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Tuesday, December 14, 2010

A college student complains of the sudden onset of fever, chills, malaise, nonproductive cough, and numerous sick contacts in the fall season.

A 21-year-old college student presents to the clinic complaining of a sudden onset   of   chills   and   fever, muscle   aches,   headache,   fatigue,   sore   throat, and painful nonproductive cough 3 days prior to fall final exams. Numerous friends of the patient in the dormitory reported similar symptoms and were given the diagnosis of influenza. He said that some of them were given a prescription for ribavirin. On examination, he appears ill with temperature 39.4°C (103°F). His skin is warm to the touch, but no rashes are appreciated. The patient has mild cervical lymph node enlargement but otherwise has a normal examination.

◆     What is the most likely diagnosis?

◆     What is the biochemical mechanism of action of ribavirin?

◆     What is the genetic make up of this infectious organism?



Summary: A college student complains of the sudden onset of fever, chills, malaise, nonproductive cough, and numerous sick contacts in the fall season. 

◆     Likely diagnosis: 
                                  Acute influenza infection 
◆     Biochemical mechanism of action of ribavirin:  
                                A nucleoside analogue with activity against a variety of viral infections. 
◆     Genetic makeup of organism:  
                               Ribonucleic acid (RNA) respiratory virus 

CLINICAL CORRELATION 

This   21-year-old   college   student  has  the  clinical  clues  suggestive  of  acute influenza. Typically, the illness occurs in the winter months with an acute onset of   fever,   myalgias   (muscle   aches),   headache,   cough,   and   sore   throat.   Usually, there are outbreaks with many individuals with the same symptoms. This patient is young and healthy, and antiviral therapy is not mandatory. The best way to prevent   the   infection   is   by   influenza   vaccination,   usually   given   in   October or November of each year. Because of the antigenic changes of the virus, a new vaccine must be given each year. Patients who are at especially high risk for severe complications or death should receive the vaccine each year. These include the elderly and people with asthma, chronic lung disease, human immunodeficiency virus (HIV) infection, diabetes, or chronic renal insufficiency.