Immune System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M47_F1.jpg"}},{"insert":"\n\n"},{"insert":"Your days at the specialized infectious diseases center are slowly coming to an end.\r\n\r\nWhile you\u0027ve had some great experiences there, and made some (hopefully!) lifelong friendships, you cannot help but think about your next posting.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M47_F2.jpg"}},{"insert":"\n\n"},{"insert":"You arrive at your unit, just in time.\r\n\r\n\u0022... are you sure? She came in just a few minutes ago ... yes, she\u0027s in the isolation room\u0022, you overhear the nurses saying, while you sign in.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M47_F3.jpg"}},{"insert":"\n\n"},{"insert":"As you straighten up and turn towards your office, you almost bump into the head of the department, who is clutching a file in his hand.\r\n\r\n\u0022Safety first as always - and keep me updated!\u0022, he says and hands you the file.\n\nYou walk into your office, and begin to familiarize yourself with the new patient.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M47_F4.jpg"}},{"insert":"\n\n"},{"insert":"Helen D. is a 29-year-old humanitarian aid worker who was recently in the West African subregion.\u00a0 She spent just over a month there and returned home two weeks ago.\u00a0\n"}]}


{"ops":[{"insert":"Helen developed a high-grade fever around five days ago, in association with generalized muscle pains, a backache, abdominal cramps, and a sensation of \u0022feeling weak\u0022. She did not seek medical attention and self-medicated with acetaminophen.\n"}]}


{"ops":[{"insert":"Helen started feeling \u0022really bad\u0022 today. When\u00a0she woke up in the morning, she barely had the strength to get up from bed.\u00a0She vomited up a small amount of frank red blood a short while later, prompting her partner to call emergency services.\r\n\u00a0\n"}]}


{"ops":[{"insert":"Questioning by the doctors at the hospital she was initially brought to revealed that a member of the family she stayed with while in\u00a0West Africa had similar symptoms. This was ~3 to 4 days before she left the country.\r\n\r\nThis prompted them to transfer her to your unit, for isolation and expert management.\u00a0\n\nYou peruse the rest of the file and note that\u00a0Helen\u0027s\u00a0medical, surgical, and family histories are unremarkable. She has no known\u00a0allergies.\u00a0\r\n\r\nHer last menstrual period was around 2 weeks ago, and she is currently on the oral contraceptive pill.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M47_F8.jpg"}},{"insert":"\n\n"},{"insert":"At the time of admission to your unit, her\u00a0temperature was 101.2 \u02daF (38.4 \u02daC), pulse was 108 bpm, blood pressure was\u00a0116\/76 mmHg, respiratory rate was 28\/min, and oxygen saturation (SpO2) was 98% on room air.\n"}]}


{"ops":[{"insert":"General examination showed bilateral\u00a0conjunctival injection, while\u00a0examination of the abdomen showed generalized mild tenderness, with hepatomegaly of ~2 cm below the right costal margin.\r\n\r\nNo other general or systemic signs were present.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M47_F10.jpg"}},{"insert":"\n\n"},{"insert":"The doctor in charge of admissions has queried the possibility of a\u00a0viral hemorrhagic fever, with\u00a0Lassa fever and Ebola infection being key possibilities.\n"}]}


{"ops":[{"insert":"Done with the file, you proceed to the isolation ward, and present yourself to Helen.\r\n\r\nAfter introductions, you perform a\u00a0quick history and examination, which reveals that\u00a0not much has changed since her last assessment.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M47_F12.jpg"}},{"insert":"\n\n"},{"insert":"You proceed to order a battery of investigations, including a complete blood count, serum electrolytes, liver and renal profiles, a blood gas analysis, blood for grouping and crossmatching.\r\n\r\nFor what it is worth, you also order blood cultures,\u00a0a viral hepatitis panel, and screening for\u00a0malaria, dengue, and yellow fever.\n\nGiven that Lassa fever and Ebola infection are the key differentials here, you ponder what else you should order.\n"}]}


{"ops":[{"insert":"Which investigation will you request?\n"}]}
1. Viral cultures
2. Southern blotting
3. Reverse-transcriptase PCR