History
- Host high risk : <5y, advanced age, DM, pregnancy, Immunocompromised
- Exposure risk : เข้าป่า เล่นน้ำตก เที่ยวถ้ำ sexual intercourse, high risk food, expose ต่อสัตย์ เช่นหมา แมว หนู ประวัติ แผล IVDU
- Clinical symptom
- Rash: Dengue fever, typhus, syphilis, gonorrhea, Chikungunya, HIVseroconversion
- Jaundice: Hepatitis, malaria, leptospirosis
- Lymphadenopathy: Rickettsial infections, HIV, Epstein-Barr virus, cytomegalovirus, toxoplasmosis
- Hepatomegaly: Amebiasis, malaria, typhoid, hepatitis, leptospirosis
- Splenomegaly: Malaria, typhoid, typhus, dengue fever
- Eschar: Typhus, anthrax
- Hemorrhage: Meningococcemia, hemorrhagic fever, leptospirosis
Investigations
- CBC c plt, LFTs, UA, CXR
- Malaria thick, thin film
- H/C, UC, Stool C/S
- IFA for rickettsial
- Deugue IgM (positive >d5), NS1 recombinant (d1-9)
- Influenza A and B nasal swab
- ESR, VDRL, HIV
Diseases Commonly Associated with Fever
- Undifferentiated fever: malaria, dengue, chikugunya, leptospirosis, HIV, samonellosis, shigellosis, campylobacteriosis, hepatitis
- Fever with respiratory symptom: Influenza, SARS
- Fever with hemorrhage: viral hemorrhagic fever, meningococcemia, leptospirosis
- Fever with CNS symptom: meningococcemia, rabies, malaria, encephalitis, poliomyelitis
Empirical treatment
- Ceftriaxone 2 gm IV OD, ciprofloxacin, 400 mg IV q 12hr or ciprofloxacin(500) 1x2 for 14 days. Alternatives: azithromycin 1 gm PO on d1; 500 mg PO OD for 6 days
- + Doxycycline(100) 1x2 for 7 days
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