Treatment of Fifth Disease, Mononucleosis, and Kawasakis Disease - Case Study Example

Case Study This paper will provide a diagnosis, assessment, treatment and management of three diseases that can affect a 16-year-old female. It will show the signs and symptoms of these diseases. The three diseases that are affecting this teenage child is one of the following Fifth Disease, Mononucleosis, and Kawasaki’s Disease. With these differential diagnoses and the research that is available we will be able to delineate the better treatment that is needed and this will help the prevention of the others that will help educate them. This will also help us to screen for probable problems that could arise for each of these diseases. For each of these diseases a physical examination will have to be done to achieve a proper diagnosis of each. Keywords Fifth Disease, Kawasaki’s Disease, Mononucleosis, diagnosis, treatment, management, assessment, differential diagnosis Introduction A 16-year-old female (Jesse) presented with her mother (Mrs. B.) at the doctor’s office. Jesse states that the following subjective symptoms that she is experiencing included feeling extremely tired and fatigued, lack of appetite. In fact, she appears to have ‘tomato red cheeks’ as if someone slapped her. She also states that she has had a fever for the past 24 hours. According to the Mrs. B, she gave her daughter Tylenol for the fever, and noted that it was effective for a short period. She also revealed that they had just moved to California three months ago. Moreover, the patient had recently begun working as a teacher’s helper in a preschool. At the school a number of students had not reported to school due to a rash outbreak. In addition, Jesse also revealed that she had her period (menses) one week ago. Her mother asks a question about her own health for she happens to be five months pregnant. On further examination the objective symptoms that the patient presents are as follows: Vitals---- Temperature 101.4 Blood Pressure 100/68/48 Pulse 84 Respirations 20 Oxygen saturation 99% Weight 103 pounds Height 63 inches Patient is alert, cooperative, and exhibits no apparent distress. Physical Examination HEENT: Significant- bright erythematous cheeks bi-laterally and slight erythema of oropharnyx without tonsillar enlargement. NECK: Supples without lymphodenopathy RESPIRATORY: Lungs are clear anterior and posterior CARDIOVASCULAR: WNL with no murmur or rub GASTROINTESTINAL: Soft and non-tender without organamegaly; Patient also denies no nausea, vomiting or diarrhea. MUSCLOSKELETAL: WNL with erythematous of the hands and feet; papular lesions were exhibited; no bruises or other rashes present. NEUROLOGICAL: WNL, but does complain of pruritis (itching) of the hands and feet bilaterally and no non-specific rashes were present. The three differential diagnoses that this patient could be suffering from are Mononucleosis, Fifth Disease, and Kawasaki’s Disease. This 16 year old female is exhibiting prodromal symptoms (symptoms that occur before the actual onset of the disease) of these three diseases. Three Differential Diagnoses for this Patient Mononucleosis Diagnosis- Characterized by malaise, anorexia, chills and fever which is a prodromal symptom, pharyngitis and lymphadenopathy. Occasionally, the disorder comes on abruptly with high fever. Seek help when severe pharyngitis lasts for five to seven days. Only 90% of patients suffer from lymphadenopathy even though the patient shows no signs at this moment. Rashes that appear look like Rubella when it may appear. Although the disease is common with teenagers it also affects the elderly and the symptoms and management are the same. Screening- Most persons during adolescence and young adulthood and in the upper socio-economic classes in developed countries. Relatively asymptomatic when it occurs during childhood and confers complete immunity to the virus. It has been known as the ‘Kissing Disease’. You should check the EBX seropositive blood results even if it is not a highly contagious disease. Prevention and Management- The treatment for mononucleosis is not well defined. Moreover, being a viral disease the only available drugs are not objected towards treatment but rather towards relieving the symptoms. In addition to the drugs the patient is advised to; take plenty of fluids, freshen with warm salt water to ease a sore throat, rest, take acetaminophen or ibuprofen to suppress pain and fever ( Lerner, Beqaj, Gill, Edington, Fitzgerald, & Deeter, 2010). Kawasaki’s Disease Diagnosis- The symptoms of this disease are; presence of a fever that lasts for five or more days without another more reasonable explanation, rash, redness and swelling of hands and feet, fever, strawberry coloring. Prevention and Management- The treatment of this disease is mainly through; Aspirins- this helps in reducing the pain in addition to reducing blood clot risks, Immunoglobulin (IVIG) medication- it is injected into the veins for the purpose of reducing inflammation the blood vessels. Further due to the dryness in the skin it is recommended that the skin should be kept moist through the use of lotions ( Yap, Lin, & Wang, 2012). In addition, heavy doses of IV globulin are administered to the patient. Fifth Disease-(Erythema Infectioseum) Diagnosis- Erythema on the face and chiefly on the cheeks like they were “slapped cheeks” and this appearance disappears one to four days. About one day after a rash appears on the face there are macropapular red spots appear systematically distributed on upper and lower extremities and the rash progresses from the proximal to the distal surfaces and may last a week or more. The rash subsides but reappears if the skin is irritated or traumatized. The patient may have swollen joints (Broliden, Tolfvenstam, & O., 2006). Further, during pregnancy, serologic testing should be conducted to determine the immune status. Screening- This disease is known as another name Human Parvovirus B19 (HPV) and the infected persons do not know how it is transmitted and it is possibly a respiratory problem and with the secretions that contain blood. It has incubation period of 4 to 14 days and as long as 20 days. There is a period of communicably and it is uncertain but before the onset of most symptoms in most children for about one week (Staroselsky, MD, Klieger-Grossmann, MD, Garcia-Bournissen, MD, & Koren, MD, 2009). Prevention and Management- Take plenty of fluids; take acetaminophen like Tylenol to regulate the fever, however, sidestep aspirin as it may cause Reyes syndrome in a child with fever (Ramirez & Mastrobattista, 2005). Mrs. B should be very careful not to get the infection of the fifth disease because it causes complications if the patient is pregnant. Further, if the disease is transferred from the mother to the unborn child, then it may result to fatal implications. Consequently, it is known to cause anemia and this may translate to the baby’s blood count being lowered. However, if the disease is detected promptly, these effects may be tamed through proper treatment. Objective of healthy people 2020 In regards to communicable viral diseases, the objective of healthy people 2020 is to campaign through vaccines where possible. Moreover, under this scheme the four foundation health measures will continuously be evaluated. These foundations include; the general health status, the health- related quality of life and well-being, causes of health, and differences. Therefore, these foundations will deeply help in the management of the discussed communicable viral diseases. Caution for the pregnant woman It is important for pregnant women to safeguard their own health so that they can consequently transfer this to their unborn children. The health of the mother greatly determines the health of their unborn children. Therefore in order to move in line with the objectives of healthy people 2020 then campaigns must be adequately carried to protect pregnant women form various diseases. Recommendation The most suitable recommendation to diagnosis this patient is the one named Fifth Disease. The main reason being the signs of the “tomato red cheeks”; the complaints of the headache; fatigue and the fever. Consequently, it fits with the symptoms she stated in her hands and feet. These must be as a result of dry skin. Mrs. B should be more careful when around her daughter and should also use universal precautions when around her daughter due to her pregnancy. Notable also is the fact that she is not immune to the fifth disease and this might cause fatal implications on her unborn child. Lastly, both Mrs. B and her daughter Jesse should adequately rest so that they can suppress these symptoms and consequently recover. References Lerner, A., Beqaj, S., Gill, K., Edington, J., Fitzgerald, J., & Deeter, R. (2010). An update on the management of glandular fever (infectious mononucleosis) and its sequelae caused by Epstein–Barr virus (HHV-4): newand emerging treatment strategies. Virus Adaptation and Treatment, 135-145. Yap, C.-Y., Lin, L.-H., & Wang, N.-K. (2012). An atypical presentation of Kawasaki disease: a 10-year-old boy with acute exudative tonsillitis and bilateral cervical lymphadenitis. Clinics vol.67 no.6. Broliden, K., Tolfvenstam, T., & O., N. (2006). Clinical aspects of parvovirus B19 infection. Journal of Internal Medicine Vol 260 issue 4, 285-304. Ramirez, M., & Mastrobattista, J. (2005). Diagnosis and management of human parvovirus B19 infection. Clinics in Perinatology, Vol 32 (3), 697-704. Staroselsky, MD, A., Klieger-Grossmann, MD, C., Garcia-Bournissen, MD, F., & Koren, MD, G. (2009). Exposure to fifth disease in pregnancy. Journal of the College of Family Physicians of Canada Vol. 55 issue 12, 1195-1198. Read More