Problem
Cristina Esplanada, 28 years old, call center agent, female, presently residing in Sampaloc, Manila, consulted a private MD due to back pains. This started 5 days PTA, when she experienced body malaise and frequency in urination. Three days PTC, she began having flank pain more on the lumbosacral area described as stabbing pain. No medications were given. Two days PTA, she was noted to have moderate grade fever, good appetite and irritable with the flank pain increasing in severity. Paracetamol 500mg /tablet was given that gave temporary relieved. Few hours PTA. patient noted his urine was to be of unpleasant smell and with the recurrence of fever. With the above signs and symptoms, patient decided to seek consultation to the nearest hospital.
Physical Examination
• General survey: conscious, coherent, active, not in respiratory distress.
• Vital signs: BP: 120/70 mmHg Temp: 37.0 C CAR: 110 beats/minutes RR: 20/minute
• Skin: fair skin turgor, CRT< 2 seconds
• HEENT: moist lips, eyeballs no sunken, no tonsillopharyngeal congestion
• Abdomen: flat, hyperactive bowel sounds, (+) kidney punch test on the left
Laboratory Procedures were done with the following results:
• Urinalysis: WBC: TNTC with WBC casts
• Urine culture: Gram (-) bacilli, non- lactose fermenter, greenish metallic sheen culture in EMB
• Ultrasound of the Kidney, ureter and Urinary bladder: presence of small inflammatory exudates in the kidney capsule; pyramid is slightly dilated in the left kidney; both kidneys are not enlarged
Task
A. Based on the salient features of the patient, what is the diagnosis? Justify
B. Identify the most likely causative agent based on the results of the tests. Name at least 2 other pathogens that cause the disease and differentiate them based on their biochemical and physiologic properties (enzyme/s present, IMViC tests, cultural characteristics)
C. Define the disease.
D. Thru a concept map, explain the pathophysiology of the disease.
E. What other laboratory work up can be done to do to support the diagnosis?
F. Formulate your plan of pharmacologic and non- pharmacological management.
G. What are the complications that may arise from the disease?
H. What can be done prevent further complications to occur?