Ashanti C., a 37-year-old Chadian Woman, was admitted to the Emergency Room at Bon Secours Richmond Community Hospital, in Richmond Virginia. She complained of an illness that was getting progressively worse and thinks it may be related to her Sickle Cell Disease. Symptoms exhibited were a low-grade fever, nausea, dizziness, and generalized feeling of greater fatigue for the last two weeks. She states that she has also noticed a pruritus rash and notes she has had bilateral extremity swelling develop over the past week, which is seemingly worse in the left limb (Centers for Disease Control and Prevention, 2018). She also states that she has had to dramatically reduce her activity level and has been unable to work over the past week, due to the pain and swelling in her lower extremity. The patient’s past medical history includes sickle cell anemia, blood transfusions, chronic pain, leg ulcers, malnutrition, and frequent lower respiratory tract infections (Mayo Clinic, 2018). Her past surgical history includes a splenectomy approximately 18 years ago (Maakaron, 2018). The patient denied any frequent alcohol consumption or illegitimate drug use. The patient also denied any environmental or food allergies.
When asked about her lifestyle she stated that she tends to exercise daily, and that she eats very healthy. She states that she is currently employed as a secretary for a law firm in her community at this time. She brought it to our attention that she is an immigrant from Chad, Africa. She told of how she journeyed to the United states twenty years ago with other members of her village with the hopes of living a better life, and that she has only recently settled in Richmond, Virginia where she met her husband Paul, who is a professor at the University of Richmond. There he teaches molecular biochemistry.
The patient does admit to recently traveling outside of the United States to her home country of Chad (World Health Organization, 2018). She says that she had gone to visit her dying grandmother the previous year. While she was there she states that she assisted with many of the chores to help her family in their time of need. These tasks included grinding millet, caring for the children and livestock, and gathering her family’s water supply from a nearby pond, all of which are things she used to do (Countries and their Cultures, 2018). She claims that upon her arrival back to the states that she had felt the way she typically does as a victim of sickle cell anemia, and despite being predisposed to constant sickness and infection, she had only recently fallen so ill (Mayo Clinic, 2018). She rejects any recent trauma to the lower limb, insect bites, exposure to poison ivy, or chance of pregnancy.
Vital signs were documented as follows: oral temperature 101.2 degrees Fahrenheit, noninvasive blood pressure 136/88 taken from right arm, heart rate 72 bpm in sinus rhythm, oxygen saturations 96% on room air, respirations 16 beats per minute and nonlabored. One-sided weakness can be noted in left lower extremity, otherwise the patient seems to be neurologically intact. Lung sounds were clear upon auscultation in both upper lobes and bases with equal expansion. Capillary refill time was not delayed (Maakaron, 2018). The patient’s weight is 160lbs and her height is 5’9. Patient is awake, and she is alert and oriented times four.
Significant blister formation was noted near lateral malleolus region of the left extremity. The blister had peripheral redness and showed signs of infection. The patient’s remaining skin is intact and normal (Dahwan, 2018). Bowel sounds were noted in all quadrants, and upon abdominal palpation the patient denied any pain. Patient is urinating appropriate quantities of clear yellow urine without strain. Last bowel movement was noted this morning with slight diarrhea (Centers for Disease Control and Prevention, 2018). Diagnostic values include a slightly elevated white blood cell count for a sickle cell patient of 20.1 with an indication of eosinophilia (Dhawan, 2018). Hemoglobin and Hematocrit 6.2/20, while patient’s platelet count was increased. Current medications include Hydroxyurea, Percodan, ibuprofen, nortriptyline, folic acid, glutamine, and deferasirox for the treatment and management of her Sickle Cell Disease (Maakaron, 2018).
It was originally determined that the patient’s blister was just a side effect of her Sickle Cell Disease which be a complication of this disorder (Mayo Clinic, 2018). The patient was given antibiotics to treat the blister due to suspected infection, and she was sent home with the instructions to return if pain and symptoms did not resolve within a couple of days. It was just five days later when the patient returned. She stated that the blister had begun to feel like a burning hot coal within her leg, and that the pain was simply unbearable (Centers for Disease Control and Prevention, 2018). She explained how the blister had grown to be even larger over the past week and that she has had ulcers in the past and that this one was unlike the others. She stated that the blister had ruptured just that morning while she was in shower and showed the now exposed wound that remained on her left leg (Centers for Disease Control and Prevention, 2018). She described having a decrease in pain after the blister burst and a sensation that there was something moving within the ulcer (Dahwan, 2018).
Upon further examination of the ulcerated region of the patient’s left leg, it should be noted that there was indeed a worm infestation within the lesion, however, it is unknown at this time the infectious agent. The worm emerged from the blister when the wound was being cleansed with normal saline solution and therefore seems to have an affiliation with water (Centers for Disease Control and Prevention, 2018). Additional research will be required for a definitive diagnosis.
Diagnosis was confirmed as Dracunculiasis which is also known by the name of Guinea Worm Disease (Chris, 2018). This disease is caused by the nematode Dracunculus medinensis (Centers for Disease Control and Prevention, 2018). Dracunculiasis is very rare within the United States and is seen scarcely in individuals who have recently traveled to endemic countries. This diagnosis was confirmed on the basis of specimen identification, patient history, and symptom presentation. The head of the specimen that was residing in the ulcer that had developed in the region of the patient’s lateral malleolus of the left leg was undoubtedly a guinea worm and allots a definitive diagnosis (Dahwan, 2018). The worm’s eruption from this sore was characteristic in timing, approximately one year after the patient had traveled to the foreign country of Chad. The country of Chad is one of the few remaining countries that still reports a miniscule number of guinea worm infections annually following the eradication efforts that have since been put in place by the Carter Center (World Health Organization, 2018). There in the country of Chad, the patient likely ingested a contaminated water source containing water fleas that had swallowed the guinea worm larvae. Once the patient ingested the water fleas, the stomach acids successfully destroyed them, however this destruction allowed the larvae that the water flea had consumed to enter the gastrointestinal tract.
The patient’s plan of care will include interventions that maximize the patient’s energy level, promote rest, and control pain levels. Interventions that can be taken outside of the aspect of comfort are very negligible. Treatment and management of guinea worm disease is very primitive in nature. Successful removal of the guinea worm is only accomplished when the entire body of the worm has exited the ulcer.
I greatly enjoyed writing this Case Study on Guinea Worm Disease. At the beginning of Microbiology, I had assumed that I would likely end up writing this assignment on a bacterial or viral disease. Afterall, those are the microbes that you cannot see with the naked eye. Once I saw the Guinea Worm slide during Microbiology lecture, however, it immediately caught my eye. I was fascinated in this strange infection in which I had never heard of. It was unbelievable to hear of a disease that no one had yet found a treatment or vaccine for. Writing this Case Study on Guinea Worm also opened my mind to the fact that there are so many diseases that exist in underdeveloped countries that go unnoticed simply because they rarely occur in the Western World. Never in my entire life had I heard of a worm that could only be reeled out of the human body with a stick in the nightly news, despite the number of people who were infected in eastern countries being as high as 3.5 million per year. For me, that seems unreasonable that this number was so high because this disease is easily preventable by having access to clean drinking water. It saddens me to know that so many people’s lives were deeply altered after contracting this painful disease and the secondary infections that consequentially follow, yet I am happy that some people, such as the people involved with the Carter Group, cared enough to make a change. Through educational methods, this group has helped to nearly eradicate Guinea Worm from the World.
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