Apply laboratory results to diagnosis or clinical conditions and/or diseases. Wh

Question

Apply laboratory results to diagnosis or clinical conditions and/or diseases. What are the possible diagnoses, what is the most likely diagnosis, how are possible diagnoses differentiated? Acute Diarrhea in a Young Traveler 36 yr old male – chief complaint – Fever, chills, and diarrhea for 1 week. History of present illness: Patient reported he recently spent 47 days in India and during that time followed a strict vegetarian diet and drank only bottled water. However, he did eat some well-cooked indigenous foods. He felt good until the last day of his trip when he because acutely ill and fatigued. He reported having a headache, fever, up to 39*C chills, and 6-8 episodes of diarrhea per day. He reported the diarrhea to be clear without visible blood and did not have an unusually foul odor. A few days prior, the patient had been diagnosed with Giardia, Endolimax, and Blastocystis hominis at another hospital and was treated with ciprofloxacin with no resolution of his symptoms. He reported to our ER because of continuing diarrhea and fever. Family social history was not significant Physical exam: Temp 39.6*C Blood pressure 111/89 Heartrate 139 (normal <100) Patient appeared ill, cachtic and was shaking. Rectal exam was positive for blood. He was admitted to the hospital for additional testing. Diagnostic Procedures and Lab Tests Chest Xray demonstrated increased vascular markings bilaterally Fungal blood culture were negative Aerobic and anaerobic blood cultures were positive for GNR Urine culture – negative Stool culture Negative for Salmonella, Shigella, and Campylobacter spp. However, Candida albicans growth was heavy Stool for ova and parasites was negative however many RBC were present. Chemistry Total protein 5.0 6.3-8.2 g/dl Albumin 2.4 3.5-5.2 g.dl BUN 8 7-21 mg/dl Creatinine 0.9 0.6-1.2 mg/dl AST 567 13-40 IU/L ALT 392 10-40 IU/L LD 960 100-190 IU/L Amylase 27 29-108 IU/L Lipase 42 7-59IU/L Sodium 123 135-145 mEq/L Potassium 3.9 3.6-4.5 mEq/L Chloride 88 98-109 mEq/L Carbon dioxide 25 22-31 mEq/L Glucose 101 65-110 mg/dl Calcium 8.4 8.4-10.2 mg/dl Magnesium 1.3 1.4-1.8 mEq/L Phosphorus 1.6 2.4-5.4 mg/dl Total bilirubin 2.0 0.2-1.3 mg/dl Direct Bilirubin 1.0 0.0-0.3 mg/dl HCVAb Not reactive Not reactive HBsAb Not reactive Not reactive HAV Ab IgM Not reactive Not reactive HIV-1,2 Ab Not reactive Not reactive Hematology WBC 3.7 4.5-11.1X103/ml Neutrophils 81 35-80% Lymphocytes 9 20-50% Monocytes 4 2-12% Eosinophils 0 0-7% Basophils 1 0-2% MCV 81.2 82-105 fl MCHC 34.4 31-35 gg/dl Hemoglobin 13.6 11.7-16.9 g/dl Hematocrit 39.7 35-45% Platelets 176 50-450 X103/ml Coagulation PT 11.9 9.8-11.9s PTT 29.5 23.0-32.5s Urine Findings Appearance Yellow and clear Specific gravity 1.004 1.002-1.030 pH 7.0 5.0-7.0 Protein 30 mg/dl Neg Glucose Neg Neg Ketone Neg Neg Bile Neg Neg Urobilinogen 0.2 0.1-1.0 EHR Leukocyte esterase Neg Neg Nitrite Neg Neg RBC None 0-3 WBC None 0-3 Bacteria occasional - Blood culture results: MacConkey; many clear colorless colonies Hektoen; many transparent colonies with black center Trace amount of H2S on slant and butt of TSI negative for indole, citrate, motility, urease, and gas formation, positive for lysine utilization/decarboxylate lysine

Explanation / Answer

Differential Diagnosis of Diarrhea:

From the above Laboratory tests, present illness, and symptoms, the potential diagnosis of diarrhea can be differentiated as

1. Non-infectious diarrhea that is lack of clinical symptoms.

2. Gastroenteritis: It is the Infectious Diarrhea that results in the large volume of watery stools that accompanied with signs and symptoms of nausea, vomiting, abdominal cramps.  

-E.coli

-Vibrio cholera.

-Shigella, Salmonella species, Campylobacter species which is negative for this patient.

- Yersinia enterocolitica.

3. Inflammatory colitis: Infectious colitis accompanied by fever, dysentery, and tenesmus.

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