- A patient with persistent high fever
A 30 years gentle man presents with persistent high fever for 7 days without any remission.
What are the diagnoses striking in your mind?
- Enteric fever
- Rickettsial fever
What key questions would you ask?
Fever- continued* fever, body pain, headache, constipation followed by diarrhea,
abdominal distension and cough- are suggestive of enteric fever.
Fever- continued but may be remittent**, An erythematous maculopapular rash over the trunk, face and limbs, including the palms and soles- Rickettsial fever
History of insect bite- Rickettsial fever
What will you examine?
Raised temperature, relative bradycardia,***centrally coated tongue, caecal gurgling, rose spots and just palpable spleen- enteric fever.
Eschar, maculopapular rash and painless generalized lymphadenopathy- Rickettsial fever
Clinical diagnosis– Enteric fever (typhoid)
Investigation-
CBC –leucopenia with relative lymphocytosis
Widal test- rising titre or four fold rise is significant
Other essential investigations- Blood culture (usually not available in primary and secondary level)
Other tests to exclude D/D e.g.
Rickettsial antigen (part of tripple antigen)
Treatment-
Tab. ciprofloxacin 500mg 12 hourly for 14 days (drug of choice)
In case of resistance
Tab Azithromycin 500 mg daily for 14 days or 1 gm daily
for 5 days is used.
Ceftriaxone or cefotaxime
- Rickettsial fever may occur as co-infection of typhoid fever. Scrub typhus is common in Bangladesh. Treatment of scrub typhus is
Tetracycline 500 mg 6-hourly or
Doxycycline 200 mg daily (1 cap bid) for 7 days.