Concluded Case

prolonged fever

13 years old female came with c/o fever for 5-6 days..no other complaint...systemic examination normal...haemodynamic stable...cbc,crp,esr, attached.. send patient on oral treatment as they refused for admission...after 4 days they came back with persiatent fever, only in evening and abdominal pain RHC region since 1 day.. repeat blood reports attached...blood culture was not available due to covid19 crisis in periphery.... Diagnosis?? Kindly check investigations date... Usg abdomen attached....

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Concluded answer

case of enteric fever as per sonography of abdomen report

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Never leave a prolonged fever in a female n pediatrics both without r/o uti. Coming to this case there's high crp n esr. Pointing towards bacterial etiology. Then theres leucopenia n thrombocytopenia with lymphocytosis. Can happen in dengue and enteric fever. Usg supportive of enteric fever too. Sgpt can be elevated in dengue n sometimes in enteric fever too. Though widal is negative. I think treatment should b with ceftriaxone 2.5 GM in divided doses n azithromycin 500 mg twice daily with other supportive Rx.

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CBC reveals decrease in WBC count, thrombocytopenia, with reactive lymphocytes, ESR and SGPT raised. Examine for HSM, if present go for scrub typhus. Adv USG abd, CT Abd, if reveals lymphadenopathy, go for FNAC. Find any history of tubercular contact. Admit and start with antibiotics pipercillin+ doxycycline, ivf, ppi, antipyretic. Rest line of treatment based on lab findings

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WBC and platelet counts have improved . Need to do Dengue profile , ? Recovering Dengue CRP is high suggesting bacterial infections Anemia is severe . C/O abdominal pain in RHC ,? Cholecystitis Needs urgent Abdominal ultrasound , need to investigate anemia . Admission, iv support, iv antibiotics

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This is a c/o viral fever more likely dengue fever Investigate dengue profile

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case of enteric fever as per sonography of abdomen report

Requires further evaluation. Rule out dengue , typhoid and rickettsial fever.

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Evening time fever rule out malaria

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