Monday, July 25, 2016

#AnswerTime: Female with weakness of lower limbs

Okay so answer tim! 
I posted a quiz time question here: http://www.medicowesome.com/2016/07/quiztime.html?m=0
Here's the solution to it. 

Sorry this got so late, I've had exams -.-

The diagnosis of the woman is Gullian Barre Syndrome.

Pointers to diagnosis -

Ascending type paresis, Hyporeflexia , Cyto-albuminological dissociation on CSF. And Nerve conduction studies were done (findings of which I find too complex so I did not  put them) but the fact that they did it shows peripheral neuropathy.
Also she was given IVIG so that's a huge clue too.
So here's clue 1. Campylobacter is generally associated with gbs.  But organisms like CMV and  influenza B can also be predisposing factors. But she went to Brazil (endemic for a current emerging infection ) and gave h/o rash associated fever.  Let's keep this in mind.
Now she got pregnant and the child had microcephaly.
Commonest causes for this would be syndromes like Patau or Edwards,etc. But the karyotype was normal and no other simultaneous dysmorphic features were seen. So those are ruled out.
No TORCH positivity. So rubella or CMV ruled out (so GBS couldn't have been because of CMV.)
Also, she hadn't given any h/o diarrhea.  So Campylobacter can be ruled out.
Her h/o travel to Brazil , occurrence of GBS and Microcephaly together point towards Zika Virus infection.
Zika has been associated with both GBS and Microcephaly. 
Since this association is not a causal one(strength not proven yet) , and all other causes have been ruled out , RT PCR was done for Zika and she was found + for it.

So the answers are 1,2,3,7
(Listerial sepsis is most often due to colonisation of mother. Intrauterine infection .)
(Cong rubella shows vertical transmission )
(Yf due to aedes)
Since sexual transmission also occurs , it'll be 1,2,3,7.

Hope you guys found this informative and fun. . Will keep posting 1 such question each weekThanks :)

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