TEST YOUR KNOWLEDGE

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AN ADULT WOMAN WITH FEVER, COUGH AND ABNORMAL LIVER FUNCTION

CL Teng, MMed(FamMed, UM), FRACGP, FAFPM
Associate Professor, Department of Family Medicine, International Medical University, Seremban, Malaysia

Address for correspondence: Dr CL Teng, Associate Professor, International Medical University, Jalan Rasah, 70300 Seremban, Malaysia. Tel: 06-76777798, Fax: 06-7677709, Email: tengcl@gmail.com

Teng CL. Test Your Knowledge: An adult woman with fever, cough and abnormal liver function. Malaysian Family Physician. 2007;2(1):33-34

Case history
A 44 year-old Malay housewife presented to the outpatient clinic of a private hospital with history of high grade fever for four days associated with chills but no rigors. She experienced cough, headache, body ache, nausea and occasional vomiting. There was no urinary or bowel symptoms.

Progress of the patient (Figure 1)

• At initial presentation to the clinic at Day 4 of illness, she was unwell with fever 38oC. Otherwise there were no abnormal findings. Both upper respiratory tract infection (URTI) and dengue fever were considered likely. The dengue serology (both IgG and IgM) were negative but platelet count was slightly reduced. Her PCV was 40%. She was advised rest at home with symptomatic relief.
• She returned for a follow-up at Day 6 of illness, blood investigations confirmed dengue fever and she was advised admission. Her PCV in the ward was 38%. She was well in the ward (blood pressure normal and no bleeding tendency) and requested discharged two days later and remained well thereafter.
• She was seen on two more occasions in the outpatient clinic. At Day 10, despite remaining well, her liver enzymes showed elevation of up to two-three times normal but returned to near normal by Day 16.

Figure 1. Symptoms, laboratory test and progress in patient

NB: ALP, alkaline phophatase; AST, aspartate transaminase; ALT, alanine transaminase; GGT, gamma-glutaryl tranasminase; liver enzymes are in IU/L; platelet is in count x109/L

Question

1. What type of dengue fever was she having?
2. How common is cough in dengue fever?
3. Is it necessary to check liver function test in dengue patient in the primary care setting?

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