Micro Case Study

[ShortStackRN]

So I'm taking Micro with my nursing classes this semester which is a nightmare within itself...but here's the thing. I have to do a case study with an unknown organism. I think I have broken the case, but I was just wondering if any Micro-Aces out there had a second opinion or confirmation of my conclusion.

My patient is a 4 year old boy returning home from a church trip to Mexico; presents at the ER with high fever for several days, severe earache, excrutiating neck pain (keeping the child from sleep), myalgia, screaming when pen-light shined in eyes, and vomiting. Mother states that symptoms started about a week after returning back to the US. No one else from the trip was sick.

Here's what I think...Dengue Fever. It's transmitted by day-biting mosquitos which could be the reason why only this child was sick; also Dengue Fever is commonly referred to as "breakbone fever" related to the severe joint pain. Also, the CDC states specifically that Dengue Fever causes retro orbital pain (which would explain the child's screaming with the eye exam). It can also cause Nausea and vomiting which the child has experienced. The only symptom listed in my case study that I can't find ANYWHERE on ANY disease is the earache....however I would assume that the earache could possibly be referred pain from the headache and joint pain. Also, DF has an incubation period of 3-15 days which would explain the late onset of symptoms.

Does anyone have any thoughts on this? I've been through just about every possible "somewhat common" travellers disease and this one seems to fit the bill. Just curious if anyone concurred or disagreed.

Thank you!!!:heartbeat

[ghillbert, MSN, NP]

Sounds good.

I'd also want to rule out meningitis: classic neck pain, photophobia, fever.

[ShortStackRN]

Sounds good.

I'd also want to rule out meningitis: classic neck pain, photophobia, fever.

I forgot to update my thread last night...after reading over it again I realized that the kid actually didn't get sick in Mexico...I read over one small sentence but MAJOR detail in the study...the daycare he attended called the mom and said "none of the other sick kids have been allowed to stay you need to come get your son"...HELLO?! He got sick in daycare...which is a breeding ground for meningitis! How did I miss this...it's absolutely meningitis! I was trying to make this thing all complicated! And I should have known this seeing as how I had viral meningitis 5 years ago! Wow...and as a nursing student you would think that I would have paid attention to ALL of the details...I think my brain is turning to mush! Maybe it's residual from my past illness...haha

Thank you!!!

[Daytonite, BSN, RN]

I read your post last evening and had to go off to do something and didn't have time to respond, My first thought was that the child had meningitis. Meningitis is always a complication and secondary infection that has migrated from a primary site. In this case the infection started somewhere else, probably the ear since he has a severe earache. Since this is micro I thought you needed to identify the organism, but there really isn't any information about it. The cardinal sign for meningitis is nuchal rigidity (the excrutiating neck pain).