typhoid Fever

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

A 45 year old male, a non alcoholic with no major illness in past, presented with fever since 5 months( on and off, high grade, no joint pain) . Gen weakness since 5 month. Patient had a history of cavity in tooth and abscess there which was extracted locally near his residence.he was also prescribed antibiotics for the same. Now patient reffered to us with severe anaemia and blackish brown spotts over fingertips of all 4 extremeties. Pallor +++ Platelets low 58000 as mentioned. Spleen 2 cm below costal margins. Cva normal, no signs of SABE Bilirubin normal. He was earlier treated for enteric fever and megaloblastic anemia in some hospital where blood culture was normal and all other reports attached( white ones) Gbp is awaited. Marrow is planned once platelets are normal. Givin 2 units of prbc. What will be the dd and further management plan. Hb fall from 7 to 3 in three days duration. With no signs of hemolysis.

pt having fever since last one month..fever comes in interval.age of pt is 12yrs..week.and lithargy and vomiting.headache..and body ache..mild.pt. suggest..your opinion..

40 yo Pharmacist presents today complaining of generalized fatigue, muscle aches, headache, and upper abdominal pain bilaterally x 7 hours. Pt vitals: BP: 121/81, Pulse: 130, Resp: 20, Temp: 99.9F, O2: 99% ORA. No PMHx, PSHx, FHx, or Social History/Medications. On exam Pt appears toxic without other abnormality besides Tachycardia with normal rhythm. Lungs CTAB, abdomen non-tender without distention or tenderness to palpation. Oral mucosa are moist and skin tumor is intact. A few tests were done prior to myself going into the room including a Flu which was negative. And Urine which showed small blood and trace protein. Pt denies any chest pain SOB, back pain, numbness, tingling, weakness, jaw pain, changes in vision, diarrhea, disorientation, discoordination. Dx and tmt?

ALL YOU NEED TO KNOW ABOUT SWINE FLU: Editor: Dr.Shashank Kumar Srivastav MICU/ICCU Incharge, Care Hospitals, Hyderabad, Former President Indian Medicos Association. Email: dr.shashankksrivastava@gmail.com INTRODUCTION The classical swine flu virus an influenza type A (H1N1) virus was first isolated from a pig in 1930. Swine flu viruses cause high level of illness, but low death rates in pigs. Like all influenza viruses, swine flu viruses change constantly. Pigs can also be infected by avian influenza and human influenza viruses. When influenza viruses from different species infect pigs, the viruses can reassort (i.e. swap genes) and new viruses that are a mix of swine, human and/or avian influenza viruses can emerge. Suspect Case: A suspect case is defined as an individual with fever (temperature 100.4°F/ 38°C) and one or more of the following manifestations- cough, sore throat, or shortness of breath. Probable Case: A probable case is defined as an individual with an influenza test that is positive for influenza A, but is unsubtypable by reagents used to detect seasonal influenza virus infection or an individual who died of an unexplained acute respiratory illness. Confirmed Case: A confirmed case is defined as an individual who is confirmed in the laboratory with PCR or virus culture for pandemic influenza virus 2009. TRANSMISSION The SO-IAV has efficiently transmitted between humans since its first detection in April 2009. So far it has spread in the Northern hemisphere outside of the flu season and in the Southern hemisphere during its flu season. It has caused mild disease, and that is in accordance with absence of the pathogenicity marker PB1- F2. As seasonal influenza A (H1N1) viruses are also circulating in humans since 1977, mild disease could also be due to partial immunity in the population. It will now be critical to watch how the virus behaves as it comes back to the Northern hemisphere in the next wave with the approaching flu season. All previously characterized pandemics have been due to viruses generated by antigenic shift involving the HA gene of avian lineage – H1 for 1918 virus, H2 for 1957 virus and H3 for 1968 virus. Though still of the H1 serotype, the HA of SO-IAV is different from the H1 HAs of seasonal influenza viruses; the inclusion of a porcine H1 in human influenza A viruses has been considered an antigenic pseudo- shift. Although SOIAV is of zoonotic origin, it’s HA may not be sufficiently divergent to call it a true antigenic shift5. Compared to viruses that caused previous pandemics, SO-IAV is at present not sufficiently virulent. But, it is already transmitting like a pandemic virus and is undergoing adaptive mutations. Whether it will remain mild or develop into a highly pathogenic fully pandemic virus remains to be seen. PREVENTION * There currently is no vaccine to protect humans against the H1N1 flu virus. The following tips will help you prevent flu infections such as the common flu and the H1N1 flu. 
 * Wash your hands often with soap and water, especially before eating and after sneezing or coughing. 
 * You can also use an alcohol gel product available over the counter, which is also effective in protecting against flu. 
 * When you cough or sneeze, cover your mouth and nose with your elbow or sleeve. Or use a tissue and be sure to throw away the tissue after use. Wash your hands after you sneeze or cough. 
 * Try to avoid close contact with sick people. Avoid touching your eyes, nose, or mouth. Germs spread this way. Try to stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. 
CLINICAL MANISFESTATIONS 
Signs 
Swine flu, or H1N1, is a type A influenza virus that can infect humans. It is similar to the seasonal influenza virus, but can be more severe in people who may be at high risk because of a preexisting condition. According to the Centers for Disease Control, risk factors include chronic medical conditions such as diabetes, heart disease, and asthma. 
Aches and Fevers 
Swine flu is severe body aches, this can include muscle weakness and difficulty standing up or walking. Headaches in combination with body aches are also quite common. 
Upper-Respiratory Symptoms 
A common element of swine flu is upper-respiratory symptoms. These can be similar to a cold, except more severe. A runny or stuffy nose combined with head congestion is typically present. Itchy or watery eyes may also be a symptom. 
Weakness 
Feelings of general malaise or weakness are common with swine flu, as is overall discomfort. Many people infected with the virus are tired and too weak to complete most normal day-to-day activities, and may sleep longer and more often than usual. Staying home and getting plenty of rest is the best way to fully recover from swine flu. 
Gastrointestinal 
In some cases of swine flu, people experience gastrointestinal effects. These can range from stomachaches and cramping to nausea and vomiting, and diarrhea. Swine flu may be confused with food poisoning because of the symptoms of stomach pain and upset. 
Warning Signs 
Other signs to watch for may indicate that swine flu is developing into a secondary medical condition that can be serious or life- threatening. Because swine flu involves the respiratory tract, there is a risk for developing pneumonia, respiratory failure, and bronchitis. 
According to the Centers for Disease Control and Prevention (CDC), in humans the symptoms of the 2009 "swine flu" H1N1 virus are similar to those of influenza and of influenza-like illness in general. Symptoms include fever, cough, sore throat, body aches, headache, chills and fatigue. 
 * DIAGNOSIS 
The first cases of swine flu were diagnosed in the US in San Diego in mid-April. The discovery was serendipitous, the result of out of season. US-Mexican border surveillance and use of a new diagnostic test at the Naval Health Research Center. When the new test protocol showed infection with influenza A with undeterminable subtype, follow-up testing showed it to be an previously unknown swine flu virus. Detection of a second, apparently unlinked swine flu infection in San Diego got the outbreak (now pandemic) investigation rolling. That was just a month ago, but it established the initial diagnostic pattern that was the tail end of the flu season, but seasonal influenza was still present in the community and for the first weeks of the outbreak CDC's lab in Atlanta was the only place that had the reagents to confirm an infection was from swine flu and not seasonal flu or another virus altogether. So a make-shift case definition was set-up to take this into account. If a person with an influenza-like illness (which required sudden onset, fever and respiratory symptoms) had a rapid flu test positive for influenza (or influenza A if the test could differentiate), a nose or throat swab was sent to the state lab. As a result of preparedness activities envisioning a possible pandemic with bird flu, CDC had been training state labs to make the differentiation between the two seasonal flu subtypes, H1N1 and H3N2, and bird flu, H5N1, so the capability to do seasonal sub typing already existed outside of CDC. But neither the reagents nor the proficiency for the new swine virus did. Therefore all specimens that were positive with a rapid test at the point of visit, and so were putative influenza A, were first subtyped at the state lab level. If they could not be sub typed, they were sent on to CDC for confirmation as swine flu. CDC later determined that virtually all unsubtypable influenza A specimens turned out to be swine flu. TREATMENT The main symptoms of Swine Flu are a cough, sore throat, runny nose and fever. Usually there's more muscle pain, headache, fever and chills than seen with the common cold. If you think your child has Swine Flu, here's what you can do to make him feel better: Prescribing pattern for swine flu: 1. For a stuffy or blocked nose, use saline (or warm-water) nose drops followed by nose blowing or suctioning. 2. For throat pain, Tylenol or ibuprofen is very helpful. Children over 6 years old can also suck on hard candy. Children over 1 year old can sip warm chicken broth or other warm liquids. 3. For coughs, try to soothe the throat. For children over age 6, give cough drops. If your child is over 1 year of age, give honey. The dosage would be 1/2 to 1 teaspoon as needed. Never give honey to babies. If honey is not available, you can use corn syrup. 4. Flu can cause body aches that include leg pain, back pain, chest pain and headache. Give ibuprofen to make these sore muscles feel better. 5. For diet, mainly encourage your child to drink adequate fluids to prevent dehydration. This will also thin out the nasal secretions and loosen the phlegm in the lungs. 6. Tamiflu is an antiviral medicine that may be useful for some children. Finally: Your job is to keep your child comfortable. Determine your child's main symptoms and treat them. Antiviral Drugs for Influenza Oseltamivir: The neuraminidase inhibitor oseltamivir formulated as capsules or oral suspension (Tamiflu®) is FDA-approved for the treatment of uncomplicated acute influenza in patients 1 year and older who have been symptomatic for no more than 2 days. Zanamivir: The neuraminidase inhibitor zanamivir formulated for oral inhalation (Relenza®) is FDA-approved for the treatment of influenza in patients 7 years of age and older who, similar to approved uses for oseltamivir, have uncomplicated illness and have been symptomatic for no more than 2 days. Peramivir: A third neuraminidase inhibitor peramivir formulated for intravenous (IV) administration is an investigational product currently being evaluated in clinical trials. Children: Children younger than 2 years of age are at higher risk for influenza-related complications and have a higher rate of hospitalization compared to older children. Children aged 2 to 4 years are more likely to require hospitalization or urgent medical evaluation for influenza compared with older children and adults, although the risk is much lower than for children younger than 2 years old. Adults aged 65 years and older: Even though persons aged 65 years and older are less likely to become ill with 2009 H1N1 influenza compared to younger persons, when they do acquire influenza, they are at higher risk for severe influenza-related complications. Pregnant women: Pregnancy increases the risk of complications, hospitalization, and severe disease. One study estimated the risk of hospitalization for 2009 H1N1 to be four times higher for pregnant women than for the general population hile oseltamivir and zanamivir are "Pregnancy Category C" medications.