I thought it might be avian bird flu since it's written that it's a fairly recent pathogen and is also prevalent in Thailand. However, the neurodegenerative symptoms don't match up. Could anyone help me make a diagnosis?

its mad cow disease!!!!!the necrosis of the liver and the severe mental state of the patient fit this possible diagnosis..

Seems like you will need to also find a disease that "nests" (gosh, I suck in biology, but I'm good with clues! for 45 days plus or minus (1 week in hospital + 10 days in american hospital + three weeks home).

 

It might be transferable by blood or bodily fluids, and it seems to me that it should also be hard to identify until it breaks out.

As far as I know, some diseases can be detected in the blood even before symptoms show - this doesn't appear to be the case here, since she was in 2 different hospitals since her accident (which is likely where she got sick) and none identified a problem. It might not be relevant, but..

 

Anyways, I'm curious, even just for general knowledge, do post your answer when you have one

IMO mad cow disease doesn't cut it because the time course is too quick, and no neural tissue was transferred.

I don't know a lot about differential diagnosis, but I do know examiners often ask unexpectedly difficult questions.

Is there any proof that there's only one disease involved?

how about leukemia? foreign DNA in the blood? could it be the bus driver's cancerous cells growing in her blood? [/kooky idea]

Mad cow disease is proteinaceous in origin, which might explain the foreign bits of protein?

I'm thinking something along the lines of acute hepatitis. Viral hepatitis at a guess, since the increased immune activity would indicate infection.

 

Doesn't really explain the neurological stuff though. And I don't recall having heard much of anything about hepatitis in 2008.

normally it would be an idea to hit the books, specifically the: Merck Manual of Diagnosis and Therapy, but if you don`t have this book then try here:

 

http://www.merck.com/mmpe/index.html

I narrowed it down to schistosomiasis, malaria, or hepatitis. I'm leaning towards Hepatitis D, which requires Hepatitis B to replicate. That would explain the different RNAs, and the one foreign DNA. Hepatitis B is a DNA virus that makes RNA intermediates, and Hepatitis D is a circular RNA virus. The recurrence of the symptoms after dormancy should also mean that it should be a virus instead of a bacteria. None of these seem like big news in 2008 but they're the only ones that had a good match-up of the symptoms.

Since schisto and malaria are both parasitic diseases, I'd have guessed that they would've shown up in the one of the biopsies, when the parasites would have been visible with a microscope.

From looking at the liver symptoms and the pale stools and dark urine symptomatic of a liver disorder, I would have guessed at yellow fever or hepatitis which both damage the liver causing necrosis of tissue. Yellow fever seems more common in Africa though.

The serology is also important because it will also help to lead you to the correct answer. All you need is a good search engine. Good luck.

Hep C? its pretty contagious and its an RNA virus so that might help explain some of the foreign RNA found. Not sure it would cause such a dramatic decline in such a short space of time though.

The answer was Hep B with Hep D satellite. So I got it right.

Nice. But how exactly was that a pathogen that was well known in 2008?

I think it is fairly well known? By virologists anyway!

I suppose I was expecting something that I had heard of on the news this year. Oh well.

AIDS?

idk guess he was lying. Hep D is older than 2008.

there's nothing inconsistent about the question's answer. Hep D is well-known now as it was in the past. it didn't say it was a disease which was in the news or a disease which was an epidemic. It just said a disease which was well-known.