Tuesday, March 21, 2017

Double pathology is not that uncommon



Patients admitting to post-natal wards is not uncommon with fever. Episiotomy site infections, urinary tract infections, viral fever, endometritis, surgical site infections are common causes. Usually they are treated with common antibiotics while observing the response.  However the focus of infection is not always evident. In peripheral hospital where laboratory facilities are limited, treating such patients is quite challenging.

When I was working in such unit, I came across a patient who delivered her baby by normal vaginal delivery few days back admitted with fever for 2 days. She has done her full blood count outside with a CRP. Full blood count showed WBC something around 7 x109/l, platelets 180 x109/l & CRP more than 100. She was febrile too. But no other foci of infections. Urine also was normal. What it could be?  Endometritis? Well it could be the most likely. She was started with iv antibiotics- meropenum immediately after taking blood cultures after seen by the consultant obstetrician.

Patient continued to have fever spikes & seemed to be flushed. Even with this super antibiotic her fever did not resolved. At the 3rd day of antibiotics, full blood count was repeated. WBC- around 5 x109/l & platelets around 60 x109/l. 

Dengue haemorrhagic fever is not uncommon in this tropical region. Actually when sent for the serology, she was positive for dengue. Patient was at the verge of dengue shock state. Patient was admitted immediately for ICU care & her life was saved. 

Doing dengue NS1 antigen is much expensive & usually not affordable to the vast majority of patients who come for treatments in this kind of peripheral units. And also doing NS1 antigen may not be cost-effective. True that you have a most likely diagnosis, but still keep in your mind that something else also might be there. When the things are not going with our expectations it is wise to reconsider other possibilities. Double pathology is not that uncommon too.   

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