MICROBIOLOGY
Case A 24-year-old female was apparently well prior to consultation. Three days ago, she developed
fever of 39°C, body weakness and lack of appetite. A red rash appeared on her arms and legs.
CBC results: Hgb: 150 g/dL Hct: 0.45 RBC: 5,000,000 / cu mm WBC: 8,000 / cu mm PMN: 60 %
Lymph: 40 % Platelets: 180 After a day, repeat CBC revealed: Hemoglobin (Hgb): 150, Hematocrit (Hct):
0.48, Platelet (Plt): 150 Epistaxis and gum bleeding were observed,
another CBC revealed: Hgb: 150, Hct: 0.49, Plt: 80 The patient was advised admission.
Questions:
1. What is the most likely diagnosis and basis for this?
● Dengue Fever
● Basis for diagnosis:
○ Fever of 39°C
○ Body weakness (malaise)
○ lack of appetite
○ rashes on the extremities (arms and legs)
○ Platelet of 80
○ Epistaxis and gum bleeding
2. What are the differentials?
● Chikungunya
● Malaria
● Flu ( Influenza)
● Leptospirosis
● Measles
3. What lab tests can be done to confirm the diagnosis?
● Dengue NS1
● Dengue IgG/IgM
● CBC
4. How are patients managed?
● Reduction of high fever: paracetamol only
● Promote oral feeding: soft diet, milk, fruit juice, oral rehydration solution (ORS).
● Isotonic salt solution in the critical period, e.g. 5% dextrose in normal saline solution (NSS), 5%
Ringer Acetate, 5% Ringer-Lactate.
● The 5% dextrose in NSS is preferable because the severe cases needing admission are those
with poor appetite
● The rate of IV fluid should be adjusted according to clinical vital signs (BP, pulse, respiratory
rate, temperature), hematocrit (Hct) and urine output (0.5 ml/kg/hr)
● Follow up CBC everyday
● Advise to come back to the hospital ASAP when there is no clinical improvement
5. How do we prevent infection?
● Clothing: Reduce the amount of skin exposed by wearing long pants, long-sleeved shirts, and
socks, tucking pant legs into shoes or socks, and wearing a hat.
Case A 24-year-old female was apparently well prior to consultation. Three days ago, she developed
fever of 39°C, body weakness and lack of appetite. A red rash appeared on her arms and legs.
CBC results: Hgb: 150 g/dL Hct: 0.45 RBC: 5,000,000 / cu mm WBC: 8,000 / cu mm PMN: 60 %
Lymph: 40 % Platelets: 180 After a day, repeat CBC revealed: Hemoglobin (Hgb): 150, Hematocrit (Hct):
0.48, Platelet (Plt): 150 Epistaxis and gum bleeding were observed,
another CBC revealed: Hgb: 150, Hct: 0.49, Plt: 80 The patient was advised admission.
Questions:
1. What is the most likely diagnosis and basis for this?
● Dengue Fever
● Basis for diagnosis:
○ Fever of 39°C
○ Body weakness (malaise)
○ lack of appetite
○ rashes on the extremities (arms and legs)
○ Platelet of 80
○ Epistaxis and gum bleeding
2. What are the differentials?
● Chikungunya
● Malaria
● Flu ( Influenza)
● Leptospirosis
● Measles
3. What lab tests can be done to confirm the diagnosis?
● Dengue NS1
● Dengue IgG/IgM
● CBC
4. How are patients managed?
● Reduction of high fever: paracetamol only
● Promote oral feeding: soft diet, milk, fruit juice, oral rehydration solution (ORS).
● Isotonic salt solution in the critical period, e.g. 5% dextrose in normal saline solution (NSS), 5%
Ringer Acetate, 5% Ringer-Lactate.
● The 5% dextrose in NSS is preferable because the severe cases needing admission are those
with poor appetite
● The rate of IV fluid should be adjusted according to clinical vital signs (BP, pulse, respiratory
rate, temperature), hematocrit (Hct) and urine output (0.5 ml/kg/hr)
● Follow up CBC everyday
● Advise to come back to the hospital ASAP when there is no clinical improvement
5. How do we prevent infection?
● Clothing: Reduce the amount of skin exposed by wearing long pants, long-sleeved shirts, and
socks, tucking pant legs into shoes or socks, and wearing a hat.
