Rafting Trip Leads to Fever, Chills, Myalgia – Let’s Diagnose

A 13-year-old girl was brought to urgent care by her mother due to fever, chills, dry cough, and myalgia. On examination, the patient had a temperature of 101°F (38.3°C). There was conjunctival injection and blanching patches on the face and neck. When asked about travel history, the mother mentioned that the family had recently visited Brazil. During their travels, they ate local food, drank local (unfiltered) water, sustained a few mosquito bites, and went white water rafting. The patient’s symptoms began approximately 1.5 weeks after their return home.

Is it malaria, leptospirosis, legionellosis, or influenza?

Can you diagnose the patient? Use the Differential Builder in VisualDx to help you.


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