32: Protozoans

PATIENT PRESENTATION

Chief Complaint

Fever for almost a week

History of Present Illness

AB is a 58-year-old male with history of latent TB (s/p INH × 9 months), recent month-long trip to Kenya, returned 1 week ago and developed fevers, malaise, body aches, abdominal pain, and headaches. He received multiple mosquito bites while in Kenya, and did not take malarial prophylaxis. His fevers occur every 24 to 48 hours.

Past Medical History

Hypertension, hyperlipidemia, diabetes, depression, latent tuberculosis: s/p INH × 9 months

Surgical History

None

Family History

Father alive with type 2 diabetes, mother died at 72 of MI

Social History

Married with 2 adult children, nonsmoker, drinks occasionally

Allergies

NKDA

Home Medications

Citalopram 20 mg PO daily

Docusate 100 mg PO BID

Gabapentin 100 mg PO TID

Ibuprofen 400 mg PO q8h PRN fever

Lisinopril 20 mg PO daily

Acetaminophen 650 mg PO q6h

Physical Examination

Vital Signs

Temp 103.3°F (oral), pulse 114 bpm, RR 18 breaths per minute, BP 112/80 mm Hg (sitting position), SpO₂ 97%, Ht 5′10″, Wt 87 kg

General

Well-nourished, well-developed, patient appearing stated age in no acute distress

Eyes

Pupils equally round and reactive to light, no conjunctival injection/scleral icterus, extraocular motions intact

Ears/Nose/Throat/Mouth

Atraumatic external nose and ears. Moist mucous membranes; no pharyngeal erythema, no evidence of any acute otitis media or external canal infection/mastoiditis bilaterally. No nasal congestion noted. Neck: Supple and non-tender. Trachea midline. No anterior cervical lymphadenopathy. No JVD

Cardiovascular

Sinus tachycardia, no murmurs or gallops. Peripheral pulses 2+ and equal in all extremities

Pulmonary

Unlabored respiratory effort. No wheezing, rhonchi, or rales noted. No chest wall tenderness noted

Abdomen

Abdomen is soft with nonspecific abdominal pain, is protuberant and not distended. No masses or hernias appreciated. No rebound, guarding, or peritoneal signs noted. Splenomegaly present.

Musculoskeletal

Extremities without deformity, edema or tenderness to palpation

Skin

Warm, dry; no rashes or lesions

Neurological

Normal gait and balance; sensation grossly intact

Psychiatric

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