PAMANTASAN NG LUNGSOD NG MAYNILA

COLLEGE OF MEDICINE
DEPATMENT OF MICROBIOLOGY AND PARASITOLOGY

Case Discussion In Virology

CASE No.1 : Group 1

An 9-month old infant develeoped intermittent moderate grade fever of 5 days duration,
associated with nasal discharge, cough and purulent eye discharge. On the 6th day of fever, the
mother noted beginning erythematous rash on the forehead area. The baby at this time had
decreased feeding. Persistence of the signs and symptoms prompted consultation and
subsequent admission. Immunization history: infant received vaccination for BCG (1 dose), Hep
B (3 doses), DPT and OPV (3 doses).
Pertinent PE findings: Wt : 7.5 kg HR : 100/min RR : 43/min T. 38.7C
(+) starting erythematous maculopapular rash below the hairline on the forehead and behind the
ears, (+) purulent eye discharge, (+) nasal discharge, (-) alar flare, slightly dry lips but moist
buccal mucosa, (+) whitish lesion on an erythematous base on the buccal mucosa opposite the
2nd molar , (+) pharyngeal congestion, normal heart rate, regular rhythm, no murmur, harsh
breath sounds, (-) rales, globular abdomen, normoactive bowel sounds,no organomegaly, no
tenderness, full pulses.
QUESTIONS :
1. What is the most likely etiologic agent ? Describe its characteristics.
2. Give other viral etiologic agents that will present as fever and rashes in the pediatric age
group. Tabulate the differences according to etiologic agent, incubation period, mode of
transmission, characteristic of the rash, other clinical characteristics, treatment and prevention.
3. Discuss the natural history of the disease ( expected course of the illness)
4. Give definitive laboratory tests. Are there serological tests that will diagnose this condition?
5. Discuss management and preventive measures pertinent to this case.

Case No.2 : Group 2

A 15 year old male sought consult for fever and enlargement of the salivary gland which
started initially on the right then eventually became bilateral. He was apparently exposed to a
classmate who presented with the same manifestations 2 weeks ago.
QUESTIONS :
1. What is the most likely diagnosis ? etiologic agent?
2. How is this transmitted? What is the period of communicability ?
3. What are the most common complications which may arise from this disease ?
4. Give diagnostic evaluations that can be done in the case above
5. What is the treatment of choice ? How can this be prevented ?

Case No 3 : Group 3
A 21 yr old female student complained of pruritic vesicular rashes which are present on the face,
trunks and extremities. Some lesions were macular, some vesicular, some pustular and some
are already forming scabs. Apparently, she had exposure to a neighbor with the same signs 3
weeks ago.
QUESTIONS :
1. What is the most likely cause of this disease ?
2. What are the differential diagnosis ?
3. What is the period of communicability ?
4. What are the common complications which may arise from this disease ?
5. What are the diagnositic tests that you can request for?
6. Give your plan of management for this student and cite preventive measures pertinent to this
case

Case no 4 : Group 4
A 5 year old child was brought to the ER for dog bite . He was apparently playing with
friends when he was chased by a dog. He fell to the ground and sustained puntured wounds
secondary to the dog bite on the arms and facial area. The wounds bled spontaneously.
QUESTIONS :
1. How should the patient be treated ?
2. What will most likely happen to the child if no intervention will be given ?
3. What are the pathognomonic signs of rabies ?
4. What diagnostic tests can be requested in a patient with possible rabies?
5. How are patients with rabies managed?
6. Cite preventive measures for rabies.

Case No 5 : Group 5
A 5 year boy developed acute onset high fever (39.0 C). On the second day of illness,
with the persistence of fever, the child also had headache and decreased appetite. On day 3 of
illness, the fever started becoming low grade but the child was noted to have epistaxis and
abdominal pain. This prompted ER consultation and subsequent admission. Pertinent PE
showed the following: BP 90/70, CR 110/min, RR 25/min T. 37.0C; (+) flushed skin; blood clots
on both nostrils; tachycardic; no rales; globular abdomen with slight tenderness on the right
upper quadrant; cold extremities with fair pulses
QUESTIONS:
1) If this were a case of dengue, how would you classify the patients condition?
2) What are the important virologic properties of the etiologic agent?
3) Discuss briefly antibody dependent enhancement.
3) What laboratory tests can be requested for the patient?
4) How are dengue patients managed in general?
5) Enumerate important preventive measures pertinent to this case.

Case No 6 : Group 6
A 21 year old college student consulted the out-patient clinic due to yellowish
discoloration of the sclerae and skin. He related that 1 week ago he developed fever, malaise
and anorexia that persisted until present time. He also started experiencing abdominal pain and
noted his urine to be darker in color than usual. He claims to be fond of eating in small canteens
surrounding his dormitory. Pertinet physical examination findings are as follows: well-nourished
male, oriented to time, place and person; temperature 37.8C; mild icterus of sclera and skin,
RUQ abdominal tenderness, (+) hepatomegaly.
QUESTIONS:
1. What is the most likely causative agent in this case?
2. What serologic marker will you request to determine the specific virus causing this patients
condition?
3. Tabulate the other viruses likely to cause hepatitis and characterize each in terms of
incubation period, mode of transmission, at risk population, important serologic markers,
propensity to cause chronic infection and mode of prevention.
4. How will you manage this patient?
5. What advise can be given to the close contacts of this patient?