Case-study in Virology
Dr.Jawad Kadhim Tarrad
Case-1
Complaint(ID/CC):
A 67- year-old man has right- sided chest pain and a rash on his chest. His pain began one week ago. The rash, which didn’t begin until 3 nights ago, is in the same distribution as the pain.
History(HPI):
The patient is usually healthy and takes no regular medications. He does not smoke or drink alcohol. Family history is unremarkable.
Physical exam(PE):
Exam reveals a rash on the left side of back and chest in a dermatomal distribution, which consists of many vesicles, many of which have crusted over. The patient is tender in the region of the rash. The rest of the exam is unremarkable.
Tests(Labs):
Complete blood count : normal
Tzanck smear from the base of one of the vesicles on the patient chest : multinucleated giant cells.
Questions(Qs):
· What is name of the condition affecting this patient? Which virus causes it?
· Where does this virus live in its human host?
· How can this infection be prevented and treated?
· What clinical infection does this virus typically cause in children?
Case-2:
Complaint(ID/CC):
A 41-years-old woman complains of nausea and vomiting. She also reports that her eyes have turned yellow , her abdomen is sore, and her urine has turned dark. The patient first felt ill 3 to 4 days ago. She mentions that she went to a seafood restaurant 3 week ago. Apparently , all her dinner partners from that night also are experiencing fatigue and nausea and vomiting.
History(HPI):
The woman is usually health. She takes no regular medications; is monogamous, and does not smoke, drink alcohol, or use illicit drugs.
Physical exam.(PE):
A low-grade fever is present, and the patient is jaundiced. Abdominal exam reveals right upper quadrant tenderness and mild hepatomegaly.
Tests(labs):
Hemoglobin: 14 g/dL(normal 12-1 6g/dL)
Alanine aminotransferase(ALT): 100 IU/L(normal 1-21 IU/L)
Aspirate aminotransferase(AST): 98 IU/L(normal 7-27 IU/L)
Bilirubin, total 3-2 mg/dL(normal : 0.1-1 mg/dL)
Bilirubin, direct 1.6mg/dL( normal 0.1-0.4mg/dL)
Alkaline phosphatase 42 IU/L(normal 13-39IU/L)
Urinalysis : elevated urobilinogen ; negative for glucose, protein, and bacteria.
Hepatitis A IgM : positive
Hepatitis B panel: negative
Hepatitis C IgM antibody: negative
Hepatitis D IgM antibody : negative
Questions(Qs):
· Given her history and lifestyle , how many of the four hepatitis viruses listed would the woman be unlikely to contact?
· What is the route of spread of HAV? Is there a chronic state for this virus?
· How is HEV transmitted? What is the link between hepatitis E and pregnancy? Is there a chronic carrier state this virus?
Case-3
ID/CC
A 30-year-old male presents with a high fever and chills, headache , nausea, vomiting, and muscle aches.
HPI
Yesterday he had an episode involving abnormal movements of his right hand and face(focal seizure). He also has difficulty comprehending speech and has olfactory hallucinations. He has no history of psychiatric illness.
PE
VS(Viral signs): tachycardia, mild tachypnea, normotention. PE: confused and disoriented, papilledema; mild nuchal rigidity, Kernigʼs sign positive, paraphasic error in speech , deep tendon reflexes normal and bilaterally symmetric.
Labs
Cytology by LP(lumbar puncture): cells 400/µl which mononuclear pleocytosis. Biochemistry: mildly elevated proteins, and normal glucose. Bacteriology exam. Negative.
CSF-PCR reveals herpes simplex virus type-1. Serology: serum complement-fixing antibody titer more than 1:1000. EEG(electroencephalography):spiked and show waves localized to temporal lobes.
Imaging:
CT: characteristic changes of encephalitis seen over temporal lobes.
Gross pathology:
Hemorrhagic , necrotizing encephalitis most severe along inferior and medial regions of temporal lobes and orbitofrontal gyri.
Micro pathology
Brain biopsy reveals Cowdry intranuclear viral inclusion bodies in both neurons and glial cells with perivascular inflammatory infiltrates.
Treatment
Intravenous acyclovir.
Discussion:------
Case-4
Mr.Fadhil left his place of employment at 3:00 P.M complaining of headache ,fatigue, general achiness,runny nose, cough and distinct chill. Headache and severe muscular aches ensued , and a temperature rise to 120F was noted by early morning of following day. Laryngitis with hoarseness and cough and substernal soreness were noted. Epistaxis was also noted. Physical examination revealed slight tachycardia and somewhat lower than normal blood pressure. The lymphoid follicles of the soft palate were enlarged and dewy in appearance. The nasal mucous membrane appeared bright red and there were areas of hemorrhage. The patient complained of loss of appetite and experienced a sense of fatigue and weakness. Nausea, vomiting or diarrhea were not observed.
1. The disease is diagnosed as ------which similar in C/F of------
2. The most common complication is------
3. A specific therapy for the disease is------
4. The most effective disseminators occur in age group------
5. The control measures against the disease include------
Case-5
Complaint
A 32-year-old woman comes in for a routine Pap smear. She has no complaints, but has not had a Pap smear before and she saw a TV program on it recently , prompting her to make the appointment.
History
The patient is healthy and has no significant past medical history. She takes no medications and does not illicit drugs or alcohol. She smokes roughly one pack of cigarettes per day. The woman is heterosexual and has multiple previous sexual partner, using birth control pills and condoms sporadically.
PE
The PE reveals no significant abnormalities. Full pelvic exam and pap smear are performed.
Lab.tests
Urine pregnancy test: negative
Pap smear: atypical cells
Routine culture for gonorrhea and Chlamydia : negative
Cervical biopsy: koilocytic atypia in cell of upper epithelial laver.
Qs:
· Which infectious organism is likely responsible for the changes?
· What is koilocyic atypia?
· What common clinical condition does this organism cause?
· What is relationship between this organism and cancer?
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