Ariana is a 21 year old woman of African American heritage. She tells you, "my parents made me come. The only reason I'm here is because they threatened to cut off my college tuition fund. They're the ones that should be here anyway as they are paying for this.
ShareCompartir Malaria must be recognized promptly in order to treat the patient in time and to prevent further spread of infection in the community via local mosquitoes. Malaria should be considered a potential medical emergency and should be treated accordingly.
Delay in diagnosis and treatment is a leading cause of death in malaria patients in the United States. However, for a definitive diagnosis to be made, laboratory tests must demonstrate the malaria parasites or their components. A patient with fever who had recently traveled to a malaria-endemic country is being evaluated in the emergency room.
Diagnosis of malaria can be difficult: Where malaria is not endemic any more such as in the United Stateshealth-care providers may not be familiar with the disease. Clinicians seeing a malaria Diagnosis case study may forget to consider malaria among the potential diagnoses and not order the needed diagnostic tests.
Laboratorians may lack experience with malaria and fail to detect parasites when examining blood smears under the microscope.
In some malaria-endemic areas, malaria transmission is so intense that a large proportion of the population is infected but not made ill by the parasites. Such carriers have developed just enough immunity to protect them from malarial illness but not from malarial infection. In that situation, finding malaria parasites in an ill person does not necessarily mean that the illness is caused by the parasites.
Likewise, the physical findings are often not specific elevated temperature, perspiration, tiredness. In severe malaria caused by Plasmodium falciparumclinical findings confusion, coma, neurologic focal signs, severe anemia, respiratory difficulties are more striking and may increase the index of suspicion for malaria.
If possible, clinical findings should always be confirmed by a laboratory test for malaria. In addition to ordering the malaria specific diagnostic tests described below, the health-care provider should conduct an initial workup and request a complete blood count and a routine chemistry panel.
In the event that the person does have a positive malaria test, these additional tests will be useful in determining whether the patient has uncomplicated or severe manifestations of the malaria infection.
Specifically, these tests can detect severe anemia, hypoglycemia, renal failure, hyperbilirubinemia, and acid-base disturbances.
Prior to examination, the specimen is stained most often with the Giemsa stain to give the parasites a distinctive appearance. This technique remains the gold standard for laboratory confirmation of malaria. However, it depends on the quality of the reagents, of the microscope, and on the experience of the laboratorian.
Diagnosis Microscopy Antigen Detection Various test kits are available to detect antigens derived from malaria parasites.
Malaria RDTs are currently used in some clinical settings and programs.
However, before malaria RDTs can be widely adopted, several issues remain to be addressed, including improving their accuracy; lowering their cost; and ensuring their adequate performance under adverse field conditions. The World Health Organization is conducting comparative performance evaluations of many of the RDTs which are commercially available worldwide based on a panel of parasites derived from a global network of collection sites.
Results of this testing is available at: Blood smear stained with Giemsa, showing a white blood cell on left side and several red blood cells, two of which are infected with Plasmodium falciparum on right side.
On June 13,the U. This RDT is approved for use by hospital and commercial laboratories, not by individual clinicians or by patients themselves. It is recommended that all RDTs are followed-up with microscopy to confirm the results and if positive, to quantify the proportion of red blood cells that are infected.
The use of this RDT may decrease the amount of time that it takes to determine that a patient is infected with malaria. Although this technique may be slightly more sensitive than smear microscopy, it is of limited utility for the diagnosis of acutely ill patients in the standard healthcare setting.
PCR results are often not available quickly enough to be of value in establishing the diagnosis of malaria infection. PCR is most useful for confirming the species of malarial parasite after the diagnosis has been established by either smear microscopy or RDT. Serology does not detect current infection but rather measures past exposure.
Serology Drug Resistance Tests Drug resistance tests must be performed in specialized laboratories to assess the susceptibility to antimalarial compounds of parasites collected from a specific patient.
Two main laboratory methods are available: The parasites are grown in culture in the presence of increasing concentrations of drugs; the drug concentration that inhibits parasite growth is used as endpoint.Asthma symptoms and diagnosis: case study 1.
Start module. About this module.
Reflect on the challenges of making a differential diagnosis in asthma. This module draws on the clinical expertise of practicing primary care practitioners. In this case study, David has been experiencing some recent issues with his breathing. Complete this module to.
The Case Study / Case Studies Method is intended to provide students and Facultys with some basic information. This Case Study Method discuss what the student needs to do to prepare for a class / classroom, and what she can expect during the case discussion.
We also explain how student performance is evaluated in a case study based course. Psoas syndrome is an easily missed diagnosis. However, it is important to consider this condition as part of the differential diagnosis for patients presenting with low back pain—particularly for osteopathic physicians, because patients may view these practitioners as experts in musculoskeletal conditions.
Sample Case Studies and Diagnoses Following are four examples of patient descriptions with a link to the corresponding diagnosis.
These sample case studies are . Case List Disclaimer: Review of the case(s) is intended for educational purposes ONLY, NOT for research. Diagnoses for Sample Case Studies. The following are sample diagnoses for the Sample Case Studies on this page.
Case study 1.
Major Depressive Disorder (single episode) Return to Case Studies Case study 2. Generalized Anxiety Disorder. Return to Case Studies Case study 3.
Mental health diagnosis page.