Prolonged Fever: Key Investigations and Diagnostic Approaches

Prolonged Fever: Key Investigations and Diagnostic Approaches

Question. How will you investigate a case of prolonged fever?

Answer. Following are the investigations that are carried out as important investigations in case of a prolonged fever:

1. ESR platelet correlation: If ESR is more than 100 mm/hr with thrombocytosis, the following diseases can be thought of i.e.
   1. Tuberculosis
   2. Malignancy
   3. Connective tissue diseases. If ESR is less than 100 mm/hr with thrombocytosis, viral infection can be suspected.
2. Assessment of alkaline phosphatase levels: If alkaline phosphatase levels are higher following infections are suspected, i.e. biliary tract infections, alcoholic hepatitis, primary and secondaries of the liver, hypernephroma, lymphoma, military tuberculosis, cytomegalovirus infection.
3. Serological tests: They are helpful in assessing enteric fever, hepatitis, CMV infection, tularemia, secondary syphilis, brucellosis, fever, amoebiasis, and HIV.

Prolonged Fever: Key Investigations and Diagnostic Approaches

1. Imaging techniques:
   1. X-ray chest: In cases with prolonged fever when the initial X­ray is normal, a second X­ray must be taken after three weeks to rule out military tuberculosis.
   2. Ultrasound: Excellent imaging is done in thin individuals and poor imaging in obese individuals, SOL in the hepatobiliary tree of more than 1 cm and endocarditis vegetation of more than 2 mm can be detected.
   3. CT scan: Provide excellent imaging in obese patients.
      SOL in the liver is more than 1 cm and the CNS lesion is more than 0.2 cm.
   4. Radionuclide scans: 99mTc­sulphur colloid is used for scanning the liver and spleen. 111Indium labeled leukocytes are used for the detection of intra­abdominal mass.

Question . Write a short note on pedal edema.

Answer. Pedal edema is defined as swelling of feet and ankles caused by a collection of fluid in the tissues and is a possible sign of congestive heart failure.

Pedal Edema Causes Trauma.

Pedal Edema Clinical Features

• Swelling appears on the feet and ankles.
• Pittng type of edema is present.
• Obstruction of inferior vena cava.

Causes of Prolonged Fever and Diagnostic Investigations

Pedal Edema Treatment

• Sodium restriction is done.
• Diuretics should be used, i.e. spironolactone.
• Management of underlying disorder.
• ACE inhibitors are given.
• Leg elevation of patient.