Problem
A 29 year old female reports to her GP complaining of nausea and diarrhea, body aches, chills and night sweats. Her physician notes a low grade fever of 100.4 oF. She asks the patient about her energy levels, the patient says she has been feeling fatigued lately. Her physician notes bilateral posterior cervical adenopathy. The GP asks about sexual partners and she says she has had two partners in 3 years and one being within the last month. The GP asks about protection and the patient replies always during penetrative intercourse. The GP orders a CBC and differential, both were mostly unremarkable except for a slight lymphocytosis indicative of a viral infection. No manual diff was performed. A monospot was performed and was negative (Monospot sensitivity=85%). Even with this the GP was confident the patient had contracted Epstein-Barr (EBV mononucleosis). The GP explains this and sends the patient home telling her to get as much rest as possible and everything should clear in a month or so. The GP also suggests her partner be tested for EBV.
A. Was the GP justified in making this diagnosis? Why or why not?
B. What symptom(s) above are not indicative of EBV?
About a year later the patient returns and says her symptoms cleared up in 2-weeks and she was fine until a few weeks ago. The patient complains of being extremely tired and has had diarrhea for 2-weeks. The GP takes a stool sample and results show cryptosporidiosis.
C. Considering the clinical timeline and crypto what is the very next test the GP should order?
D. Considering the above and what would you expect to see if the GP orders a CBC with diff now?
E. What is the probable infection?
Is the probable organism easily distinguishable from EBV without serological tests? Should the GP have ordered the test in question 3 a year ago?