flushing
Vertigo
Bleeding from nose or gum
Jaundice
Rash
Litrea ture review
Leishmaniasis is transmitted by the bite of female phlebotomine sandflies. The sandflies inject the infective stage, promastigotes, during blood meals.
Promastigotes that reach the puncture wound are phagocytized by macrophages.
They transform into amastigotes.
Amastigotes multiply in infected cells and affect different tissues.
Sandflies become infected during blood meals on an infected host when they ingest macrophages infected with amastigotes.
In the sandfly's midgut, the parasites differentiate into promastigotes. Migrate to RES
TYPES:
VISCERAL LEISHMANIASIS (Bangladesh, Brazil, India, Nepal and Sudan)
• CUTANEOUS LEISHMANIASIS (Afghanistan, Brazil, Iran, Peru, Saudi Arabia and Syria)
• DIFFUSE CUTANEOUS LEISHMANIASIS
• MUCO CUTANEOUS LEISHMANIASIS (Bolivia, Brazil and Peru.
Post kala azar dermal leishmaniasis (Endemic to India and the Sudan
Clinial presentation:
Variable - Incubation 3-100+ weeks
Low grade fever
Hepato-splenomegaly
Bone marrow hyperplasia
Anemia, Leucopenia & Cachexia
Hypergammaglobulinnemia
Epistaxis , Proteinuria, Hematuria
The following symptoms were found in eight visceral leishmaniasis patients returning from Desert Storm
• Fevers: 6 of 8
• Weight loss: 2 of 8
• Nausea, vomiting, low-grade watery diarrhea: 2 of 8
• Lymphadenopathy: 2 of 8
• Hepatosplenomegly: 2 of 8
• Anemia: 3 of 8
• Leukopenia or thrombocytopenia: 0 of 8
• Elevated liver enzymes: 6 of 8
• No symptoms: 1 of 8