Case 22-2003 - A 22-Year-Old Man with Chills and Fever after a Stay in South America

doi:10.1056/NEJMcpc020030

Volume 349:287-295		July 17, 2003		Number 3

Case 22-2003 — A 22-Year-Old Man with Chills and Fever after a Stay in South America

Johanna P. Daily, M.D., and Mary Ann Waldron, M.T.(A.S.C.P.)

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Presentation of Case

A 22-year-old man was examined in the clinic because of fever,chills, and thrombocytopenia.

Five months earlier, the patient, who was late in planning asix-week trip to South America, had received vaccines againsthepatitis B and yellow fever and had begun taking doxycyclinedaily for prophylaxis against malaria. One week later, he anda group of others traveled to northern Ecuador, had a prolongedstay in the jungle, and swam in the "dark water" of lakes andrivers. At night, they used mosquito netting and applied a 30percent N,N-diethyl-3-methylbenzamide (DEET) spray, but thepatient received many insect . . . [Full Text of this Article]

Differential Diagnosis

The Evaluation of Patients with Fever after Traveling

Salient Features of the Current Case

Amebiasis

Bartonella Infection

Malaria

Clinical Diagnosis

Dr. Johanna P. Daily's Diagnosis

Pathological Discussion

Pathological Diagnosis

Source Information

From the Infectious Disease Division, Brigham and Women's Hospital, and the Department of Medicine, Harvard Medical School and Harvard School of Public Health (J.P.D.); and the Clinical Microbiology Laboratories, Parasitology Section, Massachusetts General Hospital (M.A.W.) — all in Boston.