传染病学精品教学（汕头大学malaria a case report.ppt

A 22-Year-Old Man with Chillsand Fever after a Stay in South America Presentation of case Chief complaint: A 22-year-old man was examined in the clinic because of fever, chills, and thrombocytopenia. Five months earlier, the patient, who was late in planning a six-week trip to South America, had received vaccines against hepatitis B and yellow fever and had begun taking doxycycline daily for prophylaxis against malaria. Presentation of case One week later, he and a group of others traveled to northern Ecuador, had a prolonged stay in the jungle, and swam in the “dark water” of lakes and rivers. At night, they used mosquito netting and applied 30 percent N,N-diethyl-3-methylbenz amide (DEET) spray, but the patient received many insect bites. He recalled that he had drunk water treated with an iodine filter, but he had also consumed local food and fresh fruit. During the trip he had one bout of diarrhea, without fever, chills, nausea, or vomiting; he recovered within 24 hours after taking three doses of ciprofloxacin. Presentation of case On one occasion, his group played soccer barefoot with local children in the jungle, and thereafter three companions noted intensely pruritic, erythematous papules on the soles of their feet; the lesions disappeared within one week after the application of a topical adrenocorticosteroid agent. On the final two weeks of the trip, he traveled through the beaches and high mountains of Peru, hiked the Inca Trail, and visited Lima, where he had no symptoms. Presentation of case After returning to the Boston area, he continued taking doxycycline daily as prophylaxis for two weeks. He was well until 11 weeks later, when he began to have a temperature as high as 40℃, with chills, sweats, stiffness of the neck, and back pain. He made an appointment with his physician but later canceled it because he felt much improvedafter taking ibuprofen. Presentation of case The next day (nine days before the diagnostic procedure) the patient!s temp