2. HISTORY
6 year old femlae child sadia d/o shoaib , wt 20 kg, 5 DOA Resident Of Lyari admitted through opd
with Complaint of:
Fever 6 days
Leg pain 3 days
HISTORY OF PRESENTING
COMPLAINT
A/C to mother , My pt. Was alright 6 days back then she developed fever that was sudden in
onset,high grade documented as 103 F, continuous in nature, No aggrevating and relieving factor
associated with rigors and chills.pt also have leg pain that was gradual in onset,mild , Present
through out the day,aching in character No aggrevating and relieving factor and no referred. Or
shifting of pain.hx of nausea was present that was occasional with no hx of rashes
3. PAST HISTORY
PAST MEDICAL:
No Previous Significant Medical Admission
PAST SURGICAL:
Non significant
Hx of birth
Non significant
Allergic hx
Non significant
Tranfusion hx
Non significant
5. VACCINATION HISTORY
Completely Vaccinated Child
Nutritional Hx:
before illness pt was having one paratha chai at morning along with one roti and salan at lunch
dinner Along with one snacks
Now she is having biscuits chai at morning ,. ½ roti with salan at lunch and dinner With no
snacks in between
Apetite decreases after illness
6. FAMILY HISTORY
Product of consanguineous marriage
Mother age 38 yrs and Father 42 yrs
3 siblings ( 1 sister and 2 brother) alive and healthy
No hx of any chronic illness in family
Personal hx
Sleep normal
Apetite dec
Bowel habits normal
Hx of pica positive
7. SOCIOECONOMIC HISTORY
Live in rented house
6 members
One earner
earning is 28250 per month (security guard)
Use tap water
Ventilated house
8. EXAMINATION
My pt was lying on bed with cannula on her right hand fully oriented as per time place and
person
VITALS:
HR:115 bpm
RR: 32/min APM
Temp: 101o F wt: 20 kg length 115cm ( SD Median)
BP : 110/95 mm Hg
CRT: 2sec
o2 sat :98 percent
SUBVITALS:
A+, J-, CL-, C-, D-, E-, LN-
HEENT appears to be normal
9. SYSTEMIC EXAMINATION
CARDIOVASCULAR:
S1+ S2 + 0
CENTRAL NERVOUS SYSTEM:
Intact
ABDOMEN:
On inspection there Was normal breathing pattern umbilicus was placed centrally with
no buldging or scar marks Or prominent veins
On palpation liver was palpable 2 cm below subcostal margins Smooth regular surface
and borders ,non tender with an average span of 11 cm rest of the findings were non
significant
On percussion dull
On ascultation gut sounds were audible
CHEST
Examination of chest was non significant with bilateral air entery and no added sounds
centrally placed trachea and apex beat at 4 ics
14. MPICT
P
. Falciparum = Negative
P Vivax = Negative
Dengue Serology:
Dengue IgM Antibodies: positive
Dengue IgG Antibodies: negative
Blood C/S:
No Organism Seen
15. Treatment Given
Admit In Paeds Ward
TPR Monitoring 4 hourly
Maintain IV Line
Orally allowed
0.45 percent D/S 1500 ml @ 60 ml/ hr
Inj Ceftriaxone 700mg IV BD
Inj Provas 20 ml IV SOS
Syp Panadol 1 TSF SOS
17. DENGUE
INTRODUCTION:
Dengue viruses are spread to people through the
bite of an infected Aedes species
Dengue virus (DENV) is the cause of dengue fever. It
is a mosquito-borne, single positive-stranded RNA
virus of the family Flaviviridae; genus Flavivirus. Four
serotypes of the virus have been found DENV-1,
DENV-2, DENV-3 and DENV-4, a reported fifth has yet
to be confirmed, all of which can cause the full
spectrum of disease.
18. EPIDEMIOLOGY:
Before 1970, only 9 countries had experienced severe dengue epidemics. The disease is
now endemic in more than 100 countries in the WHO regions of Africa, the Americas, the
Eastern Mediterranean, South-East Asia and the Western Pacific.
Since 2010, Pakistan has been experiencing an epidemic of dengue fever that has
caused 16 580 confirmed cases and 257 deaths in Lahore and nearly 5000 cases and 60
deaths reported from the rest of the country. The three provinces facing the epidemic
are Khyber Pakhtunkhwa, Punjab and Sindh.
19.
20. Dengue Hemorrhagic Fever
The risk factors for developing dengue hemorrhagic fever include
This rare form of the disease is characterized by:
high fever
damage to the lymphatic system
damage to blood vessels
bleeding from the nose
bleeding under the skin
internal bleeding
bleeding from the gums
liver enlargement
circulatory system failure
The symptoms of dengue hemorrhagic fever can trigger dengue shock
syndrome, which is also characterized by low blood pressure, weak pulse, cold,
clammy skin, and restlessness. Dengue shock syndrome is severe and can lead
to excessive bleeding and even death.
21. SYMPTOMS:
Common Dengue symptoms include:
Symptoms, which usually begin four to six days after infection and last for up to 10 days,
may include
Sudden, high fever
Severe headaches
Pain behind the eyes
Severe joint and muscle pain
Fatigue
Nausea
Vomiting
Skin rash, which appears two to five days after the onset of fever
Mild bleeding (such a nose bleed, bleeding gums, or easy bruising)
22. INVESTIGATIONS
Dengue NS1: The presence of dengue nonstructural protein 1 (NS1) antigen is consistent
with acute-phase infection with dengue virus. The NS1 antigen is typically detectable within
1 to 2 days following infection and up to 9 days following symptom onset.
Dengue Serology: The IgM become detectable on Day 3 to 5 of illness in case of primary
dengue infection and persist for 2 to 3 months, whereas IgG appear by the fourteenth day
and persist for life. Secondary infection shows that IgG rises within 1 to 2 days after onset of
symptoms, simultaneously with IgM antibodies.:
Positive IgM and IgG tests for dengue antibodies detected in an initial blood sample mean
that it is likely that the person became infected with dengue virus within recent weeks.
23. TREATMENT
There is no specific medicine to treat dengue infection. If you think you may have
dengue fever, you should use pain relievers with acetaminophen and avoid medicines
with aspirin, which could worsen bleeding. You should also rest, drink plenty of fluids,
and see your doctor. If you start to feel worse in the first 24 hours after your fever goes
down, you should get to a hospital immediately to be checked for complications.
24. PREVENTION
The best way to prevent the disease is to prevent bites by infected mosquitoes, particularly if you
are living in or traveling to a tropical area. This involves protecting yourself and making efforts to
keep the mosquito population down. In 2019, the FDA approved a vaccine called Dengvaxia to
help prevent the disease from occurring in adolescents aged 9 to 16 who have already been
infected by dengue. But, there currently is no vaccine to prevent the general population from
contracting it.
To protect yourself:
•Use mosquito repellents, even indoors.
•When outdoors, wear long-sleeved shirts and long pants tucked into socks.
•When indoors, use air conditioning if available.
•Make sure window and door screens are secure and free of holes. If sleeping areas are not
screened or air conditioned, use mosquito nets.
•If you have symptoms of dengue, speak to your doctor.
To reduce the mosquito population, get rid of places where mosquitoes can breed. These include
old tires, cans, or flower pots that collect rain. Regularly change the water in outdoor bird baths
and pets' water dishes.
If someone in your home gets dengue fever, be especially vigilant about efforts to protect
yourself and other family members from mosquitoes. Mosquitoes that bite the infected family
member could spread the infection to others in your home.
29. How can pneumonia be described more exactly?
Experts also classify pneumonia according to factors other than where the patient was infected and the severity. But that typically
doesn't affect how the pneumonia is treated. Instead, it's useful for getting a better description of the illness.
Atypical pneumonia
Typical pneumonia generally begins with a sudden high fever and chills, and then coughing with phlegm coming later.
Atypical pneumonia is caused by other germs, which are also referred to as "atypical." Older people in particular have fewer or slightly
different symptoms if they have atypical pneumonia: It then starts off rather slowly with a mild fever and/or headache and aching
Rather than coughing with phlegm, they have a dry, tickly cough.
Atypical symptoms don't mean that the lungs are less severely inflamed or that the disease will take a milder course though.
Upper, middle and lower lobe pneumonia
X-rays play an important role in distinguishing between these types: the term lobar pneumonia is used if an entire lung lobe is visibly
inflamed. Depending on which lung lobe is affected, the pneumonia is referred to as upper, middle or lower lobe pneumonia.
If there are several multi-lobe focal inflammations in the lungs, the term focal pneumonia is used. Some people use the term
bronchopneumonia if the focal inflammations started in inflamed airways (bronchi).
Sometimes, it's the air sacs that are more inflamed (alveolar pneumonia), and sometimes it's the tissue between the sacs (interstitial
pneumonia).
