feverprojr malaria 32/M

 malaria - 

date of admission 3//4/2024 

date of discharge 8/4/2024









1)CLINICAL MALARIA

2)PANCYTOPENIA WITH SPLEENOMEGALY ? SECONDARY TO MALARIA /?B12 DEFICIENCY

Case History and Clinical Findings

A 32 YR OLD MALE AUTO DRIVER BY OCCUPATION RESIDENT OF MIRYALGUDA CAME TO GM OPD WITH

CHIEF COMPLAINTS OF:

FEVER SINCE 1 MONTH

COUGH SINCE 2 DAYS

HISTORY OF PRESENT ILLNESS:

PATIENT WAS APPARENTLY ASYMPTOMATIC UNTIL 1 MONTH AGO THEN HE HAD C/O FEVER - LOW GRADE NOT ASSOCIATED WITH CHILLS AND RIGORS, INSIDIOUS IN ONSET , INTERMITTENT, NO DIURNAL VARIATION, A/W LOSS OF APPETITE, NAUSEA, SHORTNESS OF BREATH CLASS III(MMRC), COUGH, GENERALISED WEAKNESS,

C/O COUGH- PRODUCTIVE, YELLOWISH SPUTUM, THICK AND MUCOID IN CONSISTENCY,, NON-FOUL SMELLING, A/W BLOOD STAINED IN MORNINGS, A/W CHEST PAIN

NO C/O

NO C/O EDEMA

NO C/O

NO C/O

ORTHOPNEA, PND, PALPITATIONS, DIZINESS

BURNING MICTURITION, INCREASED OR DECREASED URINARY OUTPUT, PEDAL

LOOSE STOOLS, VOMITING

HEMATURIA, HEMATOCHEZIA.

PAST HISTORY


N/K/C/O HTN/DM/CAD/CV/THYROID/TB/EPILEPSY

GENERAL EXAMINATION

PATIENT IS CONSCIOUS COHERENT CO-OPERATIVE

TEMP 97.5 F

PR 60 BPM

RR 20 CPM

BP 110/50 MMHG

SPO2 100

GRBS 115 MG/DL

CVS S1 S2 HEARD NO MURMURS

RS BAE+ NVBS

Inspection:

NO nasal polyp,turbinate hypertropy,DNS

Oral cavity: NO halitosis,oral thrush,pharyngeal deposits,dental caries,

Redness present over the posterior pharyngeal wall

Trachea: appears to be central

No drooping of shoulders,No supraclavicular hallowness

No visible scars, veins,pulsations

chest movement with respiration appears to be equal

Apex beat seen in 5th ICS

PALPATION:

All inspectory findingd confirmed

Trachea is central,Trail sign negative

chest wall movements-equal on both sides

PERCUSSION: RIGHT LEFT

Suprclaavicular Resonant Resonant

infraclavicular Resonant Resonant

mammary Resonant Resonant

suprascapularResonant Resonant

infrascapular Dull Resonant

interscapular Dull Resonant


axillary Dull Resonant

infra axillary Dull Resonant

Chest Measurements: AP diameter-25cm

Transverse-37cm

hemi-diameter-45cm inspiration-1cm

chest diameter-90cm(movement with respiration -2cm)

Vocal Examination: RIGHT LEFT

Suprclaavicular Normal Normal

infraclavicular increased Normal

mammary increased Normal

inframammary Normal Normal

suprascapular increased Normal

infrascapular increased Normal

axillary Normal Normal

infra axillary Normal Normal

AUSCULTATION:

SuprclaavicularNormal Normal

infraclavicrulaNormal Normal

mammary Normal Normal

suprascapularNormal Normal

infrascapular Decreased Normal

axillary Decreased Normal

infra axillary Crepts positive Normal

Vocal Resonance:

SuprclaavicularNormal Normal

infraclavicrulaNormal Normal

mammary Normal Normal

inframammary increased normal

suprascapular incresaed Normal

infrascapular incresaed Normal

axillary incresaed Normal

infra axillary incresaed Normal


Aegophony positive on right side

No sucussion splash

PA SOFT NON TENDER

CNS NFND

COURSE IN THE HOSPITAL

32 YEAR MALE CAME TO GENERAL MEDICINE OPD WITH ABOVE MENTIONED COMPLAINS, NECESSARY INVESTIGATIONS WERE DONE. CBP SHOWED HB-3.6 TLC-1600 PLT-90000 PANCYTOPENIA, AND DECREASED ABSOLUTE RETIC COUNT AND INCREASED LDH. USG SHOWED SPLEENOMEGALY. ON EXAMINATION- ORAL PETECHIAE PRESENT OVER HARD PALATE, RESPIRATORY EXAMINATION PATIENT HAD EGOPHONY, INCREASED VOCAL RESONANCE AND TACTILE FREMITUS IN ISA,IAA,AA . BLOOD, URINE. SPUTUM CULTURES AND SPUTUM CBNAAT WERE NEGATIVE. PATIENT HAD CONTINUOUS FEVER SPIKES. IN VIEW OF CLINICAL SUSPICION OF MALARIA OR TYPHOID WITH BONE MARROW INFILTRATION PATIENT WAS TREATED WITH INJ MONOCEF AND ANTI MALARIAL DRUGS- FALCIGO 4 DOSES. ON DAY 3 ONE PINT PRBC WAS TRANSFUSED. ON DAY 4 PATIENT HAD NO FEVER SPIKES, COUGH REDUCED, SOB SUBSIDED, PATIENT WAS STARTED ON LARINATE KIT(ARTESUNATE 200MG+PYREMETHAMINE 50MG+SULFODXIME 500MG).ON AUSCULTATION PATIENT HAD B/L CREPTS IN INFRAAXILARY AREA AND INJ LASIX 20MG IV STAT WAS GIVEN . PATIENT IMPROVED SYMPTOMATICALLY AND HEMODYNAMICALLY STABLE HENCE BEING DISCHARGED.

Investigation

HEMOGRAM (03-04-24)

HB:5.36gm/dl 13-17gm/dl

TLC:1600cells/cumm 4000-10000cells/cumm

Neutroplils:60% 40-80%

Lymphocyte:30% 20-40%

Esonophils:0% 01-06%

Monocytes:10% 02-10%

Basophils:00% 0-2%

PCV:10.7 vol% 40-50vol%

MCV:102.3fl 83-101fl

MCH:35.0pg 27-32pg

MCHC:34.2% 31.5-34.5%


RBC COUNT:1.04 millions/cu.mm 4.5-5.5millions/cumm

PLATELET COUNT:90000 1.5-4.1lakhs/cu.mm

HEMOGRAM (04-04-24)

HB:3.7gm/dl 13-17gm/dl

TLC:1700cells/cumm 4000-10000cells/cumm

Neutroplils:60% 40-80%

Lymphocyte:30% 20-40%

Esonophils:0% 01-06%

Monocytes:10% 02-10%

Basophils:00% 0-2%

PCV:10.7 vol% 40-50vol%

MCV:98.1fl 83-101fl

MCH:34.5pg 27-32pg

MCHC:34.9% 31.5-34.5%

RBC COUNT:1.08millions/cu.mm 4.5-5.5millions/cumm

PLATELET COUNT:90000 1.5-4.1lakhs/cu.mm

HEMOGRAM (05-04-24)

HB:4.0gm/dl 13-17gm/dl

TLC:2200cells/cumm 4000-10000cells/cumm

Neutroplils:50% 40-80%

Lymphocyte:45% 20-40%

Esonophils:2% 01-06%

Monocytes:3% 02-10%

Basophils:00% 0-2%

PCV:11.4 vol% 40-50vol%

MCV:100fl 83-101fl

MCH:34.6pg 27-32pg

MCHC:34.6% 31.5-34.5%

RBC COUNT:1.14millions/cu.mm 4.5-5.5millions/cumm

PLATELET COUNT:1Lakh/cumm 1.5-4.1lakhs/cu.mm

HEMOGRAM (07-04-24)


HB:5.5gm/dl 13-17gm/dl

TLC:1780cells/cumm 4000-10000cells/cumm

Neutroplils:53% 40-80%

Lymphocyte:40% 20-40%

Esonophils:5% 01-06%

Monocytes:01% 02-10%

Basophils:01% 0-2%

PCV: vol% 40-50vol%

MCV:96.1fl 83-101fl

MCH:34.9pg 27-32pg

MCHC:37.9% 31.5-34.5%

RBC COUNT:1.53millions/cu.mm 4.5-5.5millions/cumm

PLATELET COUNT:43000 1.5-4.1lakhs/cu.mm

HEMOGRAM (08-04-24)

HB:5.4gm/dl 13-17gm/dl

TLC:2500cells/cumm 4000-10000cells/cumm

Neutroplils:44% 40-80%

Lymphocyte:49% 20-40%

Esonophils:01% 01-06%

Monocytes:06% 02-10%

Basophils:00% 0-2%

PCV:16.3 vol% 40-50vol%

MCV:99.3fl 83-101fl

MCH:33.2pg 27-32pg

MCHC:33.4% 31.5-34.5%

RBC COUNT:1.64millions/cu.mm 4.5-5.5millions/cumm

PLATELET COUNT:54000 1.5-4.1lakhs/cu.mm

HEMOGRAM (09-04-24)

HB:5.2gm/dl 13-17gm/dl

TLC:1500cells/cumm 4000-10000cells/cumm

Neutroplils:46% 40-80%

Lymphocyte:49% 20-40%


Esonophils:0% 01-06%

Monocytes:05% 02-10%

Basophils:00% 0-2%

PCV:15.0 vol% 40-50vol%

MCV:98.1fl 83-101fl

MCH:34.0pg 27-32pg

MCHC:34.6% 31.5-34.5%

RBC COUNT:1.5millions/cu.mm 4.5-5.5millions/cumm

PLATELET COUNT:90000 1.5-4.1lakhs/cu.mm

HEMOGRAM (10-04-24)

HB:5.2gm/dl 13-17gm/dl

TLC:2000cells/cumm 4000-10000cells/cumm

Neutroplils:54% 40-80%

Lymphocyte:41% 20-40%

Esonophils:01% 01-06%

Monocytes:04% 02-10%

Basophils:00% 0-2%

PCV:14.4 vol% 40-50vol%

MCV:96.6fl 83-101fl

MCH:34.9pg 27-32pg

MCHC:36.1% 31.5-34.5%

RBC COUNT:1.49 millions/cu.mm 4.5-5.5millions/cumm

PLATELET COUNT:1.2Lakhs/cumm 1.5-4.1lakhs/cu.mm

BLOOD UREA 03-04-2024 03:17:PM 23 mg/dl 42-12 mg/dl

SERUMBL CREATININE 03-04-2024 03:17:PM 1.4 mg/dl 1.3-0.9 mg/dl

SERUM ELECTROLYTES (Na, K, C l) 03-04-2024 03:17:PM

SODIUM 137 mmol/L 145-136 mmol/L

POTASSIUM 3.6 mmol/L 5.1-3.5 mmol/L

CHLORIDE 106 mmol/L 98-107 mmol/L

LIVER FUNCTION TEST (LFT) 03-04-2024 03:17:PM

Total Bilurubin 0.97 mg/dl 1-0 mg/dl

Direct Bilurubin 0.20 mg/dl 0.2-0.0 mg/dl


SGOT(AST) 51 IU/L 35-0 IU/L

SGPT(ALT) 16 IU/L 45-0 IU/L

ALKALINE PHOSPHATASE 223 IU/L 128-53 IU/L

TOTAL PROTEINS 5.7 gm/dl 8.3-6.4 gm/dl

ALBUMIN 3.72 gm/dl 5.2-3.5 gm/dl

A/G RATIO 1.88

PERIPHERAL SMEAR 03-04-2024 03:17:PM RBC : Normocytic normochromic WBC :Count Decreased on smear PLATELET : Inadequate

COMPLETE URINE EXAMINATION (CUE) 03-04-2024 03:17:PM

COLOUR Pale yellow

APPEARANCE Clear

REACTION Acidic

SP.GRAVITY 1.010

ALBUMIN Trace

SUGAR Nil

BILE SALTS Nil

BILE PIGMENTS Nil

PUS CELLS 2-4

EPITHELIAL CELLS 2-3

RED BLOOD CELLS Nil

CRYSTALS Nil

CASTS Nil

AMORPHOUS DEPOSITS Absent

OTHERS Nil

HBsAg-RAPID 03-04-2024 03:18:PM Negative

Anti HCV Antibodies - RAPID 03-04-2024 03:18:PM Non Reactive

STOOL FOR OCCULT BLOOD 03-04-2024 08:12:PM Negative (-ve)

2D ECHO :03/04/2024

EF:62%

IVC :1.1CM COLLAPSING

MILD AR+,MR+,TRIVIAL TR+, NO PAH

NO RWMA

GOOD SYSTOLIC FUNCTION


NO DIASTOLIC DYSFUNCTION


NO PE/CLOTS

USG ABDOMEN:03/04/2024

SPLEEN : 16CM , INCREASED IN SIZE ,NORMAL ECHOTEXTURE.

SPLEENOMEGALY

Treatment Given(Enter only Generic Name)

INJ.NEOMOL 1G IV/SOS IFP TEMP >101F

T. PCM 650 MG PO/TID

INJ. MONOCEF 1G IV/BD

INJ ZOFER 4MG IV/BD

INJ PAN 40 MGIV/OD

T.ETHAMSYLATE 250 MG PO/BD

T. LARINATE KIT PO/OD (ARTESUNATE 200MG+PYREMETHAMINE 50MG+SULFODXIME 500MG)

Advice at Discharge

T. PCM 650 MG PO/SOS

TAB ZOFER 4MG PO/SOS

TAB PAN 40 MG PO/OD X 3DAY 1-0-0

TAB OROFER XT PO/OD 0-1-0 X 30DAYS

INJ VITCOFOL 2ML ONCE DAILY IM X 1WEEK- F/B INJ

INJ VITCOFOL(1000MCG) 2ML IM ALTERNATE DAY X 1 WEEK

INJ VITCOFOL 2ML IM MONTHLY ONCE FOR 3 MONTHS

INJ VITCOFOL 2ML ONCE IN 6 MONTHS FOR LIFE

1 SACHET ORS IN 200ML OF WATER PO








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