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
- Hepatitis B: The patient's hepatomegaly and symptoms such as loss of appetite and fever could be indicative of hepatitis B, especially given her occupation as a physician assistant, which may have exposed her to bloodborne pathogens during her medical mission.
- Giardiasis: Despite drinking bottled water, the patient could have still been exposed to giardiasis through contaminated food or other means. However, the presence of hepatomegaly and high fever makes this diagnosis less likely.
- 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 can present with a variety of symptoms, including fever, diarrhea, and hepatomegaly. Given her occupation and potential exposure to bloodborne pathogens, it is crucial not to miss this diagnosis.
- Typhoid fever: This diagnosis is also a consideration given the patient's symptoms and travel history. Typhoid fever can present with fever, headache, and hepatomegaly, and is often contracted through contaminated food or water.
- Rare diagnoses
- Shigellosis: While shigellosis can cause diarrhea and fever, the presence of hepatomegaly and the patient's travel history make this diagnosis less likely. Shigellosis is typically spread through contaminated food or water, which the patient attempted to avoid by drinking bottled water and practicing proper hand hygiene.
- Other tropical diseases (e.g., dengue fever, leptospirosis): These diagnoses are possible given the patient's travel history, but are less likely given the specific symptoms and physical examination findings presented.