23 years male pt come with law grade fever since 8/8/16 CBC MP (8/8/16) s/o TC:10200,HB:12.3,PCV:36.9,MCV:72.78,MCH:24.26,Platelets:195000,WIDAL(slide):negative treated with IV fluid 1 litre per day, cefreiaxone 1gm BD & supportive Rx given pt remain afebrile for 2 days but from 10/8/19 T:99.5 with chills ,headache bodyache,nausea and vertigo so repeat CBC mp done s/o HB:10.2,RBC:4.41,PCV:32.3,MCV:73.24,MCH:23.13,MCHC:31.57,TC:3500,Platelet: 88000,MP:ring and trophozoites of P.VIVAX(++). treatment ::: inj.RTsunate 120mg BD inj.DNS/RL @ 120ML/HR INJ.EMESET 4MG BD INJ.RANTAC 2CC BD INJ.FEBRINIL SOS INJ.VITCOFOL 2CC OD above treatment continue since 10/8/16 temperature chart: T:99.5 on 10/8/16 T:101.8 on 11/8/16 T:102.2 on 12/8/16 issue : fever spike increasing,vertigo ,vomiting and appetite decrease , please review this case and help me for further management report of date 12/8/16 attached here report of date 14/8/16: Hb-11.2,TC:9000,Platelet count-53000,MP-negative current issue: platelet decreasing,weakness,appetite decrease. but no fever,no rashes,no nausea and vomiting what can I do?? orally Rx. lumex forte BF emeset 1BD pantocid 1BD calpol 650 sos if fever /headache plz suggest me further Rx



Patient has a relapsing remitting kind of picture. Wether due to malaria or not is yet to be ascertained. Lets look at the case anew and think fresh.What are the possible causes of fever with chills. 1. Infection. points to look for:- any systemic complaints any findings on examination. what was the TLC in the second report. any lymphadenopathy. 2. Malaria: points to look for: fever which subsides with diaphoresis. since fever is for a week there may be slight icterus. hepatomegaly &/ splenomegaly. repeat MP( and not MPDA ) in the febrile phase . If still positive add doxycycline for it too has anti malarial properties. 4. Enteric fever. points to see:- any gi complaints pain abdomen , constipation , diarrhea check for IPS any gurgling sound if present ( absence doesnot rule out typhoid but presence is strongly suggestive of typhoid.) any rose spots on skin since its the second week of fever. widal test to be done. 5. Hepatic abscess- points to look for - pain abdomen dull aching which may progress to severe pain . tenderness in the upper abdomen jaundice USG W/A add inj metronidazole will cover for anaerobic infections as well as hepatic infection . # this cannot be a case of hepatitis for it has systemic compaints like fever low grade , malaise , anorexia and nausea . But not the relapsing type and not more than a week. 6. UTI .Points to see any c/o dysuria or increased frequency of urine Urine R/E + C/S wd USG w/a .

Relapsing malaria Tuberculosis HIV X-ray chest ESR Mantoux test

1,only Artudent is not enough to control MP. Always 2ante Malarials should be gives. 2,Same ante biatic given (failed) Any/clindamycin. is right. 3,second ante Malarial best is Maphaloquin 15 mg/kg body wt for 3days 4,clouseup. with .Pramaquin45 mg tab 1only . 5,Artusenate 120mg and is only for serious cases.start with 120mg . followed by 60mg 8th hour after .then 60 mg bd total 7vails/60mg .

Suggest ELISA test for Dengue IgM antibody.It is usually positive after 6 days of illness.Result will come as positive in this patient.Only supportive treatment needed.Maintain blood volume.Refer the patient to higher center where blood transfusion can be given if needed

Artenusate should have been followed by Primaquine 7.5 mg B.D for 2 weeks. Associated Platelet count also to be looked after as could be associated viral fever. Platelet transfusions and cap.Platsure B D for 10 days to be given

first give cq .10mg/kg stat followed by 5mg/kg after 6 hrs then 5mg /kg after 24hr n 48hr. if cq resistant then give alpha-beta arteether I'm od consecutively three days.definately I will get result.

Viral, advised absolute bed rest & symptomatic treatment.

Dr Hitesh Gangani YOUR Tereatment is perfect.

Rule out koch's.

now symptoms improving only bed thing is decreasing platelets, so we must do dengue serology, urine routine microscopy,stool exam, done for making diagnosis, though it is very clear Pt also suffering from viral illness also but it can be due to malaria also, in treatment part give planty of water and paracetamol sos basis along with multi vitamins and vitamin k with other supporting treatment

wat about dengue ns1, ,IgG and IgM, ,do lepto IgG & IgM, ,as the pt is on antimalarial already and platelet nt increasing add-iv hydrocort stat and b.i.d, ,or iv dexona 2 cc b.i.d, ,and repeat CBC after 24 hours, ,and if pt. "s vitals stable and no symptoms of thrombocytopenia then nothing to worry, ,ct same Rx, ,do G6PD and put him on tb pmq -15 mg od fr 14 days

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