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Case Records of the Massachusetts General Hospital
Weekly Clinicopathological Exercises
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Volume 349:287-295 July 17, 2003 Number 3
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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 a six-week trip to South America, had received vaccines against hepatitis B and yellow fever and had begun taking doxycycline daily for prophylaxis against malaria. One week later, he and a group of others traveled to northern Ecuador, had a prolonged stay in the jungle, and swam in the "dark water" of lakes and rivers. At night, they used mosquito netting and applied a 30 percent N,N-diethyl-3-methylbenzamide (DEET) spray, but the patient 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.



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