Our sympathies go out to the populations affected by the unfortunate climate events in Texas, Nepal, India, Bangladesh, Yemen and Niger. In the coming days, it will be important for the medical community and public health officials to stay vigilant to potential infectious disease complications associated with these natural disasters. The next few cases highlight some potential flood-associated infectious disease consequences.

Case number 1:

A 45-year-old diabetic female presents to an emergency room in Dhaka, Bangladesh with a 3-day history of chills, high grade fever, cough, exertional dyspnea and pleuritic chest pain.  She was recently displaced from her home in a small village east of Dhaka during the monsoon storm. During her escape from the floods, she had to swim across a flooded ravine.

Upon examination she looks acutely unwell and auscultation of her lungs reveals bilateral crepitations. Small patchy bilateral infiltrates are seen on chest X-ray imaging.  Blood and sputum cultures are sent, and the patient is started on broad spectrum antibiotics.

Based on the above history what is the most likely diagnosis:

1. Malaria
2. Typhoid Fever
3. Melioidosis
4. Mycobacterial infection

Check back tomorrow for the solution.