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IM26.1-35 | Infectious Diseases — Assignment

CLINICAL SCENARIO

This assignment presents three unfolding clinical vignettes from different infectious disease syndromes seen in Indian tertiary care settings. You will construct a differential diagnosis, select investigations, write a drug-specific management plan using current national guidelines, identify the key complication to monitor for, counsel the patient, and reflect on antimicrobial stewardship. The three cases span bacterial CNS infection, vector-borne fever, and zoonotic disease — requiring you to demonstrate integrated application of the Infectious Diseases cluster competencies across the infection spectrum.

Instructions

Complete all six sections for the three clinical cases. Use specific drug names, doses, durations, and national guideline references throughout. Write in clear professional clinical language. Do not copy SDL text verbatim — apply your learning to the specific patient scenarios. Word limit: 1,200–1,600 words total across all sections.

Length: 1,200–1,600 words across all sections

What to Submit

Section 1: Syndromic Differential Diagnosis

Guidance: Read all three case vignettes below. For EACH case, construct a differential diagnosis structured around: (a) the predominant clinical syndrome, (b) the epidemiological exposure, and (c) the tempo and pattern of fever. Identify the single most likely diagnosis with a one-sentence justification naming the specific clinical or epidemiological clue that clinches it. CASE A: A 32-year-old college hostel student from Chennai presents with sudden-onset high fever (40°C), severe headache, vomiting, and neck stiffness for 16 hours. A non-blanching petechial rash has appeared on both thighs in the last 2 hours. His two roommates had similar fever last week. CASE B: A 40-year-old rice farmer from Assam presents in August with 4 days of fever, rigors, severe anaemia (Hb 5.2 g/dL), confusion, and scanty urine output. Peripheral blood smear shows multiple rings per RBC and banana-shaped gametocytes. CASE C: A 45-year-old goat farmer from Himachal Pradesh presents with 3 weeks of undulant fever peaking in the evenings, drenching night sweats, low back pain, and progressive weakness. He consumes unpasteurised goat milk daily. Approximately 200 words.

Section 2: Investigation Selection and Interpretation

Guidance: For EACH case (A, B, C): (a) name the single most valuable confirmatory investigation and explain WHY it is more valuable than alternatives at this clinical stage; (b) state the expected result that confirms your diagnosis (specific values, morphological findings, or titre thresholds); (c) identify one investigation that would be misleadingly negative at this stage and explain why. Approximately 250 words.

Section 3: Drug-Specific Management Plan

Guidance: Write a complete management plan for EACH case. For each drug: state the generic name, dose, route, frequency, and duration. Specify the national guideline or programme you are following (NTEP, NVBDCP, NACO, standard WHO). Include: (a) immediate resuscitation/supportive steps for Case A; (b) the correct ACT regimen for Case B including the rationale for adding primaquine and the mandatory pre-requisite test before giving it; (c) the combination therapy for Case C and why monotherapy is inadequate. Approximately 300 words.

Section 4: Complication Recognition and Escalation

Guidance: For EACH case, identify the single most dangerous complication that can develop if the condition progresses or treatment is delayed. For each complication: (a) name it precisely; (b) state the EARLIEST clinical sign (not late shock or coma — an early, actionable sign); (c) describe the specific escalation step the treating physician must take and within what time frame. Approximately 200 words.

Section 5: Patient Communication and Prevention Counselling

Guidance: Choose ONE of the three cases. Write a structured counselling script (not a bullet list — write as a narrative of the consultation) that covers: (a) how you would explain the diagnosis in accessible language; (b) why completing the FULL treatment course is critical for this specific disease (state what happens if treatment is stopped early); (c) one specific, practical prevention measure relevant to the patient's occupation and environment in India. The counselling must be empathetic, non-stigmatising, and culturally sensitive. Approximately 200 words.

Section 6: Antimicrobial Stewardship Reflection

Guidance: Choose ONE case from A, B, or C. Identify a specific stewardship principle illustrated by the antibiotic choice or resistance pattern in that case. Name the resistance mechanism that makes a previously effective drug less useful (e.g., why chloroquine is no longer used for P. falciparum in India, why fluoroquinolones have lost efficacy against S. Typhi, or why combination therapy is needed for Brucella). Propose one concrete stewardship action — at the level of a treating physician in a district hospital — that addresses this problem. Approximately 150 words.

Grading Rubric — Infectious Diseases Portfolio Rubric

Criterion	Points	Full-marks descriptor
Syndromic Diagnosis and Differential (Section 1): Constructs a structured differential diagnosis for each case using clinical syndrome, epidemiological exposure, and tempo of illness; correctly identifies the MOST LIKELY pathogen with explicit reasoning.	20 pts	All three differentials structured by syndrome + exposure + tempo; most likely pathogen identified with named epidemiological risk factor; at least one diagnostic key used (e.g., eschar, non-blanching rash, banana-shaped gametocyte) per case.
Investigation Selection and Interpretation (Section 2): For each case, selects the single MOST VALUABLE confirmatory test with explicit rationale; correctly interprets the expected result and explains what makes it confirmatory vs screening.	20 pts	Correct test selected for all 3 cases with clear rationale (timing, sensitivity, specificity); expected result stated precisely (e.g., CSF profile values for TBM, Brucella agglutination threshold, smear finding for P. falciparum); distinction between confirmatory and screening clearly made.
Management Plan (Section 3): Provides a complete, drug-specific management plan for each case using current national guidelines (NTEP for TB, NVBDCP/NKEP for malaria/kala-azar, NACO for HIV); includes drug names, doses, durations, and monitoring parameters.	25 pts	All 3 plans drug-specific (name, dose, route, duration) using correct national guidelines; monitoring parameters named (e.g., haematocrit in dengue, G6PD before primaquine, LFT in ATT); national programme context cited correctly (NTEP 2HRZE+4HRE, NVBDCP ACT schedule, NKEP L-AmB).
Complication Recognition and Escalation (Section 4): Identifies the ONE most dangerous complication for each case; states the earliest clinical warning sign; and describes the appropriate escalation step.	15 pts	Most dangerous complication named for all 3 cases; earliest warning sign is specific and early (not late shock sign); escalation step appropriate and actionable (ICU, surgical debridement, therapeutic LP); timing stated where relevant.
Patient Communication and Prevention Counselling (Section 5): Demonstrates a structured, empathetic communication framework for one case; includes diagnosis disclosure, treatment adherence rationale, and specific environmental prevention measure.	15 pts	Structured counselling framework present (acknowledge, inform, explain why, advise, check understanding); treatment adherence rationale is disease-specific (e.g., full 14-day primaquine for hypnozoite clearance; full 6-week brucellosis regimen to prevent relapse); prevention measure is specific and local-context appropriate.
Antimicrobial Stewardship Reflection (Section 6): Critically reflects on a specific stewardship principle illustrated by one of the three cases; identifies the resistance mechanism relevant to that organism; and proposes one stewardship action.	5 pts	Specific stewardship principle identified (not generic); resistance mechanism named (e.g., OXA carbapenemase in Acinetobacter, NARST in S. Typhi, OprD loss in Pseudomonas, efflux pump in MDR enterics); stewardship action is concrete and institution-level applicable.

PEER REVIEW

Review your peer's assignment using the rubric. For each section, assign a score and write one specific comment justifying the score — do not copy the rubric descriptor verbatim. For Section 3 (Management), verify: (1) that the ACT regimen for falciparum includes primaquine with the G6PD rationale; (2) that the brucellosis plan is combination therapy for 6 weeks, not monotherapy; (3) that the meningococcal management sequence is correct (cultures first, then dexamethasone + antibiotics, not LP first). Flag any use of chloroquine for P. falciparum or fluoroquinolone alone for typhoid as factual errors. Submit your review within 72 hours.