Infectious Disease
Case 22: A Young Man Returning from Sub‐Saharan Africa Unwell and Drowsy
CASE
A 20‐year‐old Caucasian boy has just come back from a gap year in southern Africa. Prior to his trip he had been vaccinated for yellow fever/typhoid/tetanus and hepatitis A. He had good intentions of taking his malaria chemoprophylaxis but stopped it after 2 months.
He was brought into your hospital very unwell and drowsy. You were unable to take a history but on examination you found that he had a temperature of 39°C, heart rate of 120 beats/min and an arterial blood pressure of 95/70 mmHg. He had a respiratory rate of 25 breaths/min and his oxygen saturation was 98% on air. His chest was clear and there were no added heart sounds. He had a moderately enlarged spleen. There was no visible rash and he was Kernig negative. He had a normal central nervous system examination and there was no papilloedema on fundoscopy.
The following results were available to you:
Hb 8.4 g/dl WCC 14 × 109/L(75% neutrophils) Platelets 15 × 109/L CRP 300 mg/L ESR 40 mm/h U&Es Normal Albumin 25 g/L Bilirubin 50 µmol/L ALT Normal ALP Normal
Chest radiograph: normal
ECG: sinus tachycardia
Blood film: Plasmodium species identified with a parasite count of 15%
QUESTION 1
Your score this session: 0 of 0
What is Kernig's sign?