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Related Experiment Videos

Resolving diagnostic uncertainty in initially poorly localizable fevers: a prospective study.

Rakesh Biswas1, Binod Dhakal, R N Das

  • 1Department of Internal Medicine, Manipal Teaching Hospital, Pokhara, Nepal. rakesh7biswas@hotmail.com

International Journal of Clinical Practice
|March 5, 2004
PubMed
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Fever charting is crucial for diagnosing enteric fever in Nepal. Judicious use of this clinical tool aids in treating initially non-localizable fevers, guiding antibiotic choices effectively.

Area of Science:

  • Infectious Diseases
  • Clinical Medicine
  • Diagnostic Tools

Background:

  • Fever of unknown origin presents a diagnostic challenge in clinical practice.
  • Accurate etiological diagnosis is essential for effective patient management and treatment.
  • Understanding fever patterns can aid in differentiating infectious and non-infectious causes.

Purpose of the Study:

  • To collect prospective data on fever patients to determine etiology and diagnostic methods.
  • To identify factors that rapidly resolve diagnostic uncertainty in fever cases.
  • To evaluate the utility of fever charting in diagnosing and managing non-localizable fevers.

Main Methods:

  • Prospective observational study of patients with clinically non-localizable fever.
  • Data collection included temperature response, clinical and laboratory findings, and treatment response.

Related Experiment Videos

  • Patients were admitted to Manipal Teaching Hospital, Pokhara, Nepal.

    • Main Results:

    • Enteric fever was the most common diagnosis (56.8%), followed by urinary tract infection (15.9%) and malaria (9%).
    • Culture-positive results showed Salmonella typhi in 32% and S. paratyphi in 20% of cases.
    • Treatment response varied, with ceftriaxone showing higher efficacy (44%) in enteric fever cases compared to first-line (16%) and second-line (20%) drugs.

    Conclusions:

    • Fever charting remains an invaluable clinical tool for differentiating Salmonella infections from other fevers in adult patients in Nepal.
    • Judicious use of fever charting can effectively diagnose and treat initially non-localizable fevers.
    • Antibiotic initiation should be delayed until fever patterns suggest enteric fever, and patience is advised before switching from first-line to second-line drugs, with quinolones as a potential first-line option.