Complaints and progression of the disease (Anamnesis morbi)
The patient was admitted with a referral diagnosis of acute gastroenteritis. The disease manifested acutely.
Main complaints at the time of examination include:
- Pronounced dry mouth and irresistible thirst.
- Repeated vomiting.
- Frequent loose stools.
- Severe generalized weakness.
The dynamics of the intestinal syndrome is very specific: the frequency of defecation is 5-6 times a day. Initially, the stool was fecal in character, but as the disease progressed, it transformed into profuse, watery, and completely rice-water (colorless) stool. The epidemiological history (Anamnesis epidemica) is burdened: 3 days before the onset of symptoms, the patient returned from a trip to Southeast Asia.
Objective status (Status praesens): General examination
Upon admission, the patient's general condition is severe, although consciousness is fully preserved. Voice function is impaired — whispering speech is noted. Body temperature is reduced to 35.8°C (hypothermia). The patient is of low nutritional status.
Skin and mucous membranes:
- Pale and dry.
- Tissue turgor is significantly reduced.
- Mild acrocyanosis is detected.
- Hands and feet are cold upon palpation.
From the neuromuscular system, the leading symptom is painful, recurring cramps localized in the calf muscles and hands, indicating a critical loss of electrolytes.
Assessment of organ systems
The clinical picture demonstrates multiorgan changes against the background of massive fluid loss:
- Cardiovascular system: Pronounced hypotension (BP 80/40 mm Hg) and tachycardia (heart rate reaches 120 beats per minute) are registered. Pulse of weak volume. Heart sounds are muffled, but rhythmic.
- Respiratory system: Shortness of breath is observed. Vesicular breathing is heard upon auscultation.
- Digestive system: The tongue is dry, heavily coated with a white plaque. The abdomen is sunken on examination, soft and completely painless upon palpation. Rumbling is characteristic, audible throughout the abdomen. Stool remains watery, profuse, and turbid.
- Urinary system: Acute renal function failure has developed — anuria (urination has been absent for the past 10-12 hours).
Tasks for clinical analysis
Based on the presented introductory data, complaints, history of present illness and life, as well as detailed objective status, the specialist faces two key tasks:
- Formulate and substantiate a presumptive clinical diagnosis, taking into account the acute onset, nature of the stool, signs of dehydrational shock, and geographical history.
- Draw up a comprehensive plan for laboratory and instrumental examination to confirm the etiology of the disease and assess the degree of water-electrolyte disorders.
Briefly: answers to topical questions
What pathogens cause paratyphoid fevers A, B, and C?
Paratyphoid fevers A, B, and C are caused by bacteria of the genus Salmonella (typhoid-paratyphoid group):
- Salmonella paratyphi A (Salmonella paratyphi A) is the causative agent of paratyphoid A.
- Salmonella paratyphi B (Salmonella paratyphi B) is the causative agent of paratyphoid B.
- Salmonella paratyphi C (Salmonella paratyphi C) is the causative agent of paratyphoid C.
What are the main routes of transmission of paratyphoid fevers?
In the cited sources for paratyphoid fevers, the waterborne route of transmission is directly indicated: water has epidemiological significance as a route of transmission of acute intestinal infections, including paratyphoid A and B; pathogenic sewage flora may include paratyphoid pathogens.
What culture media are used to isolate hemoculture in paratyphoid fevers?
To isolate hemoculture in suspected typhoid-paratyphoid diseases, blood culture is inoculated into bile broth (Rapoport medium) as well as sugar broth.
To assess the severity of the condition, remember the key triad: hypothermia (35.8°C), anuria (10-12 h), and calf muscle cramps against the background of rice-water watery stools.
Class and exam questions
With what diagnosis was the patient referred to the hospital?
The patient was referred with a diagnosis of "Acute gastroenteritis" on the second day from the onset of the disease.
How did the character of the stool change during the course of the disease?
At the onset of the disease, the stool was fecal in character, but then rapidly became profuse, watery, turbid, and acquired a colorless rice-water character at a frequency of 5-6 times a day.
What hemodynamic changes were detected upon examination?
Tachycardia up to 120 bpm, weak pulse volume, and pronounced arterial hypotension (BP 80/40 mm Hg) are noted.
What is the epidemiological feature of this case?
A key factor is the patient's return from Southeast Asian countries just 3 days prior to the development of the acute clinical picture.
What else to study on this topic
- Substantiation of the presumptive diagnosis based on the symptom complex
- Formulation of an individual patient examination plan
- Assessment of the degree of dehydration by clinical signs
- Differential diagnosis of infections brought from Southeast Asia
- Mechanism of development of cramps and anuria in acute intestinal infections
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