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



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

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

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

आयुर्वेद के अनुसार मन्थन ज्वर से पीड़ित है। चिकित्सा शुरू करें, गिलोय का काढ़ा बनाकर पीने को दिया जाता है।गौहदन्ती भस्म 4 रत्ती शहद के साथ दे महानारायण तैल की मालिश करें और त्रिफला चूर्ण 10 ग्राम रात को सोते समय दूध के साथ दे निश्चित रूप से लाभ होगा योग परिक्षित है पिछले 40 वर्ष से प्रयोग कर रहा हूं

Viral, advised absolute bed rest & symptomatic treatment.

I think it would be dengue. As per my experiens you should treat with following medicines. 1) extract of papaya leaves one tea spoon twice a day 2) Sinkona Satva Navsar praval pishti Kapardika bhasma Guduchi satva Godanti bhasma Mandurbhsama ----- with tulsi extract 3) Mahajvarankush ras 2x2

give artesunate for5days first dose2.5mg/kg then tab primaquine7.5mgbd for 14 days

Treat malaria as advised. For low platelets, monitor closely.

Pl get IGG IGM study for lepto Dengu virus. X Ray chest R urine FBSl & Pp sugar add cefatoxime 200 B D & Doxy 1 200 b/d with high dose of b plex

Rx,1) Inj.Emal Im 3 days. 2)Inj. Pan 40 Iv for nausea and vomiting. 3) Inj.Cetfa+salbactum 1.5 mg bd. 4) Tab.Arte+ Lumefan 3 days. 5) Tab. Cefixime+oflox. 6) Tab.Wysolone 10 mg bd. If headche give Nim+para at morn 9 am and 6pm. U can bettet result.

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