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chbare

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chbare - Those are really good pictures and a good presentation as well. Is that your voice in the video?

Here is a picture I took through a scope with a Sony Cibershot. It took a couple of tries to get it lined up

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DSC01124.jpg

Edited by DFIB
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P. falciparum commonly known as malaria or blackwater fever. ERDoc thanks for holding back and letting us take a shot at it.

That is correct. The patient has malaria. Malaria is caused by a group of organisms in the genus Plasmodium. P. falciparum happens to be the causative organism in this case. How will you treat the patient?

However, how did a person become infected with malaria at this time of the year? How, who, what and where will you investigate?

Yes, that is my voice in the video. Nice picture you took there, high quality for sure.

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I was thinking that we would need to review his travel for four weeks but reaearch says it could be as long as a year from infection to the first symptoms. Amazing.

Here the doc would add quinine to the doxicycline. The net mentiones tetracycline or clindamycin as well.

I have never had malaria but suffered through Dengue twice. The second time I thought I was dying. I wasn't but it felt like it.

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P. vivax may be treated with quinine successfully, but QT prolongation is a concern. With P. falciparum and the region (Middle East/Asia), resistance to chloroquine is a concern. We can go many ways, but I would likely consider something like artemether and lumefantrine with yet another QTi precaution. I would not be adverse to treating with doxycycline if we believe this may be a case of severe malaria. Again, many potential options.

The patient has no history of travel to any other country except Afghanistan over the past year. Flight layovers are also looked at, with the only layover being in Dubai, UAE. The patient somehow contracted malaria in Afghanistan.

One of my microbiology professors contracted Dengue fever (bone break fever) when she was working on her doctorate in Costa Rica. From what she said, it's a pretty miserable ride.

Edit for italics.

Edited by chbare
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You know one of the things that I see that is so vital, though maybe not obvious to those that haven't been here forever, about this thread...

I was going to jump into this thread just a a sentence early on and say, "Remember, this is Chris, try not to run down a bunch of psycho rabbit trails.." But it wasn't necessary. The respect for chbare as the person presenting the scenario was obvious. No one was looking for Martian butt lice, or some other crazy, far out explanation, because they know that that isn't educational and also that Chris doesn't have the tiny penis (or so rumor has it) that seems to create the need to post such 'stump the panel' crap.

From the very beginning everyone was confident that this would be an issue within the likelihood of being something that they might someday see, and if not that at least the path would take them to places valuable for them...

Man, I'm jealous of that. There is our rating system, which shows that if you cuss often enough you can get a lot of points, like me, and then there is the general show of respect for kindness, intelligence and simply being trustworthy, as we've seen here.

I think that that is just too cool for school..

Good on you Chris.

Dwayne

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You know one of the things that I see that is so vital, though maybe not obvious to those that haven't been here forever, about this thread...

I was going to jump into this thread just a a sentence early on and say, "Remember, this is Chris, try not to run down a bunch of psycho rabbit trails.." But it wasn't necessary. The respect for chbare as the person presenting the scenario was obvious. No one was looking for Martian butt lice, or some other crazy, far out explanation, because they know that that isn't educational and also that Chris doesn't have the tiny penis (or so rumor has it) that seems to create the need to post such 'stump the panel' crap.

From the very beginning everyone was confident that this would be an issue within the likelihood of being something that they might someday see, and if not that at least the path would take them to places valuable for them...

Man, I'm jealous of that. There is our rating system, which shows that if you cuss often enough you can get a lot of points, like me, and then there is the general show of respect for kindness, intelligence and simply being trustworthy, as we've seen here.

I think that that is just too cool for school..

Good on you Chris.

Dwayne

You mean you have never treated Martian butt lice?

Now that we are done I think, I will confess that my thought process was more intuitive than intelligent or clinical knowledge based ( I am sure it was obvious).

As soon as you were "banned" from the thread for having "insider knowledge" I knew it was going to be something that would be considered exotic for the civilized world. That really narrowed the scope for me. I was beginning to believe that my suspicions were going to be as wild as Barbarella booty bumps but decided to ride it out just to see where it would go.

Thanks chbare, Great thread. It is my privilege to get to learn from all of you guys.

edited to spell check intelligent :)

Edited by DFIB
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Thanks Dwayne et al. I do try to make challenging but relevant scenarios. As Dwayne stated, little is gained when you present something so complicated that it stumps everybody just so you can swoop down and impress all with your superior intellect. This scenario was based on a real experience however.

With that, I really want to do a little follow up because that is where the real learning occurred for me aside from the fact that I "blew" the diagnosis on this one. After the positive diagnosis, the next question was how did this happen under such cols environmental conditions? Perhaps just one of those strange things; however, I believe another case was identified from another location. An investigation occurred and the conclusion was both crazy and very intuitive.

Some of the sites housed people in old aircraft hangers. Typically, small living quarters, converted railroad cars or converted storage containers were used as living quarters often with communal bathrooms. The aircraft hangers were often cooled by large air conditioning units in the summer and turned off during the winter. Unfortunately, when they were turned off, the accumulated water was sometimes not disposed and this allowed mosquitos to thrive during the colder months.

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Just to go off topic a tad .. I believe I have attracted a small group of remote type paramedics in AB to join EMT city .. perhaps we could start an interest group ? I learned a lot in this scenario as in the Great White North we just don't see a lot of this type of pathology ... lots of skitters but they only carry West Nile .. although the cases of reported cases of malaria are increasing exponentially in the immigrate and holiday travelling public in Canada.

so a query gods of the nasty tropical stuff .. what medications are used to be profalaxis when travelling, I use Doxy but have heard that malerone is another ? Although side effects for women long term doxy can be a "concern" and some adverse effects to malerone

I will be presenting an interesting case ..ok 2 when I get paperwork completed on a possible perforation to anus NYD and a presentation on onset of pancreatitis NYD..it appears I am a shyte magnet theses last 3 days.

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It's good to see you blokes wanting to dish out paracetamol (tylenol) but you have to give it at much higher dosages for it to be effective. 500mg is only one tablet (the recommended dosage is 2-4) and there is good evidence that 20mg/kg or 1500mg is very effective.

15 mg / kg with a max dose of 1g at time 4-6 hourly 4 g in 24 hours - is what the BNF would say and there's pretty good evidence for that regime as a good balance between wanted properties and minimising the hepatotoxicity which kills untreated Paracetamol ODs ...

i'm inclined to agree wit hthe rest of the suggestions and reasoning...

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