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A 26-year-old woman presents to the clinic with a complaint of fever.,…
A 26-year-old woman presents to the clinic with a complaint of fever.
History and examination
History:
Onset/Duration
: Acute (<1 wk), subacute (1–2 wk), chronic (>2 wk); sudden vs gradual
Pattern
: Continuous, remittent, intermittent; chills, rigors, night sweats
Severity
: Peak temperature, frequency, antipyretic response
Associated Symptoms
: Fatigue, weight loss, cough, SOB, GI symptoms, dysuria, rash, myalgia, joint pain, headache, neck stiffness
Exposures
: Travel, insect bites, sick contacts, animals, contaminated food/water
Medications & PMH
: Recent drugs, immunosuppression, chronic illness, surgery
Social & Family
: Occupation, alcohol/drugs, sanitation, family illness
Gyn
: LMP, pregnancy, postpartum/abortion
Examination:
Genera
l: Ill/toxic, vitals, pallor, icterus, rash, lymphadenopathy, edema, dehydration
Systemic:
Respiratory
: crepitations, bronchial breath sounds
CVS
: murmurs, endocarditis signs
Abdomen
: tenderness, hepatosplenomegaly, masses
CNS
: meningeal signs, sensorium
GU:
suprapubic/flank tenderness, pelvic findings
1. Differentials
Viral:
Influenza, COVID-19, Dengue, Chikungunya, EBV, CMV
Bacterial:
UTI, Typhoid, Pharyngitis, Occult Pneumonia,brucellosis
Other:
Drug fever, Malaria
2. History & Exam Clues
Travel / bites:
Malaria, Dengue
Rash
: Viral exanthem, Dengue
URTI
: Cough, sore throat
GI
: Diarrhea, vomiting
Urinary:
Dysuria, frequency
Lymph nodes / Hepatosplenomegaly
: EBV, CMV, Malaria
Drugs:
Drug fever
Vitals:
Fever pattern, hypotension, relative bradycardia
3. Investigations (Targeted
)
CBC → Viral vs bacterial pattern
Blood culture → Bacteremia / Typhoid
Urine analysis / culture → UTI
Malaria test → Travel-related
Dengue / Chikungunya NS1
LFTs / RFTs → Organ involvement
Chest X-ray → Occult pneumonia
Pregnancy test → Rule out
4. Approach:
Red flags → Targeted Hx/Exam → Investigate common causes first
1. Typhoid
Tx: Ceftriaxone IV / Azithromycin PO; MDR → culture-guided
Carrier: Ciprofloxacin 4w
Vaccine: Ty21a (oral), Vi polysaccharide
Supportive: Paracetamol, hydration, gastric protection
Safety: Complete ABX, hygiene, safe water
2. Brucellosis
Tx: Doxycycline + Rifampicin 6w; alternative: Streptomycin + Doxycycline
Complicated: Extend 6–12w, ± Ceftriaxone/Gentamicin
Pregnancy/Pediatrics: Co-trimoxazole
Supportive: Paracetamol, Ibuprofen, gastric protection
Safety: Avoid unpasteurized dairy, cook meat, gloves for animals
3. Dengue
Mild: ORS, Paracetamol, rest, avoid NSAIDs
Moderate: IV fluids, Paracetamol IV, monitor warning signs
Severe: Aggressive IV fluids, Dextran/Albumin, platelets <10k, organ support
Safety: Hydration, mosquito protection, monitor warning signs
Treatment for differentials
Differentials