Differential Diagnosis
- Single most likely diagnosis
- Malaria: The patient's symptoms of intermittent fever, headache, and hepatomegaly, combined with a recent trip to a subtropical location, make malaria a strong consideration. Although she drank bottled water and practiced proper hand hygiene, malaria is typically spread through mosquito bites, which could have still occurred during her trip.
- Other Likely diagnoses
- Giardiasis: Despite her precautions, giardiasis is a possibility if she was exposed to contaminated food or water. However, the presence of hepatomegaly and high fever makes this less likely.
- Hepatitis B: The patient's symptoms of loss of appetite, headache, and hepatomegaly could be consistent with hepatitis B, especially if she was exposed to infected bodily fluids during her medical mission.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- HIV: Although the patient's symptoms are non-specific, HIV infection should be considered, especially given her occupation as a physician assistant and potential exposure to infected bodily fluids.
- Typhoid fever: This diagnosis is less likely given her precautions, but it's a potentially life-threatening condition that should be ruled out, especially with symptoms like fever, headache, and hepatomegaly.
- Rare diagnoses
- Other tropical diseases (e.g., dengue fever, leptospirosis): These conditions are less likely given the patient's symptoms and precautions, but could be considered if other diagnoses are ruled out.
- Sugar (likely a typo, possibly referring to a different condition): Without further context, it's difficult to justify this as a potential diagnosis.
- Lois (unknown condition): This appears to be a typo or unknown condition, and without further context, it's impossible to justify its inclusion in the differential diagnosis.