Need diagnosis help (from student)

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Hello! I currently am in microbiology and I am just stumped on a diagnosis, and I have spent hours upon hours trying to make some points match to come up with the diagnosis and I am just coming up blank. So, I was hoping someone could help shed some light on this disease.

The patient complained from insomnia, anxiety, confusion

The patient was having difficulty swallowing.

The doctor reported that the patient had partial paralysis.

The doctor reported that the patient was very agitated and the speech was incoherent.

We received a laboratory report indicating several immunological tests have been performed on samples of saliva, serum, spinal fluid, and skin biopsies of hair follicles at the nape of the neck. The results of the serum and spinal fluid tests indicated the presence of antibodies to a specific virus.

The doctor also requested a skin biopsy for a specific antigen.

The results of the saliva test performed using a reverse transcription followed by polymerase chain reaction have indicated the presence of a virus.

So, after researching all of these tests and having positive viral results, I was thinking Rabies. There were also pictures of perivascular cuffing and a positive dFA test.

Then.....on Monday this bit of information was added: The patient is now beginning to show progressive symptoms, where there is incessant coughing and paroxysm of the symptoms. As the patient coughs it is followed by a whooping sound.

That last bit seems obvious for Pertussis, but I cannot find a link of paroxysms of cough with "whooping" associated with Rabies or a viral infection.

I have thought of a dual diagnosis, but I am just not sure.

Thanks!!

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Specializes in Hospital Education Coordinator.

West Nile has an neurological component that has resulted in more than 1000 deaths this year alone in the US. But many virus can affect the neurological system. Could be anything from Jakob-Crutzfeld (Mad Cow Dz) to meningitis to any number of things. Share with us what you learn.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I actually need to do some research...I have a few Ideas......CJD is a good idea so is tularemia. Tetnas......HUmmmmm.... I'll be back.

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I should also add that this case was found in India.

I researched CJD, but since it is caused by a prion, I am not sure that would cause a positive viral result.

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It's always possible for somebody to have two things wrong. Polio and pertussis? I'm stumped but would love to hear the answer.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

India does not immunize.....pertussis, tetnas are all good thoughts as is Tularemia.....Tularemia has a cough...but it is bacterial........what about Plague....what are the details of this patients exposure.

Viral.......back to the books.....

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Could that "whooping sound" be stridor? I'm still with Rabies may be Tularemia

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India does not immunize.....pertussis, tetnas are all good thoughts as is Tularemia.....Tularemia has a cough...but it is bacterial........what about Plague....what are the details of this patients exposure.

Viral.......back to the books.....

There is no information regarding exposure. I was hoping to get some information that she had a bite of some type. The paper is due on Wednesday, so I am pretty sure this is all the information we get. :banghead:

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Pertussis, Tetnas, Tularemia all bacterial.....CJD but they don't think that is viral anymore. I'm sticking with Rabies.....the whooping sound could be more stridorous in nature.....which would accompany the difficulty swallowing of the disease process. In the US we don't see this much as we immunize our animals and ourselves.

I had a patient with Tetnas once.....funny enough the American trained MD's were baffled.....a doctor from India walking through the ICU made comment the the patient was opisthotonic....this patient was doing this bizarre arch posturing thing......I was like "What did you say?" he went on to explain about Tetnas and how much he sees it in India....unfortunately it was fatal for this patient. I will never for get it.

They don't have to be bitten for rabies just close proximity with the sick animal or eat contaminated food.......the rabies virus is transmitted through saliva or brain/nervous system tissue. CDC - Exposure: When to seek medical attention - Rabies

Please come back and let us know.

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Thank you everyone. I also think it is Rabies and maybe my teacher is just trying to throw our group off with that last bit just to see if we will distinguish the test results and apply that whooping cough is bacterial. I will let you know when she tells us the diagnosis!

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I had a patient with Tetnas once.....funny enough the American trained MD's were baffled.....a doctor from India walking through the ICU made comment the the patient was opisthotonic....this patient was doing this bizarre arch posturing thing......I was like "What did you say?" he went on to explain about Tetnas and how much he sees it in India....unfortunately it was fatal for this patient. I will never for get it.

A bit OT, but on my first ever hospital placement as a student, I also cared for a patient with tetorifice. He spent a week in ICU and was then transferred to the ward. Initially he was bedridden, catheterised, NG tube fed etc. They expected to treat him for a few weeks then transfer him to a rehab facility. However, less than 3 weeks later, he walked out of the hospital and went home. It was pretty amazing. I always tell people not to forget their tetorifice boosters though!

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Tetorifice can give you stridor too.

):

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