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Dr K K Aggarwal

Tips to clinically differentiate between different types of fever

By Dr K K Aggarwal
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  • If a patient comes with fever with chills and rigors, think of Malaria in north and filaria in Vidarbha region in India.
  • In malaria, chills are in the afternoon; in filaria, the chills occur in the evening.
  • Fever with joint pains on extension often is due to Chikungunya (flexion improves the pain)
  • Think of dengue if there is fever with itching, rash and periorbital pain.
  • In fever with single chills, think of pneumonia.
  • Fever with sore throat, no cough, no nasal discharge: Think of streptococcal sore throat, especially in the children.
  • Fever with red angry–looking throat: Think of streptococcal sore throat
  • Fever with red epiglottis: Think of Hemophilus infection
  • Fever with cough and or nasal discharge: Think of common flu
  • Fever with cough, nasal discharge, nausea and vomiting: Think of H1N1 flu
  • Fever with toxic look, persistent fever: Look for typhoid
  • Fever with no or low rise in pulse: Look for typhoid
  • Fever with urinary symptoms (burning, frequency): Rule out urinary infection.
  • Fever with high TLC (white cell count) and liver pain: Rule out liver abscess
  • Fever with watery diarrhea, with no blood or mucous: Rule out acute gastroenteritis
  • After the fever is over, jaundice appears: This is viral hepatitis
  • After the fever is over, one feels very weak: Rule our dengue hemorrhagic fever.

Swine Flu is back but no panic

By Dr K K Aggarwal
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• Swine flu presents with fever of more than 1000 F with cough or sore throat in the absence of any other main cause. • The diagnosis is confirmed with a lab test using rRT/PCR technique. • Mild or uncomplicated flu is characterized by fever, cough, sore throat, nasal discharge, muscle pain, headache, chills, malaise and sometimes diarrhea and vomiting. In mild cases, there is no shortness of breath. • Progressive swine flu is characterized by the above symptoms along with chest pain, increased respiratory rate, decreased oxygen in the blood, labored breathing in children, low blood pressure, confusion, altered mental status, severe dehydration and exacerbation of underlying asthma, renal failure, diabetes, heart failure, angina or COPD. • Severe or complicated swine flu is characterized by respiratory failure, requirement of oxygen or ventilator, abnormal chest x-ray, inflammation of the brain, lowering of blood pressure to less than 60 and involvement of the heart muscle. These patients will have persistent high fever and other symptoms lasting more than three days. • Most patients will remain asthmatic with illness lasting 3-7 days. • The characteristic features are presence of chills, muscle pain and joint pain. • In the pregnant women, flu can cause more serious complications including death of fetus. • Mild cases do not require admission but progressive cases need to be admitted. • Underlying, organ disease and requirement of mechanical ventilation is the indication for admission. • Oseltamivir phosphate is the treatment of choice but it should be taken under medical supervision. It has to be given in the first 48 hours. It is given in severely low patients, pregnant women, underlying organ disease or age less than 5 years. • Flu vaccine can be given to all. It should be given to all high-risk patients. • The virus spreads through droplet infection and spreads with a person coughs, sneezes, sings or speaks. The virus can cover only a distance of 3 to 6 feet. • Stay 3 feet away from the person who is coughing. • The standard prevention is respiratory hygiene, cough etiquette and hand hygiene. • Hand washing should be performed before and after every patient contact or infectious material and before putting and after removing gloves. • Hand hygiene can be performed by washing with soap and water or with alcohol based hand drops. • If hands are visibly soiled, they should be washed with soap and water. • Patients should be placed in a private room or area. The health care staff should wear a face mask while entering the patient’s room. When leaving the room, the health care workers should remove the face mask, dispose it off and then perform hand hygiene. • Patients should wear a surgical mask and should be aware of respiratory hygiene, cough etiquette and hand hygiene. • Droplet precaution should be taken for seven days after illness onset or 24 hours after resolutions of fever and respiratory syndrome. • One should not cough in the hands, handkerchief but instead cough either in the tissue paper and dispose it off or in the side of the arm. • Swine flu causes fewer deaths than normal seasonal flu. • Hong Kong Study of H1N1 (Between April and December 2009]: Overall attack rate was 10.7 percent, case-hospitalization rate was 0.47 to 0.87 % among people aged 5 to 59 years, case-ICU rate was 7.9 cases per 100,000 infections in children aged 5 to 14 years, case-ICU rate was 75 cases per 100,000 infections in adults aged 50 and 59 years, case-fatality rate was 0.4 cases per 100,000 in children aged 5 to 14 years and case-fatality rate 26.5 cases per 100,000 in adults aged 50 to 59 years. • Case fatality is 0.4 – 26.5 cases per 100,000. That means 10 deaths would occur if one lac people gets fly. For getting 95 deaths we need almost one crore people getting infected with flu. This again means 10% of the society suffering from flu or two patients per family. Either the figure 95 is wrong or the figure number of positives deaths is wrong. • Two third of deaths occur in people with underlying chronic illness. • In seasonal flu more deaths are in people above 65 years of age and in H1N1 flu more deaths are in 50-64 years old age group.

Common Cold

By Dr K K Aggarwal
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• Common cold is a benign self–limiting syndrome caused by several viruses.

• It is one of the most frequent acute illnesses.

• The term ‘common cold’ refers to a mild upper respiratory viral illness presenting with sneezing, nasal congestion, nasal discharge, low grade fever, headache and malaise.

• Common cold is not the same as influenza or common sore throat, which can also involve the heart.

• Common cold affects a pre–school child 5–7 times in a year and adults 2–3 times in a year.

• It can spread by hand contact, by direct contact with the infected person or by indirect contact with a contaminated environmental surface.

• It can also spread by small particle droplets that become airborne from sneezing or coughing.

• It can also be transmitted via large particle droplets that typically require close contact with infected person.

• Most important is hand to hand transmission of the virus.

• Infection can also spread through circulating air.

• Saliva does not spread any cold.

• The disease is most infectious on the 2nd and 3rd day of illness.

• However, a person may be infectious for up to 2 weeks.

• Normal cold may last for 8–10 days.

• The diagnosis is based on clinical findings.

• Common cold can exacerbate asthma in susceptible individuals.

Tips to clinically differentiate between different types of fever

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , | | Comments Off on Tips to clinically differentiate between different types of fever

• If a patient comes with fever with chills and rigors, think of Malaria in north and filaria in Vidarbha region in India.

• In malaria, chills are in the afternoon; in filaria, the chills occur in the evening.

• Fever with joint pains on extension often is due to Chikungunya (flexion improves the pain)

• Think of dengue if there is fever with itching, rash and periorbital pain.

• In fever with single chills, think of pneumonia.

• Fever with sore throat, no cough, no nasal discharge: Think of streptococcal sore throat, especially in the children.

• Fever with red angry–looking throat: Think of streptococcal sore throat

• Fever with red epiglottis: Think of Hemophilus infection

• Fever with cough and or nasal discharge: Think of common flu

• Fever with cough, nasal discharge, nausea and vomiting: Think of H1N1 flu

• Fever with toxic look, persistent fever: Look for typhoid

• Fever with no or low rise in pulse: Look for typhoid

• Fever with urinary symptoms (burning, frequency): Rule out urinary infection.

• Fever with high TLC (white cell count) and liver pain: Rule out liver abscess

• Fever with watery diarrhea, with no blood or mucous: Rule out acute gastroenteritis • After the fever is over, jaundice appears: This is viral hepatitis

• After the fever is over, one feels very weak: Rule our dengue hemorrhagic fever.

Winter sore throat in children needs to be differentiated, because the viral sore throat needs no treatment; however, bacterial sore throat, if ignored, can end up with permanent heart or kidney damage.

Sore throat is a symptom, not a disease. During winter season if children between 5 to 15 years complain of redness in the throat with fever ranging between 101–104°F and associated enlarged tender cervical lymph nodes, they need immediate attention and antibiotics. This sore throat is devoid of any cough, nasal discharge or nasal congestion.

On the contrary, viral sore throat will present with recurrent cough and nasal discharge.

The bacteria sore throat illness may last only for 2 to 3 days and if no antibiotics are given, the child may present with joint pains and involvement of the heart/kidney weeks later.

So called strep sore throat, the illness licks the joints and bites the heart. Six out of every 1000 children suffer from this illness. The illness is more common in winter season as children tend to spend more time indoor with each other.

Schools should be especially concerned about cough in children as the disease can rapidly spread from one child to another by droplet infection.