A 70 year old patient with high grade fever documented, to be 102-103 degree celcius with weakness and body ache for the past 4-5 days.. Since dengue has been spreading rapidly in this locality, tests were done ,which were negative for dengue and chikangunya.. But he had hyponatremia (123 initially) , potassium, chloride just at the lower range. Platelet was 1.5 lac initially Paracetamol for fever and IV saline was started..for two days..during which he was even unable to sit up or walk on his own, and appeared a little confused. After that sodium was done again- 124 meq/l Malarial antigen was also negative Fever improved gradually , and we stopped the IV fluids since he's a hypertensive and sodium was continuously low. He was on telmisartan and amlodipine, no diuretics Now the latest reports of yesterday show Platelets 1 lac Sodium 129, Potassium 3.4 Dengue and chikangunya negative again He's developed rash in his lower extremities (photos added) And his hands are swollen and feel stiff from morning. Please advise..

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Though the reports are not supporting the diagnosis of dengue fever clinically it suggests to be a case of dengue fever. Further when it is prevalent in the locality we cannot overlook and we should treat this as a case of dengue fever without any hesitation since Dengue fever requires only symptomatic and supportive treatment. Since platelet count is 1 lakh we should not be worried much..Observe the patient carefully and if any complications occurs attend to them if you can otherwise refer the pt to a higher centre
There are lot more viral hemorrhagic fevers other than dengue..that is one more possibility..how are the LFT, RFT, PT,APTT ? how is the rash? is it palpable..bleeding is unusual with platelet counts of 1 lakh..multisystem involvement with all tests negative..look for any eschar especially in hidden areas..waistline,groin, etc (if he is from a forest/ hilly area) consider scrub typhus
Looks like a case of Dengue though sometimes results are falsely negative. My basic reason of diagnosis is Rashes along with low platelet counts. Ensure fluids replacement, symptomatic treatment, Caripill (if he can take orally) and regular monitoring of platelets.
Your opinion about platelet transfusion and pappaiya leaves
As per my experience and as per guidelines, platelet transfusion should be reserved only in severe thrombocytopenia or if bleeding manifestations occur along with thrombocytopenia. Malena i feel is not an indication for transfusion. If significant bleeding occurs..then whole blood transfusion is advised. Coming to papaya leaves, it can be supplemented if there is no intolerance to it. I have seen patients taking those extracts and still requiring transfusion and others who did not take them but still required no transfusion. The degree of fall of platelets depends on the virus strain i feel.
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May be interic fever .widal test .
Enteric fever can't be ruled out anytime.but there is no harm on putting on doxy considering possibility of rickettsial infection
Clinically it suggests dengue fever. ND rashes are due to dengue. Start tab caripil.nd regular monitoring of platelets.
Development of disease suggestive of dengue fever. Better to shift to higher centre. Pl take to controlled sodium.
I agree with Dr. RaviKiran. The repeat test at least have shown dengue antibodies. (IgM) if it were to be dengue.
Differential diagnosis dengue haemorrhagic fever , entering fever with septicaemia , meningococcal septicaemia
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