A 13 years old boy complains of fever with some chills for 3 days, with Generalized weakness, reduced appetite and headache since two days. Vitals and systemic exams are wnl and no localizing focus of infection is readily evident. CBC and widal were ordered and the reports are as attached. What is the probable diagnosis and how to approach the case?



As per history and available reports Treat as a case of Hyperpyrexia with unknown cause Antibiotics, preferably,cepotaxime / Ofloxacin Antimalarial Symptomatic, Rest & follow up x 5 days If temperature persist or increases then Evaluate Blood CBC ESR Dengue Serological tests for Hepatitis, meningitis During this, time to time experts opinion is always better


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Wirral reaction is a nonspecic test .Even it is done blood for Wirral should be send 7days after the onset of fever Blood for PROCALCITONIN will distinguish from a viral fever to bacterial infection Blood for Bactec blood culture malaria duel antigen Dengue N S 1 antigen urine routine + C+S are investigations to be done primarily Later X-RAY chest USG abdomen. If ñecessary Rx paracitamol

Widal is psuedopositive and tlc little higher you have not given urine report symptoms suggest viral fever so treat as viral fever with cover of antibioticlike Azithromycin500mg one dailyfor 5days and antipyretics i think you can add lumirax 80mg 1x2times for 3days. Also test for dengue profile. Maintain electrolytes with suppliment of multivitamins

ROT for Malaria,Urine routine &sos c/s to be done,RBC indices r low,Could it be Malaria,UTI,Viral fever& Anemia

since fever history is of 3 days so typhoid probable with malaria anduti . marginal neutropenia and leucocytosis. typhoid is possible may go immuno test .

possibility and probality is typhoid fever because widal is of no value in 3rd day fever .at same neutropenia and leucocytosis .so go for immuno acess of typhoid.

Focus of infection remained an enigma in this case. Appetite is better, patient is afebrile and constitutionally well. Many times a blanket cover of antibiotics is all that you can manage. Hopefully someday individuals seeking healthcare are at leisure of availing the benefits of urine/blood c/s in our country.

Thank you all for your expert comments on the case. Urine r/m and PS have come out to be Insignificant. Unfortunately, the Patient cannot afford more investigations and has been put on coamoxiclav + ofloxacin regimen. I wish to provide updates soon.

Typhoid fever.Do Widal test again.This Widal should be done on 9th day of fever & onwards.Typhi dot may be done.Treat c Inj Cefrrixone/Ciprofloxacin

As given history and lab Wbc raised Get done urine routine Repeat Widal PBS for mp Fever charting Usg abdo pelvis sos

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