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The goal of Infectious Diseases: A Case Study Approach is to provide healthcare students with a valuable infectious diseases pharmacotherapy resource. With the growing need of antimicrobial stewardship programs, healthcare professionals competent in infectious diseases pharmacotherapy are necessary. This casebook is designed to teach infectious diseases through patient cases that closely resemble situations healthcare professionals will likely face during their clinical practice. Infectious diseases-related topics covered in this book range from bacterial infections, to sexually transmitted diseases, to antimicrobial dosing recommendations. Topics were selected based on the Accreditation Council for Pharmacy Education's Coding Systems for Colleges of Pharmacy and the 2016 American College of Clinical Pharmacy's Pharmacotherapy Didactic Curriculum Toolkit. Authors of this casebook chapters are comprised of infectious diseases pharmacist faculty from Colleges of pharmacy across the United States. All these individuals have vast experiences and training in infectious diseases and are widely recognized as experts in their field. I hope that you will find this casebook useful during your studies! Jonathan C. Cho, PharmD, MBA, BCIDP, BCPS The University of Texas at Tyler Tyler, Texas
PATIENT PRESENTATION Chief Complaint 1 "I feel like I got hit by a truck. My body aches intensely, f m weak, I have a fever, fm lying under 3 blankets and can't get warm, and I can't stop shivering:' History of Present Illness AW is a 3~year-old female presenting to the emergency department with a 2-day history of myalgia, c.hills. and fever to 102.F for which she has been using over-the-counter acetaminophen. She reports a rapid onset of symptoms. including nasal congestion and cough associated with chest pain. She denies a sore throat. but complains of nausea and vomiting that began a few weeks ago and has worsened acutely. She reports 3 episodes of emesis this morning prior to coming to the emergency department She states she has never received the influema vaccine. but all of her family members are vaccinated annually. Past Medical History Asthma, HTN, HLD, hypothyroidism Surgical History Appendectomy 6 years ago Family History Father has a history of MI; mother has HTN; sister has a history of breast cancer. Soclal History Married with 3 young. healthy children (ages I. 3, and 6 years). Works as a 7th grade teacher. Denies illicit drug or tobacco use. Drinks alcohol socially. Allergies Penicillin (rash), egg (anaphylaxis) Vaccines um. refuses infiuenza vaccine due to egg allergy Home Medications Albuterol metered-dose inhaler 2 puffs q4h PRN shortness of breath Influenza Maria Heaney Jason Gallagher Amlodipine 10 mg PO daily Atorvastatin 20 mg PO daily Fluticasone-salmeterol 100 mcg/50mcg1 puff BID Levothyroxine 112 mcg PO daily Montelukast 10 mg PO QHS Physical Examination ~ V'ttal Signs Temp 101.7.F, P 84, RR 18, BP 136/84 mm Hg, Sa01 97%, Ht 5'5", Wt 64.5 kg ~ Genel'tll Lethargic female with headache ~ HEENT Normocephalic, atraumatic, PERRLA, EOMI, pale/dry mucous membranes and conjunctiva Pulmonary Stridorous breath sounds, equal lung expansion, cough present ~ Cardiovascular RRR. no murmurs, rubs, or gallops Abdomen Soft, non-tender, non-distended, normoactive bowel sounds ~ Genitourinary Deferred Neurology Lethargic. AAO X3 ANSWERS 1. Explanation: The correct answer is C. Based on AW's presentation, it is likely that she has influenza. Influenza testing can have antimicrobial stewardship implications and can influence infection prevention and control decisions. During influenza season, outpatients and patients presenting to the emergency department should be tested for influenza if they present with acute-onset respiratory symptoms and are at high risk for complications secondary to influenza infection if the result may influence clinical management. Testing may be considered for patients who are not at high risk for complications if results may influence clinical management with regard to antiviral therapy, avoidance of unnecessary antibiotics or other diagnostic tests, and shortened time in the emergency department. Testing is recommended for all hospitalized patients during influenza season who have acute respiratory illness, have exacerbation of a chronic pulmonary or cardiac comorbidity, or are immunosuppressed with respiratory or other nonspecific symptoms. All of the above methods are reliable for detecting influenza. A rapid influenza cell culture has a high sensitivity and specificity; however, it takes 1 to 3 days to produce results which would not be ideal for rapid testing in the emergency department. While a viral culture has a high sensitivity and specificity, it takes 3 to 10 days for results. Since there are other testing methods available with a more rapid time to results, a viral culture is not the most efficient method for emergency department diagnostics.
