[COMMUNICABLE DISEASE BLOCK]

Name: Mohammad Aimanazrul bin Zainudin

Matric number: 1228551

Academic Year: 2nd Year Phase II

PBL Group: Group 7

Clinical Tutor: Dr.

Declaration: I hereby declare that this case report is my own original work and I will be responsible for this work.

Prepared by:

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CLINICAL CASE REPORT

No. Content Page

01. Block and Patient’s Identification 302. Chief Complaints (CC) 403. History of Presenting Illness (HOPI) 504 Past Medical History 605. Past History

Family HistorySocioeconomic HistoryTreatment/Drugs History

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06. Review of Systems 807. Physical Examinations

General ExaminationsExamination of Specific Systems

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08. Problems List 1209. Differential Diagnosis 1310. Investigation 1411. Final Diagnosis 1512. Discussion

TreatmentPathophysiology of DiseasePathophysiology of Signs and Symptoms

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CONTENTS

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1. Block and Patient’s Identification

Block: Communicable Disease Block

Patient’s Identification: 0692399

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Name: Shivaji Patil

Age: 58y/o

Sex: Male

Race: Indian

Religion: Hindu

Occupation: Farmer

Marital Status: Married

Informer ; brother

Address: khanapur, Belagavi

Date of Admission: 22 September 2015

Date of Clerking: 24 September 2015

2. Chief Complaints

General Chief Complaints

1. Continous fever - 10 days, sudden onset

2. Generalized body ache – 10 days

3. History of Presenting Illness and Past Medical History

History of Presenting Illness

The patient was apparently well since 10 days back when he developed continuous fever that is sudden onset. The fever accompanies with generalized body ache that is associated with chills and rigor

1. Continuous fevera. Duration 10 daysb. Sudden in onsetc. Severity: mild

Complaint of sweating all the day Not associated with vomiting No abdominal pain Accompanied with cough for 10 days; at night and morning No sputum Sometimes complaint of pulsatile headache

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2. Past Medical History

The patient has no known history of Hypertension and non-diabetic. He had

not undergone any operations in the past or taken any significant drugs and

medications. Patient also do not have asthma, no history of TB and no recent blood

transfusion.

He had not been hospitalized in recent months and did not consult any other

doctors before the admission.

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3. Past History

Family History

Similar complaints: Nil

Parents: Dead at old age

Children: not significant

Diseases: No family members with hereditary and infectious disease such as diabetes, hypertension, and tuberculosis. No similar complaint from the family

Causes of death in family: NIL

Socioeconomic History

Marital status: Married

Spouse (health and Job): healthy, housewife

Diet: Mixed

Alcohol consumption: Nil

Smoking: Nil

Drug abuse: Nil

Tobacco chewer since years

Treatment or Drugs History

Past and Present Drugs

Past: Nil

Allergic or Reaction to Drugs: Nil

History of surgery: Nil

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4. Review of Systems

GENERAL1. WEIGHT LOSS: No2. APPETITE: Reduced3. THIRST: Nil4. ENERGY/FATIGABILITY: Generalized weakness (+)5. LUMPS: Lumps on left forearm6. SLEEP: Normal7. NIGHT SWEATS: nil

SYSTEMIC REVIEWS

GASTROINTESTINAL SYSTEM NO ABDOMINAL PAIN NO VOMITING NO FLATULANCE NO HEARTBURN NO INDIGESTION NO DYSPHAGIA NO DIARRHEA NO CONSTIPATION NORMAL STOOLS NO ASSOCIATED PAIN INCREASE BOWEL SOUND

ON AUSCULTATION

RESPIRATORY SYSTEM COUGH NO HEMOPTYSIS NOT ASSOCIATED WITH

CHEST PAIN NO WHEEZING Normal breathing

CARDIOVASCULAR SYSTEM NO CHEST PAIN NO PALPITATION NO SYNCOPE NO ANKLE OEDEMA NO ORTHOPNEA NO PND NO HEADACHES

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Heart Sounds Normal

GENITOURINARY SYSTEM NO DIFFICULTY IN PASSING

OUT URINE NO URINE INCONTINENCE NO HEMATURIA NO NOCTURIA NORMAL FREQUENCY NO POLYURIA AND

OLIGOURIA

MUSCULOSKELETAL SYSTEM NO MUSCLE PAIN NO JOINT STIFFNESS NO SWELLING NORMAL MOVEMENTS WEAKNESS PRESENT

CENTRAL NERVOUS SYSTEM NO VISUAL PROBLEM NO HEADACHE NO FITS NO FAINTING NORMAL SENSATIONS

5. Physical Examination 1. General examination

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The patient is lying comfortably in supine position supported with a pillow. He was conscious, alert and well oriented to time and space. He was not in pain neither in distress. His hydration status and nutritional status is clinically adequate. There was no gross deformity any abnormal movement or muscle wasting. There was IV line on back of right forearm.

Blood Pressure : 130/90 mmHg

Respiratory rate : 20 breath /m

Pulse rate : 66 bpm (Normal and regular)

Body temperature : afebrile

General Examination;

I. Hands moist and warm, dark complexion due to work and normal skin

colour slight clubbing no palmar erythema no pallor (adequate capillary refill) no thenar or hypothenar wasting benign painless growth on right forearm, movable unilateral fungal infection on right hand

II. Face normal complexion no pallor conjunctiva was pinkish white no discharge from orifices oral hygiene was fairly good tongue was moist and not coated no cyanosis no jaundice in sclera no lymphadenopathy

III. Leg Fungal infection on right nail (onychomycosis) No pitting edema

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CHEST & ABDOMENT: Normal Chest on auscultation (normal heart sound) and abdomen increase bowel sound

2. Examination of Specific System (per-abdominal exam)

Inspection

SHAPE: Normal scaphoid

VISIBLE PERISTALSIS: Nil

ENGORGED VEIN: Not Present

UMBILICUS: Normal (inverted)

HERNIAL ORIFICE: No Hernial cases

DIVARICATION OF RECTI: Nil

SKIN OF ABDOMEN WALL: No spider Nevi, No Operation Scar, No branding Mark, No pigmentation.

Palpation

SUPERFICIAL: Soft, tenderness at epigastric region of abdomen

DEEP: tenderness at epigastric, liver and Spleen not palpable

BIMANUAL PALPATION OF KIDNEY: Normal

BRUIT: Not heard

Percussion

FREE FLUID: Fluid thrill not noted

DULLNESS: Abdomen is mostly resonant on percussion

Auscultation

BOWEL SOUND: Heard Normal

6. Problem list

Symptoms

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1. Fever

2. Generalized body ache

3. Chills and rigor

Signs elicited

1. Tenderness at epigastric

2. Clubbing of nails

3. Onychomycosis

7. Differential diagnosis

1. Dengue fever

2. Malarial fever

3. Lymphatic filariasis

8. Investigation s

1. Full blood count

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2. Peripheral blood smear,

3. LFTs, RFT

4. Blood Film for Malarial Parasite

5. Blood culture

6. Blood Serology test

7. Nail clipping for culture (onychomycosis )

8. Urine Microscopy, urine culture

1. Blood tests :

a) Full blood count :

- Hemoglobin level : to look for hemoglobin level.

- White blood cell count : if raise indicate infection

- Differential count : to indicate whether it is viral

( lymphocytosis ) or bacteria (neurophilia) infection

- Platelet count : to see platelet level, Thrombocytopenia and

haemoconcentration will occur in Dengue

- Peripheral blood film : to look for ant atypical lymphocytes

2. Serological tests :

a) Dengue serology : a rising antibody title will confirm dengue

fever

b) Widal test : if positive indicate typhoidc) Typhidot test : if

positive indicate typhoid

3. Microbiological test :

a) Blood culture and sensitivity : to detect any pathology organism

and resistance of antibody

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b) Urine and stool culture : to detect any pathology organism

c) Tissue culture : to detect any virus

9. Final Diagnosis

DENGUE FEVER

8. Discussion

1. Treatment of Patient

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2. FLUID MANAGEMENT

Dengue with warning signs All patients with warning signs should

be considered for monitoring in hospitals

Obtain a baseline HCT before fluid therapy

• Give crystalloids solution (such as 0.9% saline)

• Start with 5 - 7 ml/kg/hour for 1-2 hours, then reduce to 3 - 5

ml/kg/hr for 2 - 4 hours, and

then reduce to 2 - 3 ml/kg/hr or less according to the clinical

response

• If the clinical parameters are worsening and HCT is rising,

increase the rate of infusion

Non-shock patient

• Encourage adequate oral intake

• Intravenous fluids are indicated in patients who are vomiting,

unable to

tolerate oral fluids or an increasing HCT despite increasing oral

intake.

• Crystalloid is the fluid of choice

• Reassess the clinical status, repeat the HCT and review fluid

infusion rates accordingly

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a. Medications

i. Paracetamol 500mg

ii. Antibiotics; ciprofloxacin

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3. Pathophysiology of disease

Mosquito bite

Inoculation of virus and reach to regional lymph nodes

Disseminated to reticuloendothelial system

Activation of reticuloendothelial system

Initial viraemia

Stimulate immune system

Release interferon and immunoglobin

Induce prostaglandin

Elevated temperature set point inthermoregulatory center in hypothalamus

Heat production and conservation

Dengue fever

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4. Pathophysiology of signs and symptoms

1. Generalized body achesViremia

↓Viral multiply in macrophages and monocyte

↓Release interferon, interleukin, prostaglandin

↓Accumulates and cause generalized body inflammation

2. Headache

Dengue fever

Vasodilation of blood brain vessels

Increase cerebral blood flow

Increase intracranial pressure

Generalized headache

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