Question

Case study 2

Adam and his wife Brenda are organic farmers. They live in northern California and believe in a natural life style, free of pesticides, processed foods and they do not believe in vaccinations or un-natural medications. They have 4 healthy happy children. But lately their younger son Billy, who is 7 years old has not been feeling well. About a month ago he had a sore throat and slight fever, which subsided in a day or two. He had a mild episode of diarrhea about a week ago and would not eat and was listless. They tried their home remedies and he got better. But Brenda noticed that Billy was having trouble walking the previous night, he seemed weak and listless again, and he seemed to have had troubles dressing himself and walking that day.

They tell the doctor that they lived in NYC but became “totally organic 8 years ago” and moved to California. They report that their older children, now 20, 19, and 18 years old, were given all required vaccines, but Billy had never been vaccinated against any disease.

On examination, the patient had no significant fever (98.9) and normal bowel sounds. His chest, ears and eyes were clear. He had no rebound tenderness in the abdomen. The doctor noted that Billy had poor muscular reflexes in his arms and legs, he was also lethargic and seemed confused.

Urine, stool and blood samples were collected for analysis.

1-What is the most likely diagnose for this disease? (40 points)

2-What causes this disease? (40 points) DO NOT GIVE ME A LIST OF POSSIBLE INFECTIOUS AGENTS, IF YOU DO SO YOU GET 0 POINTS, THAT IS NOT SOLVING THE CASE, THERE IS ONLY INFECTIOUS AGENT THAT CAUSES THIS CONDITION.

3-What tests can be used to confirm of your diagnosis? (15 points)

4-Would receiving childhood vaccines series have prevented this problem? (5 points)

Answer 1

ANSWER :

1)Most likely diagnosis is poliomyelitis.

Symptoms and signs :

• Sore throat , fever.
• Nausea , vomiting , diarrhea and constipation.
• In CNS involvement : Fever, lethargy, irritability and confusion.

2)Infectious agent is  poliovirus (member of Enterovirus)

3)Diagnostic tests :

Virus isolation in culture is most sensitive diagnostic method of poliovirus infection.

• Stool culture : Confirmatory test for polio infection.Two stool samples must be collected from the patient 24 hrs apart for isolating the virus adequately.
• Pharyngeal swab : Virus can be isolated from throat secretions.
• CSF culture : Leukocyotosis ( particulary elevated lymphocytes)is seen.Virus isolation from CSF is very rare.
• Serology : Antibodies to poliovirus can be detected in early course of infection.

4)Yes , receiving childhood vaccines series would have prevented him from the disease.