HOMOEOPATHIC APPROACH TO ERUPTIVE FEVERS CASE 1 A

HOMOEOPATHIC APPROACH TO ERUPTIVE FEVERS

CASE 1 A four year old female child came with complaints of fever with vesicular eruptions all over the body since 1 day with severe burning pains on slightest touch.

EVOLUTION Complaints started with throat pains since 3 days. A/F oily food. 2 days later started with fever which was high grade with chilliness. Since 1 day vesicular eruptions started on face and now spread to trunk back and upper extremity. Burning pains <3 slightest touch >2 draft of air Itching minimal. Has become cranky and weepy due to pain. Appetite decreased. Thirst – increased sips of water frequently.

EXAMINATION FINDINGS General Examination: Temp : Pulse : Chest : CVS: Throat- 101 O F 110/min Clear S 1, S 2 normal. Congested Local Examination: Vesicular discrete eruptions on back , face and upper extremity.

ACTION: - 1. Placebo 2. Orientation of mother regarding diagnosis.

FOLLOW UP IN 2 DAYS: Weepiness Appetite. Thirst – SQ. Decreased Desire to drink but refuses to drink due to throat pain, takes only sips of water. Fever – Same , high grade. Vesicle – Now spread to legs. Eruptions increasing in size having a bluish hue. Burning pains increased. Fear of being touched 3+

EXAMINATION FINDINGS: Temp Pulse Throat Tongue Skin : : - 102 o F 130/min Pus pockets bilateral : - Coated Bluish vesicular eruptions +

TOTALITY: • • • Irritability fever during Irritability pain during Fear of being touched 3+ Thirst : small quantities often Burning pains < touch 3+ > draft of air 2+ • Throat pain < swallowing. • Eruptions – bluish vesicle.

ACTION ARS ALB 200 1 P STAT

FOLLOW UP AFTER 2 DAYS • • • ACTIVE , PLAYFUL NO FEVER NO THROAT PAIN NO BURNING PAIN SKIN- LARGE ERUPTIONS STILL NOT DRIED ACTION- ARS ALB 200 1 P STAT

FOLLOW UP AFTER 6 DAYS • SKIN LESSIONS HEALED • NO OTHER COMPLAINTS ACTION- Placebo Later on follow up with constitutional remedy- NATRUM MUR 200 1 P

Case 2 1 year old child comes with high grade fever with cough since 10 days.

Chief Complaint Location Respiratory system Sing 10 days Since 7 days Sensation Modality Coryza watery A/F: ? Cough wet Rattling, ends in < Night 2 vomiting Vomitus Sticky High grade fever < night Not > allopathic Medicine 25 -2 -06 Concomitant Irritability 2 Desire to be carried on shoulder Activity 2 Thirst 2 Lachrymation

EXAMINATION FINDINGS Child moaning continuously Crying on being examined Temp: 103 o. F Weight 9 kg RR 60/min Tg: Thick white coated RS: Crepitations++ bilateral P/A Liver 1 finger palpable CVS S 1 S 2 NAD Skin Mild Maculopapular rash on chest. spleen Not palpable

INVESTIGATION on 25 -2 -06 Hb 9. 9 TC 8400 N 59 L 37 E 2 MP NAD Widal O: 1: 30 H: 1: 30 X-Ray: chest Bil lower zone broncho pneumonia

DIAGNOSIS Complicated measles with bilateral broncho pneumonia

INDICATIONS FOR ADMISSION 1. Measles overall decreases the immunity and hence predisposes to infective illness and its complications. Broncho pneumonia is one of them. Measles pneumonia is known to spread rapidly. MONITOR VITAL SIGNS IN VIEW OF IMPENDING COMPLICATION 2. High grade fever, high respiratory rate and decreased thirst and appetite will lead to water, electrolyte and nutrition imbalance 3. To observe remedy reaction in a case of eruptive fever

ANCILLARY MEASURES 1. ISOLATION: As it is an infective illness and also to prevent cross infection from other patient as the immunity is low 2. TPR: two hrly. 3. Plenty of oral fluids 4. I. V. fluids

TOTALITY 1. A/F: Eruption fail to appear 2. Irritability fever during 3. Carried desire to be on shoulder 4. Thirstlessness heat during 5. Vomiting coughing on 6. Rattling cough < night

REMEDIES FOR DIFFERENTIATION Ant. Tart, Sulph, Cham, Cina and Lach Cham and Cina: Not covering cause Lach: Not covering mental concomitant of carried desire to be Sulph: Suppression of eruption Ant. Tart: Eruption fails to appear

FOLLOW UP Within few dose Rash appeared all over body Within 24 hr fever settled 3 -4 days cough settled completely X-Ray on 27 -2 -06 Resolving patch X-Ray on 2 -3 -06 Normal

IMPORTANT LEARNING 1. Importance of examination 2. Clinico Pathological Co-relation 3. Susceptibility assessment 4. Remedy response evaluation

COURSE OF ERUPTIVE FEVER • • Viral infections Specific well defined course Self limiting illness If the course is tampered protracted illness complications

Eruptive fevers (therapeutic flow chart) Normal course Deviant course Complications course Identification Orientation Identification of characteristics Orientation to parents Wait and watch Infrequent repetition Infrequent to frequent repetition

IMPORTANT CONCEPTS Knowledge of illness Knowledge of complication Identification of right remedy Assessment of susceptibility Suppression Minimum repetition Follow up assessment