1. ATTACK OF THE KILLER MOSQUITOS Diane Eckert Rebecca De La Torre Jaimi Schuck

2. David returned from Africa 12 days prior to his admission to the hospital. He had been in Africa for 6 months working as a civil engineer on road building projects in Rwanda, Zaire, and Uganda. Seven days prior to admission to the hospital, he began suffering from fevers with chills, cough, and myalgia. Three days ago he had episodes of fevers and chills, three times a day. On admission, the patient was stuporous and showed mental changes. Blood work showed lowered white cell and platelet counts. He also had a hematocrit of approximately half that of normal levels with grossly prolonged bleeding times. A parasite was recovered from the blood (refer to blood smears below). Despite treatment, the patient eventually went into a coma and died.

3. Determine a differential diagnosis. List the possible causes of this condition. Consider all infectious agents we have studied thus far including allergic responses. You should have at least 5 possible etiologies in your list. Plasmodium falciparum transmitted by an insect vector, the Anopheles mosquito (Leboffe, Pierce 160). All possible etiologies that David could have contracted are, in the order of relevance: 1.Plasmodium falciparum 2.Plasmodium malariiae 3.Plasmodium vivax 4.Plasmodium ovale 5.Trypanosoma brucei

4. What further information do you need to make a diagnosis? 1.What is his past medical history? 2.Did he take a prophylaxis for malaria? 3.If he had taken a malaria prophylaxis – we would want to know if it was chloroquine, which is resistant to Plasmodium falciparum in some African countries mainly Uganda, Zaire, and Rwanda (CDC). 4.Did he use mosquito precautions, such as screens, nets, DEET skin repellent, permethrin spray on clothes and nets (Gilbert 97)? 5.Has he ever been an intravenous (IV) drug user (Nurse’s Quick Check – 492)? 6.Did he have a blood transfusion while working in Africa? 7.Did David notice any insects or insect bites?

5. Identify the etiological agent that you feel is most likely. - Plasmodium falciparum -

6. What was wrong with David? What led you to this diagnosis? You should be able to identify this organism to the species level. David was admitted to the hospital 12 days after he left Africa. The disease has now moved onto the organic hallucinosis stage, which is untreatable. David then died from the Plasmodium falciparum. We must contact the local health agency and inform them of his diagnosis.

7. Why is the observation of mental changes significant?  The mental changes tell us approximately how long the disease has been active in his system.  The bursting of the RBC’s causes clogging of the capillaries which impedes circulation to the brain.  He could have a pre-existing mental health diagnosis which could be exacerbated by the Plasmodium falciparum.  There could be an interaction with the drugs chloroquine or mefloquine.

8. Could David’s condition have been prevented? If David would have followed the following proper precautions he could have prevented this disease from killing him.  Preventing the mosquitoes from entering the house  Preventing the mosquitoes from hiding  Protective Clothing  Mosquito Repellents  Insecticide vaporizers  Mosquito coils Most importantly, David’s life could have been saved had he sought medical attention as soon as his symptoms developed. Drugs the medical staff would have used to treat David at the onslaught of his illness would have been chloroquine, oral quinine, pyrimethamine, sulfadiazine, and leucovorin.

9. WORKS CITED Garcia, L. Plasmodium falciparum. 24 February 2003. MicrobeLibrary.org. Garcia, L. Plasmodium falciparum. 24 February 2003. MicrobeLibrary.org. 14 October 2006. 14 October 2006... http://www.microbelibrary.org/ASMOnly/details.asp?id=1256&Lang=English Gilbert, M.D., David, et al. The Sanford Guide to Antimicrobial Therapy 2006. Gilbert, M.D., David, et al. The Sanford Guide to Antimicrobial Therapy 2006. 36th ed. Sperryville: Antimicrobial Therapy, Inc., 2006. 36th ed. Sperryville: Antimicrobial Therapy, Inc., 2006. Kakkilaya, M.D., B. Malaria Site – all about malaria. 14 April 2006. Kakkilaya, M.D., B. Malaria Site – all about malaria. 14 April 2006. 14 October 2006. 14 October 2006... http://www.malariasite.com/malaria/africa.htm Leboffe, Michael J., and Burton E. Pierce. A Photographic Atlas for the Microbiology Leboffe, Michael J., and Burton E. Pierce. A Photographic Atlas for the Microbiology Laboratory. Colorado: Morton Publishing Company, 1999. Laboratory. Colorado: Morton Publishing Company, 1999. Nurses Quick Check Diseases. Philadelphia: Lippincott, Williams & Wilkins, 2005. Nurses Quick Check Diseases. Philadelphia: Lippincott, Williams & Wilkins, 2005. Malaria: Topic Home 24 August 2006. National Center for Infectious Diseases, Division of Malaria: Topic Home 24 August 2006. National Center for Infectious Diseases, Division of Parasitic Diseases, Centers for Disease Control and Prevention. Parasitic Diseases, Centers for Disease Control and Prevention.. 14 October 2006.. 14 October 2006... http://www.cdc.gov/malaria/features/diagnosis_tool.htm Statistics and Malaria’s Public Health Impact 23 April 2006. National Center for Infectious Statistics and Malaria’s Public Health Impact 23 April 2006. National Center for Infectious Disease, Division of Parasitic Diseases. Centers for Disease Control and Prevention. Disease, Division of Parasitic Diseases. Centers for Disease Control and Prevention. 18 October 2006 18 October 2006.. http://www.cdc.gov/malaria/impact/statistics.htm