SYMPTOM EVALUATION

25 yrs. old Yasith is presented to OPD with 4 days history of fever.He is having gradual onset mild intermittent fever.It is responded to paracetamol,not associated with chills and rigors.no diurnal variation of fever.

Very common causes

Viral fever

URTI

LRTI

Dengue

Gastroenteritis

UTI

Ear infection

MalariaViral hepatitisTuberculosisMeningitisSoft tissue infection ex:cellulitisTyphoidLeptospirosis Infectious mononucleosusCommunicable diseases;chicken

pox,mumps,rubella

Infective endocarditis

Scrub typhus

Neoplasm;lymphoma,leukaemia,renal cell CA

URTI,LRTI,TB????No respiratory symptoms;cough,no evening pyrexia,nightsweats,weight loss

GASTROENTERITIS???No GI symptoms;vomiting,diarrhoea,intake of contaminated food

UTI,PYELONEPHRITIS???No urinary symptoms;dysuria,frequency

SINUSITIS,LEPTOSPIROSIS,MENINGITIS??No headache,severe body pains,darkurine,conjunctival suffusion,not drowsy

MALIGNANCY???No recurrent episodes of fever

No significant sexual Hx,drug Hx

Social Hx;

Occupation-computer engineer-no risk of occupational infections

No recent travel to malarial endemic area,forest,abroad

No contact Hx of TB,hepatitis,communicabledisease

Temparature-mild fever,no facial flushing

,no icterus,no pallor,no rashes

,no lymphadenopathy

,BCG scar-present,ENT-NL,no sinus tenderness

No neck stiffness,kernic sign-negative

System examination-NL-no RS signs,nohepatosplenomegaly

CVS-no murmurs

As patient is having 4 days Hx of fever,we can do FBC as basic Ix

Hb 13.5 g/dl

RBC 5 X 1012/l

WBC-9 x 109/l

Neutrophils 2 x 109/l

Lymphocytes 5 x 109/l

PLT 250 X 109/l

Viral fever

Paracetamol 10-15mg/kg of body weight per dose 6hry(maximum dose 60mg/kg/day)

If high fever,-tepid sponging

If temperature is not settling,ibuprofen(20mg/kg/day) or mefanamicacid(25mg/kg/d) can be given.but C/I in dengue

Increase in fluid intake to prevent dehydration

Educate carer about danger signs

Review in 3 days(,earlier than that ,if condition is nt improved)

When to refer

Fever>10days

Ill look/tachycardia/respiratory distress

Poor response to Rx

Persistent vomiting/not taking orally

When Iv antibiotics are indicated-pyelonephritis,meningitis

After 4 days the patient againpresented with high gradeintermittent fever and cough withpurulent sputum. He haddeveloped shortness of breathingwith mild chest pain which isintensified by inspiration andcoughing

Patient is febrile, not pale,

Pulse rate -86/min

Respiratory rate -28/min

Blood pressure-110/80mmHg

Chest expansion has reduced in left side

percussion note is dull in left middle area of the chest

On auscultation-coarse crepitation mainly at left middle area

Probable diagnosis is lower respiratory tract infection, most probably pneumonia

Full blood count-neutrophil count was increased

chest X-ray- consolidation in the left middle lobe

It is done by CURB 65 score C-confusion

U-urea>7mmolR-respiratory rate>30/minB-blood pressure-systolic<90 or

diastolic<60age-more than 65

If the score

score 0-1- can treat as out patient

score 2 -admit the patient

score 3+ -require ICU care

Since this patient CURB score is < 2 we can treat him as out patient

Treatment can treat by oral antibiotics

Amoxycilline 500mg 8hrlyor

Erythromycin 500mg tds and clarythromicin 500mg bd