Case Study 4

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Case Study 4

• By
• Lisa Iacopetti
• Jennifer Morales
• Esmeralda Reyna

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Background

• 45 year old male
• In March 2003 was in China for Business
• Spent 2 weeks traveling to various cities and
  villages
• Ending his trip in Guangdong Province in China

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symptoms

• Fever of 38 C
• Cough
• Difficult breathing

• Shortness of breath
• Headache
• Muscle Stiffness

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Patient history

• How long have you had the symptoms ?
• Any history of Asthma or any other respitory
  diseases ?
• Currently taking any medication?
• Are you a smoker ?
• If yes How many cigarettes do you smoke on a
  daily basis ?

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Patient History Continued

• Have you traveled outside of the United States.
• If yes Where did you travel to?
• How long were you there ?

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Differential diagnosis

• Influenza
• Pneumonia
• Bronchitis
• SARS ( Severe Acute Respitory Syndrome )

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Tests ordered

• CBC
• Blood Cultures
• Chest X-ray
• Pulse Oximetry
• Sputum gram stain and sensitivity
• Testing for viral respitory pathogens, especially
  influenza A and B
• ELISA
• Immunofluorescence
• PCR test on blood, sputum, tissues and stool

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Clinical Findings

• Non productive cough
• Negative culture test
• Negative sensitivity test
• Negative AFB stain
• Negative cold agglutins
• X-rays showed evidence of lung infiltrates
  consistent with pneumonia
• Positive PCR test

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Elimination of Differentials

• Chest x-rays Will not diagnose SARS but can
  confirm other potential diagnosis
• ELISA will detect antibodies to SARS 21 days
  after exposure
• Immunofluorence will detect antibodies 10 days
  after exposure ( labour and time intensive)
• PCR will detect genetic material of the SARS
  virus ( A positive test is indicative of SARS but
  a negative does not eliminate SARS )

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Chest Radiographs
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Gram Stains

• SARS Bronchitis Influenza Pneumonia

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Diagnosis

• SARS

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Patient care and treatment

• CDC recommends that anyone suspected or confirmed
  with SARS be treated the same treatment as anyone
  with a community-acquired pneumonia.
• Antipyretics
• Supplemental oxygen and ventilatory support
• Isolation preferably in negative pressure rooms
• Continue follow up care

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Precautions

• Home
• Limit interactions outside the home
• Hand hygiene
• Disposable gloves
• Cover mouth with facial tissues when sneezing and
  coughing
• Patients and family members to wear masks
• Household wastes immediately disposed

• Hospital
• Isolation in negative pressure room
• Droplet Precautions
• i.e. Surgical masks
• Standard Nursing Precautions
• Respitory hygiene/cough etiquette

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Patient prognosis

• According to CDC and WHO the mortality rate of
  SARS is higher than that of influenza or other
  common respitory tract infections.
• Mortality rate is below 1 for people age 24 or
  younger, 6 for the ages 25 to 44, 15 in those
  45 to 64 and 50 for ages 65 and older.
• Since our patient was diagnosed in the early
  stages of SARS and other wise in good health we
  feel that he will be able to recover.

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The End