A patient presenting with fever with chills and rigor

A 23 years old lady presents with fever with chills and rigor for 7 days.

What D/D would you consider? 

  • All deep abscesses including liver abscess
  • Pyelonephritis / UTI
  • Malaria
  • Cholangitis
  • First episode of pneumococcal pneumonia

 

  A patient presenting with fever with chills and rigor and loin pain.

A 26 years woman presents with fever with chills and rigors coming several times in a day and subsides with sweating. She also complains loin pain and vomiting.

Which diagnosis would your consider?

   Acute pyelonephritis

What key questions would you ask?

Fever– high temperature comes with chills and rigor, persists for minutes to hours and subsides with sweating, coming several times in a day

Loin pain– discomfort or pain in one or both loins

Dysuria– burning sensation during micturition, increased frequency of micturition occur in 30% patient due to associated cystitis.

Associated symptoms- vomiting, dizziness.

What will you examine?

 General examination- Patient is ill and toxic. Temperature – raised.

Abdominal examinationboth loins and renal angles are tender.

Investigations-

MSU (midstream urine) for culture and sensitivity (usually not available in primary and secondary level)

Urine for R/M/E- plenty of pus cells

FBC- neutrophilic leucocytosis (WBC >11000 and neutrophil >70%)

USG of KUB.

Treatment-

Ciprofloxacin- 750 mg every 12 hours orally for 14 days

Or

Ofloxacin- 200 mg every 12 hours orally for 14 days

Plenty of fluid by mouth