ATTACK OF THE KILLER ATTACK OF THE KILLER

MOSQUITOSMOSQUITOS Diane EckertDiane Eckert

Rebecca De La Torre Rebecca De La Torre

Jaimi SchuckJaimi Schuck

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

Determine a differential diagnosis. List the possible Determine a differential diagnosis. List the possible causes of this condition. Consider all infectious causes of this condition. Consider all infectious

agents we have studied thus far including allergic agents we have studied thus far including allergic responses. You should have at least 5 possible responses. You should have at least 5 possible

etiologies in your list.etiologies in your list.

Plasmodium falciparumPlasmodium falciparum transmitted by an insect vector, the transmitted by an insect vector, the AnophelesAnopheles mosquitomosquito (Leboffe, Pierce 160).(Leboffe, Pierce 160).

All possible etiologies that David could have contracted are, in the order of All possible etiologies that David could have contracted are, in the order of relevance: relevance:

1.1. Plasmodium falciparumPlasmodium falciparum

2.2. Plasmodium malariiaePlasmodium malariiae

3.3. Plasmodium vivaxPlasmodium vivax

4.4. Plasmodium ovalePlasmodium ovale

5.5. Trypanosoma bruceTrypanosoma bruceii

What further information do you need to make a What further information do you need to make a

diagnosis?diagnosis?

1.1. What is his past medical history?What is his past medical history?

2.2. Did he take a prophylaxis for malaria? Did he take a prophylaxis for malaria?

3.3. If he had taken a malaria prophylaxis – we would want to know if it wasIf he had taken a malaria prophylaxis – we would want to know if it was

chloroquine, which is resistant tochloroquine, which is resistant to Plasmodium falciparum Plasmodium falciparum in some in some

African countries mainly Uganda, Zaire, and Rwanda (CDC)African countries mainly Uganda, Zaire, and Rwanda (CDC)..

4.4. Did he use mosquito precautions, such as screens, nets, DEET skin Did he use mosquito precautions, such as screens, nets, DEET skin repellent, permethrin spray on clothes and nets (Gilbert 97)?repellent, permethrin spray on clothes and nets (Gilbert 97)?

5.5. Has he ever been an intravenous (IV) drug user (Nurse’s Quick Check Has he ever been an intravenous (IV) drug user (Nurse’s Quick Check – 492)?– 492)?

6.6. Did he have a blood transfusion while working in Africa?Did he have a blood transfusion while working in Africa?

7.7. Did David notice any insects or insect bites? Did David notice any insects or insect bites?

Identify the etiological agent that you feel is most Identify the etiological agent that you feel is most

likely.likely.

- Plasmodium falciparum -- Plasmodium falciparum -

What was wrong with David? What led you to this What was wrong with David? What led you to this diagnosis? You should be able to identify this diagnosis? You should be able to identify this

organism to the species level.organism to the species level.

David was admitted to the hospital 12 days after he left David was admitted to the hospital 12 days after he left Africa. The disease has now moved onto the organic Africa. The disease has now moved onto the organic hallucinosis stage, which is untreatable. David then hallucinosis stage, which is untreatable. David then

died from the died from the PlasmodiumPlasmodium falciparumfalciparum. We must . We must contact the local health agency and inform them of his contact the local health agency and inform them of his

diagnosis.diagnosis.

Why is the observation of mental changes Why is the observation of mental changes

significant?significant?

The mental changes tell us approximately how long the disease has been The mental changes tell us approximately how long the disease has been active in his system.active in his system.

The bursting of the RBC’s causes clogging of the capillaries which The bursting of the RBC’s causes clogging of the capillaries which impedes circulation to the brain.impedes circulation to the brain.

He could have a pre-existing mental health diagnosis which could be He could have a pre-existing mental health diagnosis which could be exacerbated by the exacerbated by the Plasmodium falciparum.Plasmodium falciparum.

There could be an interaction with the drugs chloroquine or mefloquine.There could be an interaction with the drugs chloroquine or mefloquine.

Could David’s condition have been prevented?Could David’s condition have been prevented?

If David would have followed the following proper precautions he could have If David would have followed the following proper precautions he could have prevented this disease from killing him.prevented this disease from killing him.

Preventing the mosquitoes from entering the housePreventing the mosquitoes from entering the house Preventing the mosquitoes from hidingPreventing the mosquitoes from hiding Protective ClothingProtective Clothing Mosquito RepellentsMosquito Repellents Insecticide vaporizersInsecticide vaporizers Mosquito coilsMosquito coils

Most importantly, David’s life could have been saved had he sought medical Most importantly, David’s life could have been saved had he sought medical attention as soon as his symptoms developed.attention as soon as his symptoms developed.

Drugs the medical staff would have used to treat David at the onslaught of his Drugs the medical staff would have used to treat David at the onslaught of his illness would have been chloroquine, oral quinine, pyrimethamine, illness would have been chloroquine, oral quinine, pyrimethamine, sulfadiazine, and leucovorin.sulfadiazine, and leucovorin.

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Gilbert, M.D., David, et al. Gilbert, M.D., David, et al. The Sanford Guide to Antimicrobial Therapy 2006The Sanford Guide to Antimicrobial Therapy 2006.   .   

            36th ed. Sperryville: Antimicrobial Therapy, Inc., 2006. 36th ed. Sperryville: Antimicrobial Therapy, Inc., 2006. 

Kakkilaya, M.D., B.  Kakkilaya, M.D., B.  Malaria Site – all about malariaMalaria Site – all about malaria. 14 April 2006.   . 14 April 2006.   

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Leboffe, Michael J., and Burton E. Pierce.  Leboffe, Michael J., and Burton E. Pierce.  A Photographic Atlas for the Microbiology A Photographic Atlas for the Microbiology   

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