Why a prolonged fever in a farm worker matters
A fever lasting more than a week in rural India has a short list of common, treatable causes. Her work, the season and her exposures, together with a careful head-to-toe examination, narrow it quickly.
What to ask in the history
- Fever pattern, shivering
- Headache, body aches, cough, breathlessness
- Rash
- Yellow eyes, dark urine
- Bleeding
- Work in fields, grass or water; animals; mosquitoes
- Travel, anyone else ill
- Every medicine taken so far
Red flags
- Breathlessness, low oxygen saturation
- Low blood pressure, little urine
- Confusion or seizures
- Jaundice
- Bleeding
- A falling platelet count
What to examine
- Observations
- A full skin examination for rashes, bites and lesions
- Lymph nodes
- Jaundice
- Chest
- Liver and spleen
- Neck stiffness
First investigations
- Full blood count with platelets, liver and kidney function
- Malaria test
- Dengue tests
- Antibody tests for rickettsial infection and leptospirosis
- Blood culture for typhoid
- Chest X-ray
- Urine test
Differential diagnosis of a prolonged fever in a farm worker
Grouped, not ranked. Which one fits this patient is for you to work out in the case.
Parasitic and viral
- Malaria
- Dengue
- Chikungunya
Bacterial
- Typhoid
- Leptospirosis
- Brucellosis
Rickettsial
- Scrub typhus
- Spotted fever
Other
- Tuberculosis
- An abscess
- Autoimmune disease
Common mistakes
- Relying on the Widal test.
- Not examining the whole skin.
- Holding treatment while waiting for tests when she is very unwell.