A Family Doctor's Tale - MALARIA PATIENT

MALARIA PATIENT


Coming back to my first day of posting to the Medical Department of Thomson Road General Hospital, I mentioned that there was a woman who had stayed in the ward for 1 month with a diagnosis of unexplained fever. The medical officers and housemen were asked their diagnosis of the patient. I mentioned that I suspected that it was malaria( A Simple Guide to Malaria).

The diagnosis of malaria as the cause of her fever was suspected when she was first admitted to the Hospital. However it was discarded when the blood film test for malaria parasite was found to be negative a few times.

She also had all the blood and urine tests done and X-rays taken of her chest, abdomen, brain and bones. 
She has also being examined by 
1.the kidney specialist for urinary tract infection and disease, 2.the heart specialist for any heart and lung problems,
3. the gastrointestinal specialist for any abnormal liver, gallbladder or gastrointestinal disease, 
4.an endocrinologist (specialized in hormonal diseases like thyroid diseases, diabetes, etc) for thyroid conditions which may cause fever, 
5. a neurologist to exclude any abnormal brain or nerve disease which may cause fever, and finally 
6.the gynecologist to exclude woman diseases.  
All possible diagnoses have been excluded and the consultant was still at a loss at what her illness was.


Going through her case notes, I noted there were regular daily spikes of  fever especially at night which was very suspicious of malaria. 
In addition any rigors (or shaking of the body ) will be missed especially at night when the lights were dimmed for sleep. 
Blood films for the malaria parasite were usually taken by the laboratory technician during the day when the fever was down.

I decided on my own that I would like to get a blood film from the patient when I was on night duty. 
This happened on the second night of my posting.
I observed the patient until her fever started rising in the night about 11pm. She did not have any rigors but that did not exclude malaria. Malarial parasites are usually released from its reservoir in the spleen at a certain time into the blood stream. That was the time the body reacts by raising its temperature. It was also the time when the malarial parasites were highest in the blood.


It was also the best time to do a blood film for malaria parasite. 
I did a prick on her finger and managed to get 2 thick blood films of her blood and sent it to the laboratory myself. 
A thick blood film was important as a thin film may not contain sufficient malaria parasites to show up under the microscope.

The next morning our laboratory technician called to inform the ward that in deed the blood film was positive for malaria.
The diagnosis was confirmed. The patient was treated with anti malarial drugs and after 2 days her fever had subsided and she was discharged after staying for 1 month in the ward. 
I was very happy that I could help her to be diagnosed and be cured of her condition.

It just showed how a simple change of procedure could help to effect the outcome of  a patient's illness.

Doctors should not order tests routinely for the laboratory technician to do. 
Certain tests may require the laboratory technician to come when there is a high fever(such as at night) and do a thick film instead of a thin blood film. 

It would definitely save the patient the unnecessary stay of 1 month in hospital and ease the worry of  the patient and her relatives.