Reference no: EM133332920

Case Study: A 36 years old patient was admitted to the infectious hospital by a district internist with a diagnosis ARVI on the 15/07/2019.

Complaints: weakness, severe headache in the backs of head, violation of sleep, feeling of heat, fever.

Anamnesis of illness: patient is ill the 7th day; he became ill gradually, when a light increase of temperature to 37,2°C and headache appeared. On the second day the state worsened, the temperature of body rose to 37,7°C, and the headache increased,

weakness appeared. On the 3-6th day the state became worse gradually: the signs of intoxication and headache increased, insomnia appeared, and the temperature of the body increased to 39,1°C. The patient took antipyretics independently, but the body temperature diminished only for a short time, and the patient addressed for help to an internist in the polyclinic.

Epidemiology anamnesis: 2 weeks ago (in October) the patient was at his summer residence, where he drank unboiled water from a shallow well. The patient denies any contact with infectious patients.

Objectively: The general state is of middle severity, T is 39,2°C, HR is 88 beats per minute, RR is 22 respirations per minute, BP is 130/90 mm Hg. Consciousness is clear. The patient is sick, and a dynamic apathy and confusion are present. The skin is pale, dry and hot. Any rash is absent. The tongue is coated by thick brown cover, dry, the periphery of the tongue has the imprints of the teeth, but is free of cover. Heart sounds are muffled, the rhythm is correct. There is systolic murmur on the apex of the heart. Pulse is satisfactory. On auscultation there is vesicular breathing. The abdomen is soft, floated, accessible to deep palpation, by percussion there is dullness in the right iliac area. The liver comes forward from under the coastal arc on 3cm. Spleen is enlarged by 2 cm. Other parts of the intestine are without particularities. Stool has been absent for the last 2 days. Total amount of urine per day is normal.

QUESTIONS:

1. Make and explain the diagnosis.

2. What auxiliary methods of research must be used for diagnosis of this disease? 3. Name characteristic complications of this illness, their reasons and terms of their appearing.

4. Name the terms of discharge of patients from the hospital for decreed and non-decreed groups.

5. Prescribe treatment to the patient.