In a patient with short fever with no localization, investigation inany form is not required in the first 3-4 days of illness in the absence of significant co-morbid conditions like diabetes, cardiac illness, renal disease , liver disease, old age ,etc.If the illness does not resolve within 4 days then the basic investigations will bea. Hb%, PCV, Total count, platelet count. b. Urine routinec. RBSd. creatininee. CPK-Totalf. Smear for malarial parasiteg. Blood cultureh. AST and ALTOther investigations like ultrasound of abdomen, complete liver function tests , QBC rather than conventional smear for malaria are optional.Routine CXR in the absence of clinical findings or comorbidillness is not required. Similarly tests like Widal , Ig M ELISA for Dengue , IgM ELISAfor Leptospirosis, other antibody based test are not indicated due to doubts in the validityof these tests .
The following are the findings in the initial investigations which may point towardsa particular etiology.
- Increased Hb% and PCV , thrombocytopenia and polyserositis[ pleuraleffusion, ascites] are diagnostic for dengue .Deranged liver functions can also occur butare not specific for dengue. Often IgM ELISA for dengue is requested by clinicians as aroutine in any patient with fever. I will discourage this practice since the tests identifiesantibodies to dengue in the patients serum and does not identify the viral antigen. In a patient who has all the above mentioned clinical/ lab features, a negative IgM does not