Brief Answer:
Patient can be treated on outpatient basis

Detailed Answer:
Hi, thanks for posting the concern in HCM.
From the history and avilable report it seems to be Dengue fever.

Antibody tests don't come positive at this early stage. You can only get NS1 antigen positive. Headache and severe body ache alongwith joint pain can occur in dengue. However, Chikungunya should also be excluded by antibody test.

However, shivering is not so common in dengue or chikungunya. Therefore, chances of malaria and UTI should be excluded. MP is not very accurate in excluding malaria. A test for malaria dual antigen is needed urgently. Alongwith that Urine routine examination and culture sensitivity testing should also be performed.

Now, coming to the management of dengue fever, I don't think management is at all needed unless any complication is there or platelet count is low or high-risk is present. In this case, platelets are adequate. If you find any rash, that needs to be urgently evaluated by local doctor to rule out petechiae. In case of spontaneous bleeding from any site, she also needs admission. Moreover, hematocrit should also be checked. A 20% fall in hematocrit is also high risk. Lastly, liver function test should also be repeated after 72 hours to check hepatic involvement. In case there is no complication, patient can be managed at home.

You need to take care of one thing at home- FLUID intake. Plenty of oral fluid should be consumed.
In simple dengue fever, adequate fluid intake and Tab Paracetamol 650 mg 8 hourly would suffice. If Paracetamol requirement increases to more than 4 gm, you need to admit her. No, other medication is usually needed. In case of pruritus, LFT should be rechecked and Tab Cetzine may be taken. I repeat, no other medication is needed for management of simple dengue fever. Antibiotic and antimalarials have no role, unless co-infection is there.

You should also consult local internal medicine specialist or a specialist in tropical medicine or infectious disease for further management. Platelet count should be repeated every alternate day and treating doctor should be informed accordingly.

A coagulation profile and hematocrit should be performed to rule out chances of hemorrhagic complications.

If you find this answer helpful, please close the thread and rate my answer.
Regards,
Dr. Kaushik Sarkar

---

Brief Answer:
Continue Lanol-ER tablet and disease course lasts for about 10 days.

Detailed Answer:
Hi, thanks for your reply.
As you have said, your doctor has advised to continue Tab Lanol ER, he is right regarding the same. As I have said earlier, maintaining good oral hydration and keeping watch on warning signs and platelet count and hematocrit are crucial for management.
Now, you also want to know the course of illness. I would say that the disease course typically last for about 10 days. Fever lasts for about 4 days (3-7 days) and thereafter temperature usually comes to normal or below 38 degree C. During the febrile phase, headache, bodyache, retro orbital pain are present in most of the patients. As the temperature drops, the critical phase ensues. This typically starts from day 4 (may vary according to the duration of febrile phase). In this phase, platelet count drops most and hematocrit rises. Temperature may again rise for a day or two or remain normal. This typically lasts for 3 days and then comes the stage of plasma leakage and recovery, wherein platelet count rises and hematocrit drops. The course typically lasts for a total of 10 days.
During the critical phase keep watch on the danger signs like pain abdomen, vomiting, edema, restlessness, bleeding from mucosa etc.
So, in short there is nothing more than supportive treatment and keeping watch on warning signs and typical recovery time is 10 days from the onset of fever.
If you are satisfied with my answer, please close the thraed and rate my answer.
Regards,
Dr. Kaushik Sarkar

---