TWiP 255: Katayama Fever - Case Study and Discussion

• 0:07 Introduction: The episode focuses on a case of fever and dry cough in a 26 year old female volunteer from Georgia, USA, working in Guinea, and introduces a new case for listeners to solve.

• 1:22 Case Presentation: The returning volunteer, presents with fever, dry cough, and elevated eosinophils after working in a rural, inland area of Guinea. She took doxycycline for malaria prophylaxis.

• 3:14 Initial Treatment: Despite taking precautions, she develops symptoms, is initially treated with antibiotics (Augmentin and Coartem) empirically in the ER, without a clear diagnosis.

• 5:53 Lab Results: Reveal elevated eosinophils (8,000), normal liver function tests except for a slightly elevated ALT (44) and GGT (125), and stool samples positive for eggs. Malaria screens were negative. A chest X-ray showed bilateral pulmonary infiltrates.

• 6:51 Initial Mismanagement: The patient receives an unidentified medication at the first hospital, vomits, and is given a second dose before being discharged. Her symptoms worsen, and she returns with additional watery diarrhea and nausea. She is then admitted and treated with ceftriaxone, but continues to have fevers.

• 8:33 Correct Diagnosis: After a week, she is transferred, and the correct diagnosis of Katayama fever (acute schistosomiasis) is made.

• 37:56 Steroid Importance Dr. Lebronda notes the importance of treatment with steroids to help bring down inflimation, prior to giving treatment of prozyquatel.

• 9:54 Katayama Fever: This is an acute manifestation of schistosomiasis, characterized by fever, cough, eosinophilia, and pulmonary infiltrates.

• 37:37 Resolution: Her symptoms rapidly improve within 24 hours after receiving steroids, indicating the importance of this treatment in managing acute schistosomiasis, along with praziquantel (given later to address any potential adult worms).

• 39:17 Possible long-term exposure: The patient washed clothes in local contaminated water sources, leading to possible long-term exposure.

• 50:58 New Case Introduction: A man on eculizumab, a complement inhibitor, presents with left arm swelling in Borneo. Initial blood smears are negative, but a rapid immunochromatographic test is positive. Others in his village have similar symptoms and positive antigen tests. He is treated with a four-week course of an antibiotic (not an antiparasitic) and improves. It is stated that the condition is NOT Wuchereria bancrofti.