25 year old with dengue fever

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Case of a 25 year old female with body ache and fever

This is a case of a 25 year old female, resident of nalgonda who is a homemaker, who presented to OPD 5 days ago with chief complaints of

Generalised body ache since 10 days

Pain in joints of hand and feet since 10 days

Fever since 7 days

History of presenting illness

The patient was apparently asymptomatic 10 days ago when she developed generalised body ache which were sudden in onset, continuous, aggrevating with onset of fever and relieved on taking medication.

10 days ago The patient also developed joint pains first at metacarpophalengeal joints and ankle joints later shoulder joint and knee joint were also involved. The joint pains were dull aching, continuous, did not cause any functional impairment.

7 days ago the patient developed fever which was sudden in onset associated with chills and rigor. No diurnal variation seen. The patient recorded 101-104F fever which relieved temporarily on medication and had no aggrevating factors.

4 days ago the patient consulted local RMP who asked her to get NS1 antigen test, for which she tested positive. After learning the test result, the patient was brought to kims narketpally for treatment.

On the day of admission, the patient developed 4 episodes of vomiting which were non projectile, non blood stained,occured after consumption of food, non bile stained consisting food particles.

Vomiting was not associated with neck rigidity, abdominal pain.

No aggrevating factors noted, relieved spontaneously.

Patient also developed 4 episodes of loose stools which was non blood stained no aggrevating factors, relieved spontaneously after 4 episodes.

No history of giddiness, seizures, blurring of vision.

No history of cough, cold, post nasal drip.

No history of rash.

During admission, Hess test positive

Past history

No similar complaints in past

6 months ago, patient had undergone cesarian section.

Patient is not a known case of diabetes mellitus, hypertension, tuberculosis, asthma, epilepsy.

No history of blood transfusions.

Obstetric history

P1L1

Menarch-13 yrs

Cycles regular 5/30 days

Delivered baby 6 months ago

Lscs

Family history

No similar complaints in the past

Personal history

Appetite- slightly reduced

Diet- mixed

Bowel and bladder movements- regular

Sleep- adequate

Addictions- none

Allergies- none

Community history

The patient travelled to her relatives house 15 days ago, which was surrounded by open fields, stagnant water pools. The patient also mentioned that few of her relative's neighbours were tested dengue postive during the same time.

Daily routine

The patient wakes up at 7 am

Has tea between 8-9am

Consumes breakfast at 9am

Does household chores throughout the day

lunch at 1 PM

Sleeps from 1pm to 4pm

Goes out for walk carrying her new born from 4pm to 6pm

Dinner at 8 pm

Sleeps at 10pm

General Examination

The patient was conscious, coherent and cooperative.

The patient is moderately built and moderately nourished

Vitals:

Blood pressure 110/70 mm hg

Temperature: Afebrile

Pulse rate - 68 beats per minute, normal rhythm, volume ,character, no radio radial or radio femoral delay

Respiratory rate- 22 per minute

Absence of pallor, icterus, cyanosis, clubbing, lymphadenopathy, pedal edema.

Systemic examination

Per_abdomen_

Inspection :

Umbilicus inverted, hernial orifices free, suprapubic transverse scar present, all quadrants move equally with respiration, scaphoid shape.

Palpation :

No local rise of temperature noticed

On superfcial and deep palpation

Tenderness in the right hypochondrium , epigastric region , left hypochondrium and hypogastric region felt by patient.

Percussion

- Tympanic note heard in all 9 segments of the abdomen

Auscultation

- Bowel sounds heard

Cardiovascular system examination :

S1, S2 Heard

No thrills or murmurs

Respiratory system examination

Trachea central in position

Bilateral air entry present

Normal vesicular breath sounds were heard bilaterally in all areas

Central nervous system examination

Higher mental functions normal

No focal neurological deficit found.

Provisional diagnosis: This is a case of a 25-year-old female with body ache associated with joint pains and high-grade fever associated with chills and rigour.

suggestive of dengue

Investigations

NS1 antigen test

Complete blood picture

Day 1