Case report: 28 year-old female with fever and thrombocytopenia

Detalhes bibliográficos
Autor(a) principal: Lemos, Carlos
Data de Publicação: 2018
Outros Autores: Vaz Carneiro, Cristina, Miranda, Ana
Tipo de documento: Artigo
Idioma: por
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: https://doi.org/10.25761/anaisihmt.27
Resumo: BACKGROUND: Malaria needs to be considered during examination febrile patients who traveled from endemic regions. Current blood cells analyzers are not specifically designed to detect malaria-related abnormalities. Therefore, observation of peripheral blood smear (PBS) is still necessary for malaria diagnosis. CASE PRESENTATION: A 28 year-old female living in Angola attended to a medical appointment witth fever, myalgia, cough, headaches, and diarrhoea. Complete blood count (CBC) has revealed thrombocytopenia (130.000x106/L). Search for Plasmodium spp in PBS was negative and anti- -dengue antibodies also negative. Two days later she traveled to Portugal, where she attended the emergency department. Platelet count has lowered (47.000 x 106/L), there was elevation of transaminases (ALT 124 UI/L, AST 97 UI/L) and C-reactive protein value was 2,66 g/dL. Search for Plasmodium spp and anti-dengue antibodies were again both negative. CBC was repeated 3 days later, which revealed 8% large unstained cells (LUC). A PBS was prepared and some forms of Plasmodium malariae were observed. CONCLUSIONS: Misdiagnosis of imported malaria is not uncommon. Although PBS remains necessary for malaria diagnosis, low parasite densities may initially be undetectable in PBS. Therefore, in patients with suspected malaria suspected, PBS should be repeated every 12-24 hours, for a total of 3 sets.
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spelling Case report: 28 year-old female with fever and thrombocytopeniaCaso clínico: doente do sexo feminino de 28 anos com febre e trombocitopéniaBACKGROUND: Malaria needs to be considered during examination febrile patients who traveled from endemic regions. Current blood cells analyzers are not specifically designed to detect malaria-related abnormalities. Therefore, observation of peripheral blood smear (PBS) is still necessary for malaria diagnosis. CASE PRESENTATION: A 28 year-old female living in Angola attended to a medical appointment witth fever, myalgia, cough, headaches, and diarrhoea. Complete blood count (CBC) has revealed thrombocytopenia (130.000x106/L). Search for Plasmodium spp in PBS was negative and anti- -dengue antibodies also negative. Two days later she traveled to Portugal, where she attended the emergency department. Platelet count has lowered (47.000 x 106/L), there was elevation of transaminases (ALT 124 UI/L, AST 97 UI/L) and C-reactive protein value was 2,66 g/dL. Search for Plasmodium spp and anti-dengue antibodies were again both negative. CBC was repeated 3 days later, which revealed 8% large unstained cells (LUC). A PBS was prepared and some forms of Plasmodium malariae were observed. CONCLUSIONS: Misdiagnosis of imported malaria is not uncommon. Although PBS remains necessary for malaria diagnosis, low parasite densities may initially be undetectable in PBS. Therefore, in patients with suspected malaria suspected, PBS should be repeated every 12-24 hours, for a total of 3 sets.INTRODUÇÃO: A malária integra as hipóteses de diagnóstico diferencial em doentes com febre, provenientes de regiões endémicas. Os contadores hematológicos atuais não foram especificamente desenhados para identificar alterações associadas a malária. Assim, a observação do esfregaço de sangue periférico (ESP) permanece imprescindível. DESCRIÇÃO DO CASO: Uma mulher de 28 anos, residente em Angola, recorreu a assistência médica, devido a febre, mialgias, tosse, cefaleias e diarreia. O hemograma revelou trombocitopénia (130.000x106/L). A pesquisa de Plasmodium em ESP e de anticorpos anti-dengue foram, respetivamente, negativas. Dois dias depois, a doente viajou para Portugal, onde se dirigiu a um serviço de urgência (SU). Analiticamente, observou-se agravamento da trombocitopénia (47.000x106/L), elevação das transaminases (ALT 124 UI/L, AST 97 UI/L) e uma proteína C-reativa (PCR) de 2,66 g/dL. A pesquisa de Plasmodium e de anti- -corpos anti-dengue foi negativa. O hemograma foi repetido 3 dias depois, revelando 8% de large unstained cells (LUC). Após observação de ESP para contagem leucocitária diferencial, foram identificadas algumas formas de Plasmodium malariae. CONCLUSÕES: Embora o ESP se revele imprescindível para o diagnóstico de malária, parasitémias baixas podem inicialmente ser indetectáveis. Assim, a pesquisa de Plasmodium deverá ser repetida a cada 12-24 horas, até perfazer 3 conjuntos de lâminas observadas.Universidade Nova de Lisboa2018-04-27T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.25761/anaisihmt.27oai:ojs.anaisihmt.com:article/27Anais do Instituto de Higiene e Medicina Tropical; Vol 16 (2017):  4.º Congresso Nacional de Medicina Tropical; 45-50Anais do Instituto de Higiene e Medicina Tropical; v. 16 (2017):  4.º Congresso Nacional de Medicina Tropical; 45-502184-23100303-7762reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttp://anaisihmt.com/index.php/ihmt/article/view/27https://doi.org/10.25761/anaisihmt.27http://anaisihmt.com/index.php/ihmt/article/view/27/21Lemos, CarlosVaz Carneiro, CristinaMiranda, Anainfo:eu-repo/semantics/openAccess2022-09-23T15:30:15Zoai:ojs.anaisihmt.com:article/27Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:03:50.409741Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Case report: 28 year-old female with fever and thrombocytopenia
Caso clínico: doente do sexo feminino de 28 anos com febre e trombocitopénia
title Case report: 28 year-old female with fever and thrombocytopenia
spellingShingle Case report: 28 year-old female with fever and thrombocytopenia
Lemos, Carlos
title_short Case report: 28 year-old female with fever and thrombocytopenia
title_full Case report: 28 year-old female with fever and thrombocytopenia
title_fullStr Case report: 28 year-old female with fever and thrombocytopenia
title_full_unstemmed Case report: 28 year-old female with fever and thrombocytopenia
title_sort Case report: 28 year-old female with fever and thrombocytopenia
author Lemos, Carlos
author_facet Lemos, Carlos
Vaz Carneiro, Cristina
Miranda, Ana
author_role author
author2 Vaz Carneiro, Cristina
Miranda, Ana
author2_role author
author
dc.contributor.author.fl_str_mv Lemos, Carlos
Vaz Carneiro, Cristina
Miranda, Ana
description BACKGROUND: Malaria needs to be considered during examination febrile patients who traveled from endemic regions. Current blood cells analyzers are not specifically designed to detect malaria-related abnormalities. Therefore, observation of peripheral blood smear (PBS) is still necessary for malaria diagnosis. CASE PRESENTATION: A 28 year-old female living in Angola attended to a medical appointment witth fever, myalgia, cough, headaches, and diarrhoea. Complete blood count (CBC) has revealed thrombocytopenia (130.000x106/L). Search for Plasmodium spp in PBS was negative and anti- -dengue antibodies also negative. Two days later she traveled to Portugal, where she attended the emergency department. Platelet count has lowered (47.000 x 106/L), there was elevation of transaminases (ALT 124 UI/L, AST 97 UI/L) and C-reactive protein value was 2,66 g/dL. Search for Plasmodium spp and anti-dengue antibodies were again both negative. CBC was repeated 3 days later, which revealed 8% large unstained cells (LUC). A PBS was prepared and some forms of Plasmodium malariae were observed. CONCLUSIONS: Misdiagnosis of imported malaria is not uncommon. Although PBS remains necessary for malaria diagnosis, low parasite densities may initially be undetectable in PBS. Therefore, in patients with suspected malaria suspected, PBS should be repeated every 12-24 hours, for a total of 3 sets.
publishDate 2018
dc.date.none.fl_str_mv 2018-04-27T00:00:00Z
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dc.relation.none.fl_str_mv http://anaisihmt.com/index.php/ihmt/article/view/27
https://doi.org/10.25761/anaisihmt.27
http://anaisihmt.com/index.php/ihmt/article/view/27/21
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dc.publisher.none.fl_str_mv Universidade Nova de Lisboa
publisher.none.fl_str_mv Universidade Nova de Lisboa
dc.source.none.fl_str_mv Anais do Instituto de Higiene e Medicina Tropical; Vol 16 (2017):  4.º Congresso Nacional de Medicina Tropical; 45-50
Anais do Instituto de Higiene e Medicina Tropical; v. 16 (2017):  4.º Congresso Nacional de Medicina Tropical; 45-50
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