38 year old women with dengue fever

38 YEAR OLD WOMEN WITH DENGUE FEVER

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Chief complaints :

A 38 year old women from Nakrikal presented to the OPD with a report from another hospital with decreased platelet counts .

History of presenting illness :

The patient was apparently asymptomatic 5 days back , then she developed low grade fever associated with chills and rigors . The fever was around 100 F when they measured it and was intermittent in nature that relieved on medications. She also developed body pains especially knee pains . She also had 2-3 episodes of vomitings on the first day of fever that were non bilious and non projectile . She also had abdominal discomfort for a day .

Yesterday ( 07/11/22 ) she had developed rashes on her palms and soles , that also has disappeared now with medications .

Her platelet counts :

03/11/22 - 1,62,000 cells/mm3

04/11/22 - 1,82,000 cells/mm3

05/11/22 - 92,000 cells/mm3

06/11/22 - 62,000 cells/mm3

07/11/22 - 70,000 cells/mm3

08/11/22 - 72,000 cells/mm3

Past history : Not a K/C/O HTN, DM, asthma, epilepsy, thyroid disorders, CAD

Personal history : She is a housewife so wakes up in the morning, does all her daily chores of cooking etc and sleeps at night .

Diet - mixed

Appetite - normal

Sleep - adequate

Bowel and bladder movements - regular

Addictions - none

Treatment history : She was given the following injections at the other hospital where they had first taken her :

1) Falcigo 120

2) Monocef

3) Diclofenac

General Examination : The patient is conscious, coherent and cooperative, well built and nourished .

Pallor, icterus, cyanosis, clubbing, pedal edema and generalised lymphadenopathy are absent .

VITALS :

Temperature - afebrile

BP - 100/70 mmHg

HR - 80 bpm

RR - 18 cpm

Systemic Examination : 

CVS : 

On palpation ‐

• Apex beat was felt in the left 5th intercostal space medial to the mid clavicular line. 

• JVP was normal 

• No precordial bulge 

• No parasternal heave

On auscultation ‐ S1, S2 heard , no murmurs 

RS :

On inspection ‐

• Chest is bilaterally symmetrical 

• Expansion of chest: Equal on both sides

• Position of trachea: Central

• No visible scars, sinuses, pulsations

On palpation : 

• Expansion of chest was equal on both sides. 

• Position of trachea: Central

• Tactile Vocal Fremitus: resonant note was felt.

On percussion: all lung areas were resonant 

On auscultation : 

• Bilateral air entry was present, normal vesicular breath sounds were heard. 

• Vocal resonance: resonant in all areas

P/A : soft, non tender, no organomegaly, no distension, bowel sounds heard.

CNS : The patient is well oriented to time, place, person.

Higher mental functions are intact.

Cranial nerve examination :‐

All cranial nerves are intact and functioning. 

Motor System Examination :‐

• Normal bulk in upper and lower limbs

• Normal tone in upper and lower limbs

• Normal power in upper and lower limbs

• Gait is normal 

. Reflexes are normal .

Sensory System Examination :‐

Normal sensations are felt in all the dermatomes.

No cerebellar signs .

No meningeal signs.

Investigations :

Hemogram

CUE

LFT

Serum levels

ECG

USG of abdomen

Provisional Diagnosis : Viral pyrexia with thrombocytopenia secondary to dengue fever  (NS positive)

Treatment :

1) IV fluids - NS/RL 100ml/hr

2) Inj.  Pantop 40 mg IV OD

3) Inj. Optineurin 1 amp. in 100 ml NS IV over 30 min OD

4) Tab. Doxycycline 100 mg PO BD

5) Tab. Riboflavin 5 mg PO OD

6) Calamine lotion

7) Zytee gel