Epidemic Typhus is a rickettsial fever and causes a wide range of symptoms

1. Presented by :
B.Sunil Kumar Nayak

2.  Patient Name :- ABC
 Age :- 28 Years
 Sex :- Male
 Department :- General Medicine

3.  Generalized rash all over the body since 3 days.
 Evening rise in temperature.
 Rash started after 1 week of fever with itching.

4.  MEDICAL HISTORY :- No Histories
 MEDICATION HISTORY :- Dolo 650mg
 FAMILY HISTORY :- Nothing significant
 SOCIAL HISTORY :-Nothing significant

5. S - Subjective Evidence
O - Objective Evidence
A - Assessment
P - Planning

6.  PROVISIONAL DIAGNOSIS:-
Viral Exanthema….?

7. Biochemistry
 R.B.S :- 116mg/dl (60-160)
 Blood urea :- 25mg/dl (15-45)
 Serum creatinine :- 1.3 mg/dl (0.7-1.5)
 Electrolytes :
Na :- 139 m.mol/lit (135-145)
K :- 3.6 m.mol/lit (3.5-5.5)
Cl:- 100 m.mol/lit (95-110)
Microbiology
 Hepatitis-C-virus :- Non-reactive
 HIV 1 & 2 Antibody :- Non-reactive
 Hepatitis-B-surface antigen :- Non-reactive

8. C.B.P
 Haemoglobin :- 14 gr/dl
 W.B.C :- 11000 cells/cumm
N – 80%
L – 13%
M – 04%
E – 03%
B – 00%
 R.B.C :- 4.6 mill/cumm
 PCV :- 41vol%
 MCV :- 89 fl
 MCHC :- 33%
 E.S.R :- 05mm/hr
 Recticulocyte :- 21%
 Platelets :- 1.90 L/cumm

9.  Prothrombin time :- 16.0 sec (13 sec)
 APTT :- 34.1 sec (30 sec)
Microbiology
 Dengue NS1 antigen :- Non-reactive
 Dengue IgM antibody :- Non-reactive
 Dengue IgG antibody :- Non-reactive
 Widal test :- Negative.
With the reference of the Dermatologist, suggested that the
infection is likely by Rickettisal sps but not the varicella

10. FINAL DIAGNOSIS
EPIDAMIC TYPHUS

11.  To relieve from the rash
 To maintain the body temperature
 To eradicate the organism from the body
 To prevent the complications like hypovolemia, CNS
dysfunction.

12. S.I
NO
DRUGS
(Generic names)
DOSE ROA FRE DA DS
1 Inj.Pantoprazole 40mg IV BID D1 D6
2 2 pint-NS
1 pint – RL -
IV
-
D1 D4
3 Inj.Ceftriaxone 1 g IV BID D1 D1
4 Tab.Levocetrizine 5mg PO BID D1 D6
5 Calamine lotion - Topical BID D1 D6
6 Tab.Doxycycline 100mg PO BID D1 D6
7 Tab.Valacyclovir 1 g PO TID D1 D3
8 Tab.Paracetamol 650mg PO TID D1 D6
9 Paracetamol 100ml IV SOS D1 D6
10 Tab.Trypsin+Chymotrypsin 1 tab PO TID D4 D6
11 Tab.Fexofenadine 120mg PO OD D4 D6
12 Tab.Gabapentin+Nortriptyline 400+10mg PO OD-HS D5 D6

13. DAYS PROGRESS
DAY
-1
O/E:
Patient is c/c
Temp:104.25F, P/A: soft, PR:80bpm, BP:110/70mmhg
DAY-2 O/E: Pt is c/c, PR:62/min, BP:120/80mmhg, CVS:S1S2+, RS:BAE+,
P/A: soft
DAY-3 O/E Patient is c/c
c/o Fever, Maculopapular Rash
PR:121/min, BP:110/80mmhg, CVS:S1S2+, RS:BAE+, P/A: soft

14. DAYS PROGRESS
DAY-4 O/E:Pt is c/c,
PR:72/min, BP:110/90mmhg, CVS:s1s2+
No fresh complaints
DAY-5 O/E:Pt is c/c
C/O Burning sensation all over the body
BP:110/70mmhg,PR:82/min, CVS:s1s2+, RS:BAE+
Day-6 O/E:Pt is c/c
No fresh complaints
BP:120/60mmhg,PR:50/min

15.  Body temperature is maintained.
 Intensity of the rash was decreased.

16.  Body temperature should be monitored
 Body fluid levels should be monitored,
 Monitor the CNS functions like dullness etc.

17. No problems were identified.

18.  Discharge medications:
S.I
NO
DRUGS DOSE ROA FREQ DURATION
OF USE
1 Doxycycline 100mg PO BID 8 days
2 Levocetrizine 5mg PO BID 8 days
3 Calamine lotion
-
Topical BID 10 days
4 Pantoprazole 40mg PO OD 8 days
5 Full 24 1 tab PO OD 10 days

19. 1.About Disease
2.About Medication
3.About life style modifications