Sunday, August 2, 2009

"Never do such blood tests on your own"

"Never do such blood tests for fever on your own"
I was educating the husband and wife in front of me. They were listening intently with a tinge of shame on their face.
30 year old man came to me with a series of blood test results. He is a Sales Engineer. He is having on and off fever for last 10 days. He took Paracetamol for 2 or 3 days and then noticed his urine is dark yellow in color.He immediately went to a Laboratory and asked them to do tests to see if he has jaundice. Test results showed his bilirubin is slightly high.[2.1mg]
He went to a Physician saying he has jaundice. The physician asked him to do more blood tests on Liver function and gave him some medicines for 2 days. Instead of taking that medicine and doing the tests he went to local quack to get native medicine for jaundice.
His fever was continuing on and off with no relief.So he went to another laboratory and asked them to do tests for Typhoid fever. They did the Widal test and found it to be slightly positive for paratyphi. He approached another physician to get treatment for Typhoid. He was advised admission to hospital but he refused.He was given a course of antibiotics useful for Typhoid.
Still fever was continuing. He came to see me.
After taking all this history I started examining him.He was sweating like anything in rainy cold weather.
'Did you take Paracetamol some time ago'? I asked.
"No' was his reply.
" Then why you are sweating like that?". Are you like this always?" I was curious.
'He is like this for last 5 days.Every day in the morning he gets high fever and rigors and then in 1-2 hours he sweats like this without any medicine,"said his wife.
oh........now I know why he is having fever, said my mind.
Let me confirm it with one more question.
'Have you travelled to any of the neighbouring States recently?" I asked.
"Yes to Mangalore and Bangalore" was the reply.
Being a Sales Engineer covering 3 States he is constantly in travel.
Even without a confirmatory blood smear examination I was convinced that he is having Malaria. High grade fever with rigor and chills coming same time of the day and which disappear with severe sweating without any medicines is highly suggestive of Malaria.
I told him my diagnosis and asked him to give a blood sample for Malaria immediately.
" But I have done lot of blood tests",he was confused.
" That was precisily the reason for delay in diagnosis in your case',I said.
'Never do such blood tests on your own for fever. You presented to the doctor with a lab diagnosis and the doctor did not look for a reason for fever other than what you provided.
Jaundice can occur in Malaria and the Typhoid test is not such a reliable test.Indigenous Malaria is very rare in Kerala. That's why I asked you about travel. Mangalore is notorious for Malaria.

I did his blood smear and it showed plenty of plasmodium vivax,which cause Malaria. With in few days of medicines on out-patient basis he was cured of his illness.

2 comments:

Nikhil Narayanan said...

Doc,
High school biology helped me guess that this could be malaria,when the symptom was told in the post.
May be of interest to you
http://is.gd/1YNBU
-Nikhil

Charakan said...

Nikhil,Good guess. It seems the society lost out on an intelligent doctor due to your carrier selection.