What your fever means?

Many believe that most fevers cannot be differentiated clinically. However, it is not true. Here are few tips to identify different types of fevers and their causes.

• Fever with cough and cold: think of flu
• Fever with retroorbital eye pain: think of dengue
• Fever with joints pain which improves on bending: think of Chikungunya
• Fever with lymphocytosis: think of viral fever
• Fever with lymphopenia: think of Covid 19, acute hepatitis, HIV
• Fever with jaundice: rules out viral hepatitis
• Fever subsides capillary leakage appears in dengue
• Low grade evening rise fever: think of TB
• Fever with chills and rigors: think of malaria, filaria, UTI, sepsis
• Fever with cough and breathlessness: think of COVID like illness
• Fever with ESR > 100: painful thyroiditis, sepsis
• Fever with SGOT > SGPT: dengue
• Fever with angry looking throat with no cough think of streptococcal sore throat
• Fever with red eyes: Zika illness
• Fever with eschar: scrub typhus
• Fever with single chills: pneumonia
• Fever with involvement of skin, joint and or kidney rule out auto immune disease
• Fever with TLC > 15000 is sepsis
• Fever with positive thump sign on liver rule out liver abscess

The writer is Dr KK Aggarwal, President CMAAO, HCFI and Former National President CMAAO

Lopinavir-ritonavir is the drug of choice

This combined protease inhibitor, which has primarily been used for HIV infection, has in vitro activity against the SARS-CoV  and appears to have some activity against MERS-CoV in animal studies.

Although the use of this agent for treatment of COVID-19 has been described in case reports, there was no difference in time to clinical improvement or mortality at 28 days in a randomised trial of 199 patients with severe COVID-19 given lopinavir-ritonavir (400/100 mg) twice daily for 14 days in addition to standard care versus those who received standard of care alone.

Virus can be transmitted through breast milk

The only report of testing found no virus in the maternal milk of six patients. However, droplet transmission could occur through close contact during breastfeeding. Thus, mothers with confirmed COVID-19 or symptomatic mothers with suspected COVID-19 should take precautions to prevent transmission to the infant during breastfeeding (including assiduous hand hygiene and use of a facemask).

Alternatively, to minimise direct contact, the infant can be fed expressed breastmilk by another caregiver until the mother has recovered, provided that the other caregiver is healthy and follows hygiene precautions.

Women who choose not to breastfeed must take similar precautions to prevent transmission through close contact when formula is used.

Two tests are required to declare recovery

Ideally four. Factors include resolution of clinical signs and symptoms and negative results of reverse-transcription polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on two sequential paired nasopharyngeal and throat specimens (four specimens total, each handled separately), with each pair collected 24 hours apart.

COVID-19 can’t be diagnosed without tests

In some cases, testing for COVID-19 may not be accessible, particularly for individuals who have a compatible but mild illness that does not warrant hospitalisation.