<div><span id="result_box" lang="en"><span class="hps">Igor</span><span>,</span></span></div><span lang="en"><span></span><div><br> <strong><u><span class="hps">Another</span> </u></strong><span class="hps"><strong><u>recommendation</u></strong>,</span> <span class="hps">do not forget that</span> <span class="hps">the focus</span> <span class="hps">is</span> <strong><span class="hps">prolonged fever</span> </strong><span class="hps"><strong>of unknown origin</strong>,</span> (<font size="1">would be recommended, follow the basic algorithm</font>) <span class="hps">therefore, although the</span> <span class="hps">more possible</span> <span class="hps">it is</span> <span class="hps">a</span> <span class="hps">infectious disease, rare</span> or <span class="hps">prevalent</span> <span class="hps">or</span> <span class="hps">atypical,</span> <span class="hps">the patient</span> <span class="hps">may carry</span> <span class="hps">some</span> <span class="hps">non-infectious</span> <span class="hps">disease</span> <span class="hps atn">(</span><font size="1"><span>inflammatory</span><span>,</span> <span class="hps">neoplastic</span><span>,</span> <span class="hps">etc.</span> <span class="hps">.).</span></font></div>
<div><span class="hps"></span> </div><div>Congratulations to all participants<br></div><span class="hps"></span><div><span class="hps">Successes,</span></div><div><span class="hps"></span></div></span><div><div style="text-align:center">
<strong>Prof. Marco Tulio A Garcia-Zapata, MD, PhD</strong></div><div style="text-align:center"><strong><font size="1">Medical Tropicalist / Head Professor / Principal Researcher</font></strong></div><div style="text-align:center">
<font size="1">Tropical Medicine & Dermatology Department (DMTD)</font></div><div style="text-align:center"><font size="1">Center for Studies and Research in (Re)Emerging Diseases (NUPEREME)</font></div><div style="text-align:center">
<font size="1">Reference Sentry Unit for International and Travel Medicine (USCREMIVI)</font></div><div style="text-align:center"><font size="1">Tropical Pathology & Public Health Institute (IPTSP)</font></div><div style="text-align:center">
<font size="1">Federal University of Goias (UFG)</font></div><div style="text-align:center"><font size="1">Goiania - GO, BRAZIL</font><br><font size="1"> </font></div><div style="text-align:center"><font size="1">Caixa Postal 12911 - Setor Leste Vila Nova</font></div>
<div style="text-align:center"><font size="1">Goiania - GO, 74643-970, Brazil</font></div><div style="text-align:center"><font size="1">Phone: (+2)3269-8219, Fax (+62)3521-1839</font></div><div style="text-align:center"><font size="1">E-mail: <a href="mailto:nupereme@gmail.com" target="_blank">nupereme@gmail.com</a> </font></div>
<div style="text-align:center"><a href="mailto:medicinadeviagem.hc.hdt@gmail.com" target="_blank"><font size="1">medicinadeviagem.hc.hdt@gmail.com</font></a></div><div style="text-align:center"><a href="mailto:mctulianglobal@gmail.com" target="_blank"><font size="1">mctulianglobal@gmail.com</font></a> </div>
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</div></div></div><div class="gmail_quote">2012/7/3 Igor Thiago Borges de Queiroz e Silva <span dir="ltr"><<a href="mailto:igorthiago@usp.br" target="_blank">igorthiago@usp.br</a>></span><br><blockquote style="margin:0px 0px 0px 0.8ex;padding-left:1ex;border-left-color:rgb(204,204,204);border-left-width:1px;border-left-style:solid" class="gmail_quote">
Hi, everybody.<br>
I would like some help in a case here in Sao Paulo:<br>
<br>
"Patient, 60 years, male, married, with no comorbidities, retired truck driver, coming from Manaus / AM, where he lives in urban area and has a place in the jungle.<br>
He arrived at the referring hospital with fever, myalgia, headache and dysphagia for 4 days, when it came to travel. On examination, revealed hepatomegaly (2 cm) and splenomegaly (below the left costal margin). Normal cardiac and pulmonary auscultation. No palpable lymphadenopathy.<br>
Reported contact with flood water, where had rats in peridomicile. Confirmed vaccination against yellow fever (2009). Social drinking, denied smoking or illicit drug use. One sexual partner (wife). He denied domestic animals, neither contact with birds or bats.<br>
Laboratory revealed pancytopenia, normal renal function, elevated transaminase levels (300-400) and canalicular enzymes, total bilirrubins (3) with predominance of direct fraction (2). USG confirmed homogeneous hepatosplenomegaly.<br>
Serology: Anti-HAV IgG+, HBsAg negative, anti-HCV negative, anti-HIV negative, schistosomiasis IgM and IgG negative, blood smear with negative plasmodium research, test for leishmaniasis (rK39) negative. Dengue IgM negative and IgG positive, IgM negative for leptospirosis (confirmed one week later). Bone marrow aspirate without significant changes (only karyolysis) and without the presence of parasites. Immunohistochemistry unchanged.<br>
Evolves with persistence of fever, with the biggest increase of the spleen in relation to the liver, confirmed by computed tomography. He was transferred to ICU because of pneumonia and respiratory failure after 15 days of hospitalization. Today, even without definitive diagnosis after one month of research, he persists with fever!"<br>
<br>
Any suggestions?<br>
<br>
Hug´s<br>
<br>
-- <br>
Igor Thiago Borges de Queiroz e Silva<br>
Infectologista do Hospital Giselda Trigueiro - SESAP - Natal/RN<br>
Infectologista do Hospital ABC Unidade Cirúrgica - São Bernardo do Campo/SP<br>
Mestrando do Departamento de Doenças Infecciosas e Parasitárias - FMUSP<br>
Laboratório de Soroepidemiologia e Imunobiologia (LIM38) - IMT/USP<br>
<a href="mailto:igorthiago@usp.br" target="_blank">igorthiago@usp.br</a><br>
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</blockquote></div><br><br clear="all"><br>-- <br><div style="text-align:center"><strong>Prof. Marco Tulio A Garcia-Zapata, MD, PhD</strong></div><div style="text-align:center"><strong><font size="1">Medical Tropicalist / Head Professor / Principal Researcher</font></strong></div>
<div style="text-align:center"><font size="1">Tropical Medicine & Dermatology Department (DMTD)</font></div><div style="text-align:center"><font size="1">Center for Studies and Research in (Re)Emerging Diseases (NUPEREME)</font></div>
<div style="text-align:center"><font size="1">Reference Sentry Unit for International and Travel Medicine (USCREMIVI)</font></div><div style="text-align:center"><font size="1">Tropical Pathology & Public Health Institute (IPTSP)</font></div>
<div style="text-align:center"><font size="1">Federal University of Goias (UFG)</font></div><div style="text-align:center"><font size="1">Goiania - GO, BRAZIL</font><br><font size="1"> </font></div><div style="text-align:center">
<font size="1">Caixa Postal 12911 - Setor Leste Vila Nova</font></div><div style="text-align:center"><font size="1">Goiania - GO, 74643-970, Brazil</font></div><div style="text-align:center"><font size="1">Phone: (+2)3269-8219, Fax (+62)3521-1839</font></div>
<div style="text-align:center"><font size="1">E-mail: <a href="mailto:nupereme@gmail.com" target="_blank">nupereme@gmail.com</a> </font></div><div style="text-align:center"><a href="mailto:medicinadeviagem.hc.hdt@gmail.com" target="_blank"><font size="1">medicinadeviagem.hc.hdt@gmail.com</font></a></div>
<div style="text-align:center"><a href="mailto:mctulianglobal@gmail.com" target="_blank"><font size="1">mctulianglobal@gmail.com</font></a> </div><br>