A 29-year-old woman comes to the hospital due to fever and skin rash. She returned from a trip to Brazil 10 days ago. Her symptoms started 5 days ago with a headache, retro-orbital pain, high-grade fever, and joint and muscle pains. She has also had an episode of epistaxis. Today, she noticed a skin rash all over her body. Examination shows a diffuse maculopapular rash and scattered petechiae. Laboratory study results show thrombocytopenia. Her boyfriend traveled to Brazil with her and is asymptomatic. Transmission of the pathogen causing this patient's current symptoms occurs in a manner that is most similar to which of the following diseases?

Question

A 29-year-old woman comes to the hospital due to fever and skin rash.  She returned from a trip to Brazil 10 days ago.  Her symptoms started 5 days ago with a headache, retro-orbital pain, high-grade fever, and joint and muscle pains.  She has also had an episode of epistaxis.  Today, she noticed a skin rash all over her body.  Examination shows a diffuse maculopapular rash and scattered petechiae.  Laboratory study results show thrombocytopenia.  Her boyfriend traveled to Brazil with her and is asymptomatic.  Transmission of the pathogen causing this patient's current symptoms occurs in a manner that is most similar to which of the following diseases?

Quizplus · Accepted Answer

11ec160b_381f_4f1c_9249_919275fbb375_MD0001_00 This patient's presentation after recent travel to Brazil is consistent with dengue fever (DF). DF is due to a virus transmitted by the Aedes aegypti mosquito. It is prevalent in tropical and subtropical regions (South and Southeast Asia, Pacific Islands, Caribbean, Americas). DF presents as an acute febrile illness with headache, retro-orbital pain, and joint and muscle pain. Other findings can include hemorrhage (eg, petechiae, purpura, epistaxis, melena), thrombocytopenia, leukopenia, and hemoconcentration. The Aedes mosquito also transmits the virus causing chikungunya, a febrile illness with flulike symptoms, prominent polyarthralgia/arthritis (hands, wrists, ankles), and diffuse macular rash. As a result, many areas have had simultaneous outbreaks of both dengue and chikungunya. Preventive measures against both infections include protective barriers (eg, bed nets, window screens) and insect spraying. (Choice B) Lymphogranuloma venereum can be caused by direct sexual contact with an infected individual. (Choice C) Meningococcal meningitis is acquired by droplet contact. In a health care setting, measures to prevent transmission include wearing a face mask within 3 feet of the patient (who is typically placed in a private room). (Choice D) Pulmonary tuberculosis is usually spread through airborne contact. Patients are placed in a negative-pressure isolation room, and specific respirator masks are worn by all contacts and visitors. (Choice E) Rocky Mountain spotted fever is due to Rickettsia rickettsii, which is transmitted by ticks rather than mosquitoes. (Choice F) Typhoid fever is caused by Salmonella and is usually acquired from contaminated food or water, typically in areas with poor sanitation. Educational objective: The Aedes aegypti mosquitoes can transmit the viruses that cause dengue fever and chikungunya. Classic dengue fever presents as an acute febrile illness with headache, retro-orbital pain, and joint and muscle pain. Chikungunya is a febrile illness with flulike symptoms, prominent polyarthralgias, and diffuse macular rash. __________ References: Recent introduction and rapid dissemination of Chikungunya virus and Dengue virus serotype 2 associated with human and mosquito coinfections in Gabon, central Africa. (http://www.ncbi.nlm.nih.gov/pubmed/22670036)

A 29-Year-Old Woman Comes to the Hospital Due to Fever