- A patient presenting with fever with chills and rigor
A 23 years old man presents with fever which is initially continued, then develops chills and rigor for 7 days.
What D/D would you consider?
- Malaria
- UTI
- Liver abscess
What key questions would you ask?
Fever– high intermittent* fever with chills and rigors, subsides with sweating, coming every alternate day- vivax malaria, no definite pattern in falciparum malaria, coming several times in a day- UTI, Liver abscess.
Pain in right hypochondium-liver abscess.
History of residing or returning from endemic area for malaria.
Frequency, dysuria- UTI
What will you examine?
General examination- Patient is ill and toxic. Temperature – raised or normal during afebrile period.
Abdominal examination– Liver and spleen may be palpable in malaria
Liver is enlarged and tender in liver abscess, intercostal space may be tender.
Suprapubic and loin tenderness in UTI
Clinical diagnosis-
Malaria
Investigations-
- Thick and thin film for malaria
- ICT for malaria
- Other tests to exclude D/D e.g.
- Urine for R/M/E
- USG of whole abdomen
Treatment-
Plasmodium vivax malaria
Chloroquinine 3 days + Primaquine(radical cure) 14 days
Chloroquinine- Dose Schedule:
1st Day: 4 tabs
2nd Day: 4 tabs
3rd Day: 2 tabs
Primaquine – 15 mg daily for 14 days
Uncomplicated falciparum Malaria confirmed
1st Line Treatment:
Artemethur + Lumefantrin combination (Coartem/Lumertem)
Dose: 6 divided doses over 3 days
If for any reason (e.g. pregnancy), Coartem cannot be given then
2nd Line Treatment: Quinine-10 mg/kg 8 hrly for 7 days (Q7)
Uncomplicated falciparum Malaria presumptive- same as P.vivax malaria.
- In Bangladesh, malaria is caused by P.vivax and P.falciprum.