Socioeconomic condition and Human Health zoonosis..

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A male patient of age 19yrs presented to the emergency department with a complain of fever and pain in the lower abdomen for last 4 days.The patient was alright 4 days before admission, when patient started having complain of fatigue, fever, and chills .The next day, he started having headache, vomiting which was non bilious and not blood stained, diarrhea 1 to 2 episodes watery in nature, decreased appetite, low back pain, and pain and burning sensation while passing urine.He also complained of pain in groin and scrotum.He was brought to the emergency department, where he reported dry mouth, eye pain when he was febrile, and light-headedness. He had a history of exercise-induced asthma and had been hospitalized during early childhood for diarrhea.There is no history of any drug intake or drug allergies. Patient took all immunizations according to the schedule. He lived with his mother, stepfather, and brother in an urban area and had no history of travel outside the country. The patient had a negative interferon-gamma release assay for tuberculosis two months before this evaluation. He was sexually active with one female partner and reported consistent condom use. Two months earlier, tests for human immunodeficiency virus, syphilis, gonorrhea, and chlamydia had been negative. He smoked one cigarette each day, used marijuana three times per week, and drank alcohol intermittently. He had a pet rabbit but no contact with other animals, no history of recent tick or mosquito bites, and no contact with sick persons. There was no family history of renal stones or autoimmune disorders. On examination, the patient appeared to be tired. The temperature was 39.4°C, the blood pressure 120/70 mm Hg, the pulse 121 beats per minute, the respiratory rate 36 breaths per minute, and the oxygen saturation 100% while he was breathing ambient air. The paraspinal muscles of the low back were tender. The remainder of the examination was normal. Laboratory Data, results of renal-function tests were normal, also the erythrocyte sedimentation rate, red-cell indexes, and blood levels of amylase, lipase, albumin, globulin, alkaline phosphatase, total bilirubin, and direct bilirubin were normal.Test results are shown in TABLE1. Urinalysis revealed 2+ albumin and 1+ ketones by dipstick; there were few squamous cells and very few transitional cells per high-power field, amorphous crystals, and mucin. Blood and urine culture were negative. Also tests for influenza virus, respiratory syncytial virus, adenovirus, and parainfluenza virus types 1, 2, and 3 and urinary nucleic-acid tests for Neisseria gonorrhoeae and Chlamydia trachomatis. Intravenous fluids, paracetamol, ondansetron, and ibuprofen were administered. During the next 4 hours, the fever, tachycardia, and the pain resolved, and the patient was able to drink water without vomiting. He was discharged home and advised to continue taking paracetamol, ibuprofen, and ondansetron, as well as to take rest and plenty of oral fluids. The next morning, the patient awoke with severe pain in the abdomen, groin, and scrotum on the left side. Head heaviness, dysuria, diarrhea, and nausea persisted, and he vomited after each attempt to eat or drink. He returned to the emergency department, where he reported his pain to be modrate to severe. He reported that 3 weeks earlier, he had a testicular trauma while attempting a stunt jump on his bicycle. On examination, he appeared to be uncomfortable, lying still on the stretcher. The temperature was 37.5°C, the blood pressure 122/70 mm Hg, the pulse 110 beats per minute, the respiratory rate 18 breaths per minute, and the oxygen saturation 98% while he was breathing ambient air. There was tenderness of the left costovertebral angle, the left lower quadrant of the abdomen, the left inguinal crease, and the superior aspect of the left testicle. There was no scrotal mass, edema, or discoloration. The remaining physical examination was normal. The erythrocyte sedimentation rate was normal, and the level of C-reactive protein was 162.7 mg per liter (reference value, <8.0). Examination of the urine before and after prostatic massage revealed trace occult blood by dipstick in both samples, with otherwise normal results. Ultrasonography of the scrotum, kidneys, and bladder revealed an 8-mm cyst in the left epididymal head and no acute abnormalities. Ketorolac was administered. The patient’s pain persisted, and the temperature rose to 38.9°C. Patient was admitted to the hospital. On admission, the patient reported left scrotal pain and headache. His diarrhea had resolved. The temperature was 39.2°C, the blood pressure 110/60 mm Hg, the pulse 104 beats per minute, the respiratory rate 18 breaths per minute, and the oxygen saturation 98% while he was breathing room air. There was mild tenderness of the anterior and posterior left thigh; results of the physical examination was same as in the emergency department. Intravenous fluids, ketorolac, paracetamol and ondansetron were administered. The patient’s urine was strained after each void; no stones were found. On the second hospital day, vomiting resolved but fever persisted and pain of the abdomen and groin worsened; morphine was administered for pain relief. Laboratory test results are shown in Table1.CT of the abdomen and pelvis, performed after the administration of contrast material which revealed an ill-defined low-density material that tracked along the left retroperitoneum anterior to the left psoas muscle and aorta and into the pelvis, displacing the bladder to the right. Low-density material was also seen in the left paracolic gutter.The radiologic differential diagnosis included infectious and inflammatory causes with a possible pelvic, leg, or genitourinary source or traumatic injury to the bladder or ureter. There was no hepatomegaly or splenomegaly, and other visualized structures in the abdomen, pelvis, and lower thorax were normal. On the third hospital day, the patient continued to receive morphine for pain and paracetamol for fever. Abdominal ultrasonography revealed two enlarged left external iliac lymph nodes (0.8 cm and 0.7 cm in diameter) and a heterogeneous, ill-defined, mixed echogenic collection located to the left of the bladder, a finding suggestive of loculated fluid or phlegmon. A chest radiograph was normal. Examination of a peripheral-blood smear revealed normochromic normocytic red cells, occasional symmetrical spindle-shaped red cells with smooth contours, very few burr cells, very few teardrop-shaped red cells, normal lymphocytes and monocytes, and normal platelets with occasional large forms. Results of renal-function tests and of hemoglobin electrophoresis were normal, also red-cell indexes and blood levels of amylase, lipase, albumin, globulin, alkaline phosphatase, total bilirubin, and direct bilirubin. Tests for heterophile antibodies and IgM and IgG antibodies to Ehrlichia chaffeensis, and Rickettsia rickettsii were negative, as was a polymerase-chain-reaction assay for A. phagocytophilum DNA; results of tests for antibodies to Epstein–Barr virus (EBV) and cytomegalovirus (CMV) were suggestive of past infection. Ampicillin–sulbactam and gentamicin were administered. On the fourth hospital day, the patient’s pain decreased and his fever resolved. Laboratory test results are shown in Table1. A diagnostic procedure was performed. What is the procedure? What is the diagnosis? TABLE 1 1 day before admission Day 2 after admission Day 3 Day 4 Haemoglobin 14% 13.2% 13.3% 13.0% Haematocrit 41.2 38.9 38.2 37.6 Reticulocyte count 0.4 0.3 0.3 Total WBC count (cmm) 6100 2300 2203 2200 Differtial count Neutrophils 78 62.2 54.8 36.6 Band forms 0 8.0 0 0 Lymphocytes 13.9 22.2 35.1 53.0 Atypical lymphocytes 0 3.0 0 0 Monocytes 7.2 4.0 9.5 9.1 Eosinophil 0 0 0 0 Basophil 0.1 1.0 0 0.5 Platelets 120,000 70,000 75,000 82,000 Prothrombin time 14.2 14.6 PT-INR 1.1 1.2 APTT 27.5 28.4 Fibrinogen 401 Sodium 131 134 134 132 Potassium 3.6 3.6 3.8 4.0 Chloride 94 104 102 99 CO2 24.4 22.7 23.6 24.6 Calcium 9.2 8.0 8.2 Phosphorus 3.1 Magnesium 2.1 Glucose 112 114 90 101 Total protein 7.4 5.9 5.2 ALT 28 156 154 AST 32 116 `114 LDH 467 469 CRP 120.9 178.6 156.5 Ferritin 8340 7008 Triglyceride 341 282 Iron 24 TIBC 165

What is the most likely diagnosis in this man with left knee swelling and these findings for the past 2 years? A) Nonpulmonary tuberculosis B) Tularemia C) Cutaneous anthrax D) Sporotrichosis E) Actinomycosis

Patient age 36 y Working in shoe making factory B/o fever since two days cough and cold since last one week Joint pain since one month Interpret CXR & advice further line of treatment hemodynamically stable SOB after 30 mins walking

7 years female generalised lymphadenopathy 3 months Undocumented fever for first few days No clearcut history of sorethroat One blood transfusion for anemia O/E : Not sick looking, playful Bilateral cervical (anterior and posterior) Bilateral axillary Bilateral inguinal No hepatosplenomegaly Investigations: Pancytopenia Comments are welcomed....