Fever with Thrombocytopenia- Dengue NS1 antigen+

MEDICINE CASE DISCUSSION

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CASE SCENARIO:

A 45 yr old female patient came to the opd with complaints of 

- Fever since 15 days

- Headache since 15 days 

- Body pains since 15 days

- Abdominal tightness since 15 days

HISTORY OF PRESENT ILLNESS:

Patient was apparently asymptomatic 15 days back, then she developed

fever: intermittent, high grade, associated with chills.

Headache: diffuse, dull aching type

c/o generalised body pains and abdominal tightness. 

She went to a local hospital where she was treated with antibiotics (inj. Monocef) for 3 days after which fever subsided for 2 days.

No h/o bleeding manifestations, vomitings, loose stools, pedal edema, chest pain, shortness of breath, cough, cold. 

Outside reports : Dengue NS1, IgM - reactive with thrombocytopenia 

HISTORY OF PAST ILLNESS:

Not a k/c/o diabetes, HTN, Asthma, TB, epilepsy, CAD, thyroid disorder 

PERSONAL HISTORY 

Occupation: daily labourer 

Appetite- decreased 

Sleep- adequate 

Bowel and bladder movements- normal and regular 

Addictions- occasionally toddy

FAMILY HISTORY:

Not significant

GENERAL EXAMINATION:

No icterus, clubbing, lymphadenopathy, edema, pallor, cyanosis, kolionychia

VITALS:

BP- 120/90 mm Hg

PR- 60/min 

RR- BLAE present

CVS :

 S1S2 HEARD 

no thrills no murmurs

ABDOMEN:

Non distended

Diffuse tenderness absent 

Guarding and rigidity absent

CNS- 

Patient is Conscious 

Speech: normal

No signs of Meningeal irritation

Motor & sensory system: normal

Reflexes: present

Cranial nerves: intact

INVESTIGATIONS:

— ECG

— Chest X ray

— Ultrasound 

— Hemogram 

     

    Day one:

Day two:

Day three:

— Dengue Rapid Test

— LFT 

— CUE

— Serum Electrolytes 

— Serum Creatinine, Urea

— Random Blood Sugar

— RTPCR for Covid 

PROVISIONAL DIAGNOSIS: Fever with Thrombocytopenia. Dengue NS1, IgM +   

TREATMENT :

DAY ZERO:

1) IVF- 1. NS, 1. RL, 1. DNS @ 75ml/Hr

2) Inj. OPTINEURON 1 amp in 100 ml NS/IV/OD

3) Tab. DOLO 650 mg/PO/TID

4) BP/PR/RR/Temp/SpO2 monitoring 4th hrly

5) I/O charting 

6) Plenty of oral fluids

7) W/F postural hypotension, Bleeding manifestations 

DAY ONE:

1) IVF- 1. NS, 1. RL @100ml/hr

            1. DNS with 1 amp of OPTINEURON @ 75ml/Hr

2) Tab. DOLO 650 mg/PO/TID

3) Inj. NEOMOL 100 ml/IV/SOS if temp > 101°F

4) Tab. PANTOP 40 mg/PO/OD

5) Inj. ZOFER 4 mg/IV/SOS

6) BP/PR monitoring 4th hrly

7) W/F postural hypotension, Bleeding manifestations 

DAY TWO: 

1) IVF- 1. NS, 1. RL @100ml/hr

            1. DNS with 1 amp of OPTINEURON @ 75ml/Hr

2) Tab. DOLO 650 mg/PO/TID

3) Inj. NEOMOL 100 ml/IV/SOS if temp > 101°F

4) Tab. PANTOP 40 mg/PO/OD

5) Inj. ZOFER 4 mg/IV/SOS

6) BP/PR monitoring 4th hrly

7) W/F postural hypotension, Bleeding manifestations 

DAY THREE:

1) IVF- 1. NS, 1. RL @100ml/hr

            1. DNS with 1 amp of OPTINEURON @ 75ml/Hr

2) Tab. DOLO 650 mg/PO/TID

3) Inj. NEOMOL 100 ml/IV/SOS if temp > 101°F

4) Tab. PANTOP 40 mg/PO/OD

5) Inj. ZOFER 4 mg/IV/SOS

6) BP/PR monitoring 4th hrly

7) W/F postural hypotension, Bleeding manifestations 

COURSE IN THE HOSPITAL:

35 yr old female came to the opd with c/o fever, headache, body pains, abdominal tightness since 15 days. The patient tested positive for dengue NS1 and was managed conservatively. With improvement in overall condition and resolution of above mentioned symptoms pt was discharged and advised for follow up after 1 week