Clinical Mycology Case Three Biology Assignment Template For Faster Writing

1. A fever of unknown origin (FUO) in a patient with leukemia leads itself to a wide range of differential diagnoses. Traditionally FUO is divided into four categories: classic, nosocomial, neutropenic, and HIV-associated. Classic FUO can be a result of infections, malignancy, or collagen vascular disease. Nosocomial FUO is most likely due to C. difficle infections, pulmonary embolism, or an infected catheter. Neutropenic FUO can be caused by opportunistic bacterial or fungal infection. Lastly, HIV FUO can be due to M. avium-intracellulare complex or P. carinii. Most likely because of the patient’s WBC count and history of leukemia, an opportunist bacterial or fungal infection are high on the differential diagnosis list.
2. To further confirm the diagnosis of an opportunistic infection, a physician should obtain a blood culture and a biopsy of the lesion to identify a potential infectious agent. Secondly, the doctor should order a head, chest, and abdominal CT scan to rule out any malignant lesions or infection abscesses. The CT can also rule out a pulmonary embolism. Lastly, the physician can obtain an HIV test to rule out an HIV-associated FUO.
3. Based on the patient’s history of leukemia and preliminary blood culture results, the most likely diagnosis is an opportunistic fungal infection as opposed to a bacterial infection. When the wet prep is analyzed, there were branching hyphae and sickle-shaped macroconidia. Taking this knowledge along with the combination of the patient’s leukemia and physical findings, and bloodwork, the most likely organism is Fusarium spp.
4. With the presumptive diagnosis as a Fusarium spp. infection, the physician should begin treating the patient with voriconazole or a lipid formulation of amphotericin B to treat the offending organism. The physician should not admit the patient because of the risk of developing a nosocomial infection. The patient should also have repeat blood cultures taken to determine if the fungus is cleared from the bloodstream after therapy is finished. Lastly, the physician can think about administering anti-fungal prophylaxis.