Subject(s)
Chikungunya Fever , Dengue , Zika Virus Infection , Face , Humans , Puerto Rico , Travel , Zika VirusABSTRACT
BACKGROUND: During influenza season, many patients present to the emergency department (ED) for evaluation with influenza-like illnesses (ILIs). ILIs are commonly due to influenza A or B, but other infections may mimic influenza in their clinical presentation. With the high volume of ILIs presenting to the ED during influenza season, the ED physician should be alert to other infections masquerading as influenza. CASE REPORT: We report an interesting case of a 31-year-old female who presented with an ILI during influenza season. She had recently been in contact with multiple people with influenza. Her nonspecific laboratory tests done in the ED were consistent with influenza, except for a highly elevated serum ferritin level. The serum ferritin level was the key finding that led to the correct diagnosis of dengue fever, which she acquired during a recent trip to Haiti. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: During influenza season, facing high patient volumes of ILIs in the ED, the ED physician needs to be aware of clinical features in ILIs that may suggest a mimic of influenza.
Subject(s)
Dengue/blood , Dengue/diagnosis , Ferritins/blood , Influenza, Human/diagnosis , Adult , Biomarkers/blood , Dengue/complications , Diagnosis, Differential , Emergency Service, Hospital , Female , Haiti , Humans , Influenza, Human/complications , Seasons , TravelABSTRACT
Fevers of unknown origin (FUOs) may be due to any of over 200 different disorders. We present a most unusual case of an FUO in a returning traveler from the Dominican Republic. Work-up for Q fever, Brucellosis, Bartonella, malaria and HIV were negative, but very highly elevated ESRs and ferritin levels suggested possible Legionnaire's disease. This is the third reported case of Legionnaire's disease presenting as an FUO.
Subject(s)
Ferritins/blood , Fever of Unknown Origin/diagnosis , Legionnaires' Disease/diagnosis , Aged , Diagnosis, Differential , Dominican Republic , Humans , MaleSubject(s)
Culicidae/virology , Dengue Virus/immunology , Dengue/diagnosis , Immunoglobulin M/blood , Insect Vectors/virology , Travel , Adult , Animals , Dengue Virus/isolation & purification , Diagnosis, Differential , El Salvador , False Positive Reactions , Female , Humans , Insect Bites and Stings , Travel Medicine , United StatesSubject(s)
Abscess/microbiology , Breast , Melioidosis/microbiology , Skin Diseases, Bacterial/microbiology , Breast/microbiology , Breast/pathology , Female , Humans , Immunocompetence , Middle Aged , New York , Travel , West IndiesSubject(s)
Dengue/diagnosis , Typhoid Fever/diagnosis , Adult , Animals , Brazil , Dengue/blood , Dengue/immunology , Diagnosis, Differential , Female , Humans , Immunoglobulin M/blood , Travel , Typhoid Fever/blood , Typhoid Fever/immunology , Young AdultABSTRACT
We present a case of imported dengue fever in a 52-year-old man acquired during a recent trip to Ecuador. Fever in a returning traveler from tropical areas often presents a diagnostic problem for clinicians. Our patient presented with severe arthralgias and myalgias and had a camelback/saddleback fever pattern accompanied by relative bradycardia, which was a clue to the diagnosis. He had conjunctival suffusion and the truncal rash, but adenopathy was not present. He also had a generalized headache and abdominal pain. Nonspecific laboratory abnormalities included leukopenia, lymphopenia, atypical lymphocytes, thrombocytopenia, and mildly increased serum transaminases. Clinicians should consider dengue fever in the differential diagnosis in travelers returning from dengue fever endemic areas of Southeast Asia, Latin America, and Africa. Although early findings are nonspecific, a truncal rash accompanied by leukopenia and thrombocytopenia, if followed by biphasic fever pattern (ie, camelback/saddleback fever curve with relative bradycardia), suggest dengue fever as the primary diagnostic consideration.
Subject(s)
Dengue/diagnosis , Bradycardia/physiopathology , Dengue/drug therapy , Dengue/physiopathology , Diagnosis, Differential , Doxycycline/therapeutic use , Ecuador , Humans , Male , Middle Aged , TravelABSTRACT
El paciente que tiene ictericia clinica, resultados anormales en las pruebas de funcion heptatica, o ambos, representa un dificil reto diagnostico. Muchas enfermedades infecciosas comprometen el higado y la gravedad del compromiso determnina el grado de ictericia clinicamente evidente. Algunas enfermedades que comprometen levemente el higado no producen ictericia. Una clave importante para establecer la causa del transtorno es el patron de resultados anormales en las pruebas de funcion hepatica. Una mayor concentracion de fosfatasa alcalina predomina en la fiebre Q, la sifilis secundaria o terciaria, la clonorquiasis y la candidiasis hepatica; mientras que un mayor nivel de transaminasas sericas caracteriza a la hepatitis viral, la leptospirosis, los sindromes de mononucleosis, la enfermedad de los legionarios, la fiebre tifoidea, el sindrome de choque toxico y la fiebre amarilla. Los incrementos en los niveles de bilirrubina serica son tipicos en la ictericia causada por gangrena gaseosa, sepsis bacteriana grave y fiebre recurrente. Estos hallazgos, conjuntamente con la historia del paciente, los resultados fisicos y las pruebas basicas de laboratorio, permiten un diagnostico presuntivo en la mayoria de los casos