【正文】 infection, which may have many causes. Vital hepatitis would not produce lesions seen in the CT scan. The more mon causes are listed above. Hydatid cyst is a possibility when appropriate epidemiology is present.COURSEGiven the patient’s clinical status, she was taken to the operating room. The liver lesion was pletely removed surgically, and the biliary obstruction was relieved. The patient received an antihelminthic drug postsurgery. An ELISA and subsequent immunoblot test for antibodies against a tapeworm confirmed the specific etiology.病例十七A 9yearold boy was brought to the hospital by his parents with plaints of repeating intense chills and daily high fever for 4 parents said that when his fevers would abate,he would bee drenched in sweat and feel exhausted and drained. The parents also reported diarrhea, nausea, and abdominal pain. On the days of admission the patient was noted to be lethargic and difficult to arouse. A generalized seizure was witnessed in the emergency departmentThe family had immigrated to the United States from West Africa 3 weeks before the onset of the current illness.PHYSICAL EXAMINATIONVS: T 40℃ , P 140/min, R 28/min,BP 82/40 mm HgPE: Thin male minimally responsive to verbal mands. Pupils were reactive and neck was supple. Conjunctiva was pale, and abdominal exam showed hepatosplenomegaly.LABORATORY STUDIESBloodHematocrit: 18%WBC: 16300/μL Differential: 50% PMNs, 15% lymphs, 20%bands.Platelets: 42000/μLBlood gases: , Pco230mmHg, Po2mmHgSerum chemistries: Glucose 40mg/dL,BUN45mg/dL, AST240U/L,ALT310U/L, LDH820U/L, ImagingHead CT was unremarkable.Diagnostic WorkUpTable 791 lists the likely causes of illness (differential diagnosis). Investigational approach for specific microbiologic diagnosis may includeLumbar puncture and CFS examination to rule out bacterial meningitis. Blood cultures to detect bloodborne bacteria Thick and thin smear for bloodborne parasites In failed diagnosis, virusspecific serology for the listed infections. Table 791 Differential Diagnosis and Rationale for Inclusion (consideration)African trypanosomiasisAspetic meningitisBabesiosisBacterial meningitisDengue feverLeptospirosisMalariaTyphoid feverRationale: A diagnosis shouble be aggressively sought in patients who present with sever It is always important to rule out bacterial meningitis is important for a patient to determine the possible history of exposure in an area endemic for a variety of fever and parastic infections are geographically limited, so a good history of travel is important as well. Babesiosis is found in the northeastern and upper Midwestern ., and leptospirosis is associated with animal exposure. Dengue, malaria, and trypanosomiasis are all endemic in Africa, with the latter two infections typically causing periodic fever.COURSEThe patient was admitted and required mechanical ventilation for impending respiratory puncture was performed, which was normal. Blood cultures were drawn and were negative for bioodborne pathogens. Based on the given history of travel,thick and thin blood smears were performed and yielded a diagnosis. 病例十八A 30 yearold white women was brought to the emergency department of a local hospital with a 2week history of progressively severe headache, nausea, and vomiting。穿刺液內(nèi)查到棘球蚴的原頭節(jié)，經(jīng)包蟲皮試和ELISA試驗(yàn)均為強(qiáng)陽性，診斷為肺棘球蚴病；即行左下肺切除術(shù)。109/L，中性粒細(xì)胞和嗜酸性細(xì)胞增高；肥達(dá)氏反應(yīng)：O凝集素1∶80，H凝集素1∶160；三次糞便直接涂片檢查均陰性。同時(shí)再次進(jìn)行血檢，結(jié)果在血中檢獲有瘧原蟲，經(jīng)防疫部門鑒定，血片中瘧原蟲滿視野為惡性瘧原蟲。問題：1．該患者可能從哪些途徑感染豬帶絳蟲的？2．該患者經(jīng)吡喹酮治療后，如何確定驅(qū)蟲療效?3．用什么藥物驅(qū)蟲可較好的確定驅(qū)蟲效果？4．該患者驅(qū)出成蟲后還應(yīng)注意什么問題？病例十陳，女，28歲，江西人，南昌市郊務(wù)農(nóng)。以畏寒，發(fā)熱伴乏力1周為主訴入院。三天前在廠醫(yī)院就治，服用黃連素和克感敏3天，不見癥狀緩解。糞常規(guī)：黃色，隱血陽性。20次/分，Bp因經(jīng)?？人砸约翱妊到?個(gè)月，大便有時(shí)呈黑便，消瘦一個(gè)月余入院治療。 體檢：℃,否認(rèn)其他病史。:Young child in moderate distress due to abdominal pain. Abdomen was distended and mildly tender.LABORATORY STUDIESBloodHematocrit: 38%WBC: 4500/μLDifferential: 62% PMNs, 23% lymphs, 12% eosinophils(eosinophilia)Serum chemistries: NormalImagingXrays of her abdomen were consistent with intestinal obstruction.Diagnostic WorkUpTable 491 lists the likely causes of illness (differential diagnosis). Intestinal worm infection was considered based on clinical features and xray evidence. Diagnosis is confirmed by identification of ova and parasites by microscopy of trichrome or iodinestained concentrated fecal specimens. TABLE49－1 Differential Diagnosis and Rationale for Inclusion (consideration)AppendicitisIntestinal helminth infection Ascaris lumbricoides Schistosoma spp Taenia spp Trichuris trichiuraSmall bowel obstruction from volvulusRationale: Abdominal symptoms with eosinophilia have a relatively limited differential, mainly parasitic infection. The various causes