47 yrs old woman with fever for 10 days

47 yrs old female patient from Nakrikal who is a daily wage labourer came with chief complaints of 
Fever for 10 days

History of Presenting illness
Patient is apparently asymptomatic 10 days back .Then she developed fever which was incidious in onset ,with two spikes in a day one in the morning and other at night
Not getting reduced with the routine over the counter medications
It was associated with headache and joint pains
Not associated with vomitings,cough,rash
Not associated with any swelling of legs

Past history: 
H/o similar complaints in the past. 
Hypertension,Diabetes,malignancy,
epilepsy,TB and other chronic 
illness in the past. 

Family history: 
H/o similar complaints in the family. 
hypertension,Diabetes,malignancy
,epilepsy ,TB and other chronic 
illness in the past

Personal history :
Diet Mixed
Appetite Decreased
Sleep Disturbed since the fever started
Bowel and bladder habits   Regular
Substance abuse  Occasional Toddy drinker

General physical examination:
Patient is conscious, cooperative,
Oriented to Time place and person. 
Moderately Built 
Moderately Nourished

No Pallor 
No Icterus 
No Cyanosis 
No Clubbing 
No Edema 
No Lymphadenolathy 

Other findings
Tenderness of abdomen
No distention of abdomen

Differential diagnosis
Dengue
Typhoid
Malaria


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