Reference no: EM133267867

Question - A 29-year-old woman presents to you 12 days after participating in an open-water triathlon. She swam in a freshwater lake, biked through a wooded area, and ran along a paved road during the competition. Two days ago, however, she developed fever, chills, severe headache, nausea, and vomiting. She also reports having a poor appetite and diffuse muscle soreness.

She denies photophobia, neck pain, and joint pain. She also denies eating any uncooked foods. She has no history of recent travel and denies using illicit substances.

On examination, her temperature is 102.8 °F and she appears ill. Other vital signs are: blood pressure 90/54 mm Hg, heart rate 114 beats/minute, respiratory rate 26 breaths/minute, and oxygen saturation 93% on room air.

On examination of her head, ears, eyes, nose, and throat, you note conjunctival injection with mild icterus. Her neck is supple with mild lymphadenopathy. You note bilateral crackles on examination of the lung. Cardiovascular examination is normal. Her abdomen is tender in the right upper quadrant where the liver edge is palpable just below the right costal margin. You observe mild tenderness over the paraspinal muscles but no focal abscess or point tenderness.

You obtain laboratory studies, which reveal:

Platelet count: 64,000/mm3

Aspartate transaminase: 180 U/L

Alanine aminotransaminase: 192 U/L

Total bilirubin: 4.0 mg/dL

Alkaline phosphatase: 350 U/L

Creatine kinase: 500 U/L

You obtain a chest x-ray, the results of which reveal bilateral alveolar infiltrates.

What is the cause of her acute illness?

1. Influenza

2. leptospirosis

3. Dengue fever

4. Hanta virus infection