Accurate diagnosis is among the pillars of the medical profession. Practitioners endeavor to diagnose their patients with the exact illness that they are ailing from. However, cases of misdiagnosis are common. Misdiagnosis poses a threat to the health of patients and is responsible for the administration of unnecessary and potentially harmful treatment (Solomon & Weinshenker, 2013). That different illnesses share symptoms is among the factors that set the stage for misdiagnosis. When diagnosing a patient, practitioners must exercise great care. They may rely on differential diagnosis which allows them to rule out particular possible illnesses and identify the actual ailment.
Case description
The patient was a 7 year old boy. When he came in, he complained of a sore throat and fever. Given these symptoms, we suspected that he had developed a viral illness. This initial assessment was based on the fact that various viral illnesses manifest through these symptoms. For example, it is understood that a sore throat can accompany a cold or flu which is the result of a viral infection (CDC, 2015). After further examination and tests, it was established that the child had picked up a mononucleosis (mono) infection. After it had been determined that the child had contracted mono, treatment was offered immediately. The mother who accompanied him was provided with additional instructions regarding such issues as how often the medication should be administered and the measures to be taken to prevent re-infection.
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Assessment and treatment
Apart from a sore throat, fatigue, fever, headaches, rash and swollen lymph nodes are other symptoms that those ailing from mono present with (CDC, 2016). These symptoms were relied on for assessing the patient. It was observed that he felt fatigued and suffered recurrent headaches. It was also noted that he had a rash. In most cases, the symptoms are the only considerations that practitioners make to diagnose mono. However, blood tests may also be carried out (CDC, 2016). For a patient with mono, the results of the blood test should reveal a number of key helpful insights. For example, the white blood cells should be unusual in appearance and too numerous (CDC, 2016). The blood should also have unusually low number of platelets. The blood test should also reveal that the patient’s liver does not function normally.
With the assessment carried out, the next step was the administration of treatment. It should be noted that no particular treatment for mono has been developed. Patients are usually offered medication that treats specific symptoms. For example, corticosteroid is offered to the patient with the aim of addressing the sore throat and the swelling of the tonsils. The patient may also be provided with medications that are available over the counter and are used to treat such symptoms as fever and sore throat.
Additional assessment, screening, treatment, follow-up and teaching
The administration of treatment does not mark the end of the mandate of the practitioner. It may be necessary to carry out additional assessment, screening, treatment, follow-up and teaching. Since mono shares symptoms with other illnesses, additional tests may be needed to rule out the other illnesses. Such other tests as monopost test may be carried out to ascertain that the patient is ailing from mono and not another infection (“Infectious Mononucleosis”, n.d). The EBV antibody test may also be carried out. As already observed, there is no particular treatment for mono. The patient is simply provided with medication for specific symptoms. Apart from the medication, the patient may engage in certain activities that enhance recovery. For example, plenty of rest and consuming huge amounts of water have been shown to aid recovery (CDC, 2016). Given that the symptoms of mono typically last for months, it is important to conduct follow-up. The follow-up is intended to evaluate the effectiveness of the treatment offered and to determine if additional interventions are needed.
The activities mentioned above will enhance the welfare of the child. In addition to these activities, it is crucial to conduct education. Particular focus should be given to the activities that the patient should avoid during the recovery period. Patients ailing from mono are usually advised against engaging in sports as this could cause their spleen to rupture. Patients are also instructed to avoid such medications as ampicillin and amoxicillin (CDC, 2016). These are some of the issues that will be addressed when educating the child’s mother.
Differential and zebra diagnoses
As already noted, mono shares symptoms with other illnesses. To ensure that the diagnosis is accurate, it is necessary to conduct differential diagnosis. As part of this diagnosis, consideration should be made for the zebra (the illness with a very low possibility of being responsible for the symptoms). Some of the illnesses that share symptoms with mono include viral illness, strep throat and meningitis. Sore throat, runny nose, lethargy, fever, coughing, vomiting, diarrhea and watery eyes are among the symptoms that accompany viral illnesses (“Viral Illness”, n.d). Some of the symptoms of strep throat include pain when swallowing, throat pain, swollen tonsils, swollen lymph nodes, rash, fever, headache, nausea and body aches. Vomiting, headache, drowsiness, muscle pain and confusion are among the symptoms of meningitis (“Signs and Symptoms”, n.d). Since strep throat, viral illness and meningitis manifest through symptoms that are similar to those of mono, the three illnesses should be the differential diagnoses.
The identification of the differential diagnoses is important as it narrows down the illnesses that the child could be ailing from. However, it is important to initiate procedures for ruling out these illnesses. Subjective and objective information can be used for this purpose. The subjective information includes the observed symptoms that the patient presents with. For example, to rule out strep throat, the practitioner should look for enlarged tonsils and white patches on the throat. These symptoms typically accompany strep throat. Merely assessing the symptoms is an unreliable method for ruling out the differential diagnosis. It is important to carry out tests which provide reliable and objective insights. Strep test and throat culture are some of the tests that can be carried out to determine if the patient has indeed developed strep throat (CDC b, 2016). To determine if the patient has meningitis, standard blood tests may be carried out. CT scans and lumbar puncture also aid in the diagnosis of this illness (Theobald, 2014). A blood test can be conducted to rule out viral illness.
Venezuela hemorrhagic fever is the zebra diagnosis. Some of the symptoms of this illness include fever, headache, convulsions, sore throat and arthralgia (“Venezuelan Hemorrhagic Fever”, n.d). While it is true that this illness has symptoms that are similar to those of mono, it should be ruled out. Some of the symptoms provide the subjective basis for ruling out this illness. For example, since the child did not display arthralgia or convulsions, it would be safe to rule out the illness. These symptoms do not provide a solid foundation for eliminating this illness as a possible cause of the child’s symptoms. The main objective information used to rule it out is the fact that it is a very rare disease (“Venezuelan Hemorrhagic Fever”, n.d). It is therefore very unlikely that the child has contracted it.
The case of the child highlights the need for caution when diagnosing patients. The child presented with symptoms that are associated with a number of infections. To accurately diagnose the child, the symptoms were examined. In addition to this examination, laboratory tests were carried out. The tests allowed for the elimination of such illnesses as strep throat and viral illness as the cause of the child’s symptoms. When handling patients, practitioners must be thorough and exhaust all possibilities.
References
Centers for Disease Control and Prevention (CDC). (2015). Sore Throat. Retrieved 29 th
September 2017 from https://www.cdc.gov/getsmart/community/for-patients/common-illnesses/sore-throat.html
Centers for Disease Control and Prevention (CDC). (2016). About Infectious Mononucleosis.
Retrieved 29 th September 2017 from https://www.cdc.gov/epstein-barr/about-mono.html
Centers for Disease Control and Prevention (CDC b). (2016). Worried your Sore Throat may be
Strep. Retrieved 29 th September 2017 from https://www.cdc.gov/features/strepthroat/index.html
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https://www.healthline.com/health/mononucleosis#overview1
Signs and Symptoms in Children and Adults. (n.d). Retrieved 29 th September 2017 from
https://www.meningitisnow.org/meningitis-explained/signs-and-symptoms/signs-and-symptoms-children-and-adults/
Solomon, A. J. & Weinshenker, B. G. (2013). Misdiagnosis of Multiple Sclerosis: Frequency,
Causes, Effects and Prevention. Current Neurology and Neuroscience Reports, 13 (403).
DOI: https://doi.org/10.1007/s11910-013-0403-y
Theobald, M. (2014). How Meningitis in Diagnosed in its Early Stages. Retrieved 29 th
September 2017 from https://www.everydayhealth.com/hs/understanding-meningitis/how-meningitis-is-diagnosed-in-its-early-stages/
Venezuelan Hemorrhagic Fever. (n.d). Retrieved 29 th September 2017 from
http://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=en&Expert=319234
Viral Illnesses. (n.d). Retrieved 29 th September 2017 from
https://www.rch.org.au/kidsinfo/fact_sheets/Viral_illnesses/
