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Diagnostic Challenge at Ben TaubFrom: Terrence.Jones@ncal.kaiperm.orgSat Oct 28 17:59:00 1995
Hep C does seem likely. BFP (biol. false pos.) shows up in app 2-3% (J Inf Dis, Dec/1994; 170:1579-81). You'd wonder how she contracted it, tho?! This ALT level is c/w acute infxn, and might also be assoc. with increased viral RNA load and hepatocellular damage (J Med Virol Mar/1993; 39:246-50). Just the same, be on the lookout for a false pos Hep C ELISA (J Med Virol Jul/ 1991; 34:143-7). You didn't tell us what the U/A showed -- was the "dark" urine bilirubinuria, or blood-tinged from hematuria? Also, if her crit's dropping from 33% to 24% - where's it going (guaiac/coomb's...)? Might want to r/o Dengue, as it's not uncommon in Mexico, may be assoc. with hematuria, and is freq. (70-90%) assoc with a mild transaminitis (Am J Trop Med Hyg Sept/1992; 47:265-70). Subtype viral serotesting or PCR for Dx. Obstetrical issues identified seem to not apply at this gest age -- 1) increased rate of NTD's (neural tube defx) in first trimester infxn (Int J Gyn Obs Dec/1992; 39:291-5); 2) possible vertical transmission in third trimester (Clin Infect Dis Feb/1994; 18:248-9). Epidemics, in recent past, around the Yucatan (Merida), and Taxco, were assoc. with open water cisterns, and occurred around the hot, rainy season (shorter viral replication in the mosquito vector). If the balmy fall weather in Houston supports Aedes aegypti, you might want to discourage any WATER births until the diagnosis is excluded, to avoid transmission thru the ward. :) T. Jones, KSF
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