There are some diseases that medical students spend hours reading about, studying, and memorizing. On rounds we are pimped about them, and if we're at a loss for a diagnosis, we may order the tests for them. However, we never really expect to see them. These diseases are known as "zebras." Our usual montra is: "common things are common." That means those tough, less than straightforward, cases are usually an uncommon presentation of a common illness and not a common presentation of an uncommon illness. Regardless, we all secretly hope to be the one to come across the path of a zebra.
Yesterday, when my alarm clock rang, I didn't wake up thinking that this would be the kind of day that I would remember for the rest of my career. I went through the same morning routine and walked into the resident workroom at Children's at the same time - 5:57AM. I looked at the board and saw two new patients on my list. Before that moment my hope had been to not have anyone new so rounds would be a little less rushed. Afterall, without a single day off and three long call nights, I was exhausted. That hope quickly evaporated, and I sat down to get the scoop on the new kiddos from a couple of exhausted, and relieved, residents.
One of the new ones sounded particularly interesting. Especially because no one knew quite what was going on yet. There were several tests pending, so we were in hurry-up-and-wait mode. By the time rounds started and before we could dream up the random obscure things this could be, we had our answer... malaria! My first case of malaria!! While this disease affects millions of people in countries around the world, we don't see it here very often. Thankfully. (And don't worry, I don't expect there to be a Nebraska outbreak anytime soon.)
So, even though my morning ended up being a lot more hectic than I had anticipated. I am grateful for a great learning experience!
And the cherry on top of my sundae Friday was that I got to tap a knee at clinic later that afternoon. And the whip cream - a weekend off!! YEAH!
How exactly is malaria diagnosed (what lab does it show up in)?
ReplyDeleteMalaria is caused by a parasite transmitted by mosquitos. Once infected the parasite actually gets into red blood cells. It is diagnosed by a blood smear when a pathologist looks at the blood under a microscope and physically sees the parasite within the cells. I'm sure there are some good pictures on the internet if you googled it.
ReplyDeleteSo since malaria looks flu-ish...what made you suspect/test for malaria? It's just so random...Is it like you ran out of other tests to do and that was one that was left, or was it in the Hx that the kid had been out of the country?
ReplyDeleteThat is very interesting. Sorry to bug you. (pun intended) ;)
I was more interested in what the eosinophil % looks like for someone with malaria. I don't get to see many labs for people with parasitic infections. (poor kid, hope he/she is doing better). You might live to regret having a blog because you're going to have a curious nursing student asking you questions all the time.
ReplyDeleteWe suspected it based on the history, but given some other findings we would have done a blood smear anyway - not necessarily looking for malaria in particular. Basically, anyone who has an abnormal CBC that hasn't been explained will get a smear, and hopefully the pathologist will pick up on something like malaria whether or not you were suspecting it.
ReplyDeleteYour question about eosinohilia is a great one! I honestly don't remember, and I'll have to look tomorrow. You are right that it should be elevated in parasitic infections, but I don't know if the fact that it's an intracellular parasite makes a difference. Hmmm... ;)