Clinical Problem Solving

This problem will provide practice interpreting data and information on an infectious disease. The questions are those that the primary care physician and epidemiologist ask themselves and each other as they solve a clinical problem.

1. On April 10, a 2-year-old girl who resided in Asotin County, Washington, was taken to the emergency department of a regional hospital because of a 2-day history of unsteady gait, difficulty standing, and reluctance to walk. On physical examination she was afebrile, alert, and active, but could stand only briefly before requiring assistance. She exhibited ascending weakness and loss of reflexes that affected both sides of her body. Cranial nerve function was intact. Within several hours of hospitalization, she had onset of drooling and tachypnea. What diseases are possible? What additional information do you need?

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