Misdiagnosis of Fever
Misdiagnosis and Fever
Sinusitis is overdiagnosed: There is a tendency to give a diagnosis of sinusitis,
when the condition is really a harmless complication of another infection,
such as a common cold.
Whooping cough often undiagnosed: Although most children in the Western world have been
immunized against whooping cough (also called "pertussis"), this protection wears
off after about 15 years.
Thus, any teen or adult with a persistent cough may actually have whooping cough.
This is particularly dangerous for babies too young to be vaccinated,
and any un-vaccinated children.
Whooping cough can be fatal to an infant.
The cough symptoms of whooping cough is usually productive initially, but then
becomes a persistent dry cough, lasting up to 100 days.
Elderly grandparents may also be a reservoir of undiagnosed whooping cough.
Pelvic inflammtory disease due to STD's: Pelvic inflammory disease is a general term to describe an inflammation of the uterus and fallopian tubes. It occurs as a serious complication due to sexually transmitted diseases like chlamydia and gonorrhea and occurs commonly in women of child bearing age. It can lead to serious consequences like infertilty and ectopic pregnancy.A woman can present with very vague symptoms such as mild abdominal pain,fever,unusual vaginal discharge and painful urination.The condition may be mistaken for urinary tract infection. Careful clinical assessment along with investigations like an ultrasound are helpful in coming to a prompt diagnosis.Test to identify the organisms leading to PID must also be done so that the correct antibiotics can be delivered.
Not always a case of appendicitis: Pain in the right lower quadrant of the abdomen leads to numerous differential diagnoses in the mind of the doctor.Not all cases of right sided abdominal pain are acute appendicitis.Misdiagnosis of an acute appendicitis leads to unnecessary surgery. A good clinical history must be taken to rule out various other conditions such as gastroenteritis,right renal colic,biliary colic,Meckel's diverticulum etc. Some of the symptoms that need to be looked into include moderate to severe abdominal pain,fever,nausea and vomiting.The intensity and nature of pain must be assessed along with the presence of fever .Fever maybe unlikely in a case of renal colic unless associated with infection.Accurate judgement can be made using investigative modalities such as CT scan and ultrasound.
Weil's disease has poor outcome in severe cases: Leptospirosis( Weil's disesase) is a zoonotic
condition which occurs due to the entry of spirochetes called leptospira. Transmission occurs by direct contact with the body fluid
of an acutely infected animal or by exposure to soil or fresh water
contaminated with the urine of an animal that is a chronic carrier. The
prognosis for patients with mild infection is very good. More severe have a
much poorer outcome. Extremes of age can result in more significant disease.
The relatively poor resilience of elderly people produces a high mortality from
Weil disease. Leptospirosis can be misdiagnosed as enteric fever, encephalitis
or HIV infection. Government officials, public health workers, and health care
workers should educate all populations at risk about proper preventative
measures. Patients with severe disease need to remain in a hospitalized setting
until adequate resolution of organ failure and clinical infection occurs.
Rash of Dengue can be misdiagnosed: Dengue
fever also known as 'breakbone fever' is a mosquito borne viral infection. The
most common clinical presentation is that of severe headache, eye pain, fever,
joint pain and the maculopapular rubelliform rash which can lead to a chance of
misdiagnosis. There are several conditions from which dengue has to
differentiated some of them being Leptospirosis, measles, malaria, yellow
fever, meningoencephalitis etc. No specific treatment of dengue is
available. Early institution of supportive treatment is the key to management
of patients with dengue of all forms.
Wegener's granulomatosis can be missed out: Wegener's granulomatosis is a
condition of unknown etiology which usually affects the upper respiratory tract,
lungs and the kidneys. This condition can turn to be pretty fatal initial
diagnosis is not made. It is difficult to diagnose and most of the times the
diagnosis is missed as the patients presents with generalised symptoms such as
fever with respiratory illness. The condition can most often be misdiagnosed as
a case of pneumonia, lung cancer, sarcoidosis or as a fungal infection of the
lung. An early chest ray followed by CT scan helps in coming to a quick
diagnosis.
Lack of early signs in renal cell carcinoma: Renal cell carcinoma lacks early warning signs
and makes a much generalised presentation. Hence the chances of it being
misdiagnosed are higher. It has to be differentiated from conditions like renal
abscess, metastatic disease, infected or hemorrhagic cyst and lymphoma. The
prognosis of patients with RCC depends on its stage at diagnosis. The prognosis
is worst for patients with metastatic disease at presentation and best for
patients with small masses confined to the kidney.
Acute pyelonephritis missed in children and elderly: Acute infection of the kidney can
be life threatening if not diagnosed early and treated adequately. Diagnosing a
case of acute pyelonephritis is not always straightforward and can especially
be tricky in children and the elderly age group. The presentation may vary from
mild to very severe symptoms. The conditions that acute pyelonephritis maybe
confused for include appendicitis, cholecystitis, cervicitis, endometritis,
pancreatitis, abdominal abscess, pelvic inflammatory disease etc. In healthy
non pregnant women with no other complications the prognosis is usually good.
Dizziness in children: Dizziness although not a common cause in children can have threatening causes and requires quick diagnosis as the possibility of tumours such as medulloblastoma is possible but the most commonest causes include seizure of the temporal lobe. other causes being migraine, vestibular neuronitis, psychosomatic vertigo, middle ear infections, trauma and benign paroxysmal vertigo. A detailed history regarding the onset, duration and presence of other related symptoms such as fever, earache and discharge must be recorded.
Painful throat- look for infectious mononucleosis: Infectious mononucleosis
must be considered in 15- 25 year old patients presenting with a painful
throat. The patient presents with slow onset of malaise, fever, headache sore
throat and rash. It can be misdiagnosed as HIV primary infection, tonsillitis,
viral hepatitis and leukaemia. Paul Bunnell test is one of the important lab
tests commonly done along with white cell count and blood smear. There is no
specific treatment and supportive measures will suffice. It usually runs an
uncomplicated course.
Immediate care in Quinsy: Quinsy is an episode of acute tonsillitis which is untreated
or inadequately treated and progresses to abscess formation. The highest
incidence of such cases occurs in patients aged between 20- 3o years. It is
necessary to differentiate quinsy from Peritonsillar cellulitis. Peritonsillar cellulitis
requires just antibiotics and no further treatment. The rate of recurrence of
quinsy is 10- 15%.
Neuroblastoma can be confusing...: Neuroblastoma is a malignant tumor of neural crest
origin and is the most common solid tumor of infancy and childhood. The most
common site of tumor is the adrenal medulla.
Hence a majority of signs and symptoms are related to the site of the
tumor. The spread of
tumor through blood occurs very
early.The tumor can metastasise or spread to the eyes or bones and can
present with corresponding symptoms and signs. This condition is most
oftenly confused with Wilms tumor, lymphoma,hepatoblastoma,
ganglioneuroma and rhabdomyosarcoma. Treatment consists of chemotherapy in inoperable
cases or in adjunct with surgery or radiotherapy. Surgery alone may be
possible in low risk tumors.
Dressler's syndrome or post- MI syndrome: Dressler’s syndrome also known as the post- MI syndrome usually occurs a few
weeks after the infarction. It appears to be an immunological reaction characterized
by pericarditis, fever and pericardial effusion. The term Dressler’s syndrome
is often applied to similar condition which occurs following cardiotomy. The pain
of Dressler’s syndrome may initially suggest that of a further episode of
angina or MI. pleuritic chest pain may also suggest pneumonia and pulmonary
embolism and may hence be misdiagnosed. It can follow a relapsing course but
the outcome is usually favorable.
Kawasaki's disease can be misdiagnosed as common childhood ailments: Kawasaki’s disease is a febrile disorder affecting children
below 5 years. It affects mainly the blood vessels but can also affect
the mucous membrane, lymph nodes and skin. Kawasaki's disease is
a self limiting condition but early diagnosis and treatment prevents the
development of fatal complications. Since there are no specific tests
to diagnose Kawasaki's disease, diagnosis is made by exclusion
of other common childhood conditions which have similar symptoms.
It can be misdiagnosed as Scarlet Fever, Measles, Stevens Johnson Syndrome,
Juvenile Rheumatoid Arthritis, Toxic Shock Syndrome. A diagnosis of Kawasaki's
Disease can be made if the fever lasts for five or more days and the child has
accompanying signs and symptoms.
Blindness in Tuberculosis could be drug- induced: Pulmonary tuberculosis is the infection of lung caused by the organism
called Mycobacterium tuberculosis. The involvement of the lungs is the most
common presentation. Tuberculosis spreads through the blood, lymph and reaches
others parts of the body easily, infecting it. The primary form of the disease
maybe asymptomatic or symptomatic. Patients with TB have increased risk in
developing HIV infection. The condition maybe be misdiagnosed with fever of
unknown origin. The diagnosis is usually made on chest x-ray and sputum
culture. The treatment commonly known as DOTS (directly observed therapy)
includes administration of four antibiotic drugs namely isoniazid, rifampicin,
ethambutol, and streptomycin. Ethambutol is noted to cause colour blindness,
decreased vision, central scotoma known as optic neuritis and liver toxicity.
With discontinuation of the drug patient see an improvement in the vision.
More about Misdiagnosis
» Next page: COUGH (Algorithmic Diagnosis of Symptoms and Signs)
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