nPhysicians name: Prim J., Nutchanon B., Pichayathida S., Kanyapat T.

Progressive notes:
A 24 years old male patient from Bangkok without any reported congenital disorder. Just
returned from a country with reported influenza outbreak.
CC (chief complaint): High fever (temperature read 38.9C) for at least 3 days, muscle aches,
fatigue
Dx (Diagnostic): Bacterial infection
Rx (Pharmaceutical treatment): Antibiotics, aspirin
Lab result:
Hematology CBC (Complete blood count)

Count References
Hb (Hemoglobin): 11.6 gm% 13.5-7.5%
Hct (Hematocrit): 38% 39-49%

Erythrocyte: 5.8 M/uL 4.3-5.7 (x10# /)

Platelet count: 403.0 t/mL 150-450 x10( /l
WBC count: 13,150 3,500-10,500
WBC differential:
Neutrophil 71% 57-67%
Monocyte 6.3% 3-7%
Lymphocyte 21.5% 23-33%

Eosinophil 1.2% 1-3%

Basophil - 0-1%
RBC morphology: Normal

From your knowledge of immunology, what would you diagnose this patient from the
progressive note and lab result?

Bacterial infection high WBC count, neutrophilia, having fever for about three or
more days

RESEARCH further from the suspected disease on your diagnostic, what would be your
treatment for this patient?

Ask further: color of mucus, sore throat or not, did the fever go up or down compared
to the first day
To be sure: run seven-gene blood test to determine whether if its bacterial infection or
viral infection
If bacterial infection (more likely)
 Take antibiotics: Zithromax/ Augmentin/Amoxi-clav
Aspirin/paracetamol to treat fever
Optional: to have another blood sample diagnosis or urine sample diagnosis or
culture test in order to identify the type of the bacteria.
If the sickness still remains after a while (more than a week or so), the patient should
come and get further diagnosis and treatment.

If viral infection (less likely):

Aspirin/paracetamol to treat fever

Take antiviral medications
If the condition worsen, the patient should return to get further diagnosis and
treatment