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‘TEMPO’ AT WHICH THE SYMPTOMS APPEAR, HELPS TO DIAGNOSE THE CAUSE OF COMMON FEVERS
OP Kapoor
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
Doctors are very afraid of dengue fever, leptospirosis and pyogenic meningitis - all considered as ‘dangerous’ causes of fever.
The ‘tempo’ of symptoms will often help a GP to diagnose and differentiate these conditions.
For example, dengue fever patient will present with ‘sudden’, very high fever with severe pain in the bones of the back and joints, and congested conjunctiva.
Weil’s disease patient also becomes very acutely ill with fever and severe pain, and extreme tenderness of the muscles, (markedly raised CPK).
In Weil’s disease, the tempo of the illness is very fast. Jaundice is suddenly noticed on the second or third day of the high fever in a very ill patient. Of course, presence of leucocytosis, abnormal urine findings of albumin, casts and a brisk response of the illness to penicillins or doxycycline will help in the diagnosis. While, in viral hepatitis, which is a very common cause of jaundice, the tempo of the illness is ‘slow’. There is ‘viraemia phase’ with malaise, low fever, loss of appetite lasting a few days, before the jaundice appears gradually.
Finally, sudden severe bursting headache with vomiting and high fever should make every general practitioner look for neck rigidity so as not to miss a case of pyogenic meningitis, which can be fatal within 24 hours.
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