Health Tips on Fever Management

You may lower fever by applying sponge bath ("punas") using tap water place in a container for about 5-10 minutes(to be at room temperature). Do not use alcohol ,ice , cold bath to cool the skin since these may make the situation worse by causing shivering or chills that may increase the core body temperature.

Health Tips on Fever Medications

Give only Paracetamol for fever especially if you are not sure of the cause or origin of the high body temperature since it may be due to Dengue Fever. Never give NSAIDs which includes Aspirin, Ibuprofen(Dolan etc..), Mefenamic Acid(Ponstan,Dolfenal etc..) Naproxen (Flanax etc.) because NSAIDs inhibit blood clotting which may worsen bleeding in Dengue Hemorrhagic Fever.

Epididymitis, Testicle Infection

A 24 year old male, single, sexually active, complained of pain in the right testicle with associated low grade fever of 1 day duration. He said that it was painful when touched with a heavy sensation in the testicle area he also noted that the right is slightly larger than the left testicle.

There is no past medical history of mumps, urinary tract infection and denies previous sexually transmitted disease. Patient have no history of trauma to the groin , and is not engaged in biking or other physical athletic activity.

The patient was diagnosed with Epididymitis and was given Azythromycin 1 gram as single dose and Cefuroxime 200mg Cap, 2 capsules as single dose. Bed rest was also advised as well as elevation and applying ice pack to the affected area.

Epididymitis is a condition wherein there is inflamation of the epididymis or the tube that connects the testicle with the vas deferens. Pathophysiology usually involves ascending infection via vas deferens from prostatic urethra. It usually starts with a low grade fever with associated chills and a feeling of heaviness in the testicular area. Patient usually complains of sensitivity to pressure in the area. Other symptoms may include a mass or lump in the testicle, pain during urination and also ejaculation, blood in the semen, scrotal swelling and urethral discharge.

Physical examination may reveal a red, tender mass on the affected side of the scrotum. Usually there is pain and tenderness in a small area of the testicle where the epididymis is attached. Enlarged lymph nodes in the groin is usually noted. Digital rectal exam may show enlarged and tender prostate.

The most common infectious causes are Escherichia coli, Neisseria gonorrhoea, Chlamydia trachomatis.

General risk includes prolonged sitting, strenuous exercise like biking or motorcycle riding, and also sexual activity.

Laboratory test that may be performed includes urinalysis and if necessary urine culture, complete blood count, doppler ultrasound and STD testing.

image from A.D.A.M

Impetigo, Mamaso or Talipaso

A 2 year old girl was brought to the clinic for rashes in the cheeks and forehead of 3 days duration, initially like small pinheads,"butlig", then after a day rapidly converted to vesicular rashes, "nagtutubig". It was noted that a playmate suffers from a similar condition.

On physical examination , the lesion erodes with a honey colored crust and slightly wet. Patient was occasionally scratching the lesion but nevertheless was afebrile.

The patient was diagnosed with Impetigo, locally known as Mamaso or Talipaso and was given an oral Antibiotic Cefalexin susp , every 8 hours(3xday) for 10 days . Mupirocin cream was also prescribed to be applied 3x day . Advised was given regarding improvement of personal hygiene and avoidance of crowded places.

Impetigo or Mamaso or Talipaso

Impetigo is the most common skin infection in children and is caused by Streptococcal and Staphylococcal bacteria. Preschool children are most often affected and is highly contagious.The intact skin is an effective barrier that that keeps bacteria from entering and growing in the body, but if there is a break in the skin , like that from scratching, bacteria may then enter and grow there causing inflamation and infection. Break in the skin may come from insect bite, human bites,animal bites and other trauma to the skin. It spreads across body with scratching and found easily in daycares and school. It is advisable not to share towels, clothing and other personal care articles with other members of the family and also encourage thorough washing of hands after touching the lesions.

Predisposing factors and conditions may include hot and humid weather, malnutrition, poor hygiene , over crowded living conditions, minor skin trauma like abrasions and skin conditions like Atopic Dermatitis.

The lesion or sores of impetigo usually heal slowly but seldom leave a scar. The cure rate is very good but the condition always recurs in young children thus emphasis is on hygiene and prevention.

 Bullous Impetigo

image from impetigopictures.org

photos and images compiled from Google.com

Gonococcal Urethritis , Tulo

A 30 year old male, married, taxi driver came to the clinic complaining of pain with urination and noticeable increase in frequency of 3 days duration. He also noted a yellowish green copious penile discharge that often leaves stain in his underwear. He also said that he had a slight fever and took Paracetamol 500mg which relieved the symptom. On further prodding , the patient volunteered that he had unprotected sex with a sex worker in a bar in Pasay City a week prior to consultation.
History,laboratory and physical examination points to a diagnosis of Urethritis, most probably Gonococcal(Tulo),Gonorrhea, in etiology. Patient was given Azythromycin 1gm as a single dose together with Cefixime 200mg, 2 tablets as single dose. Patient was also advised to increase fluid intake and to practice safe sex in the future.
Gonococcal Urethritis, Tulo, is a sexually transmitted disease with an incubation period of 2-7 days, that causes urinary symptoms like frequency,urgency and dysuria.Almost always there is a copious ,green, yellow urethral discharge that often leaves a mark in the underwear thus the local term "Tulo" or drip . The penile opening or meatus and the anterior urethra may also be inflammed thus a patient may experience a burning sensation with the passage of urine.
Gonorrhea also called the clap, which is caused by Neisseria gonorrhoeae, is an important public health problem and is the most common reportable infectious disease. Gonorrhea is most frequently spread during sexual contact. The most common local complication of gonorrhea in men is Epididymitis which causes unilateral testticular pain and swelling, and epididymal tenderness. Urethral dischage may or may not be present.




(image courtesy www.cdc.gov)

Photos and Images compiled from Google.com

Furuncle , Boil or Pigsa

A 20 year old ,male , consulted for a swollen firm area in the left buttocks with associated pain and tenderness of 3 days duration. A day prior to consultation, there was passage of pus and blood. Patient also complained that the problem was recurrent wherein the last episode was about a year ago.

Patient was given Cloxacillin 500mg capsules every 6 hours(4xday), for 10 -14 days and advised to apply Povidone 10% soln(Betadine) 2-3xday. Mefenamic acid 500mg capsule 3xday was given for inflamation and pain management.

The patient's condition is known as Furuncle, Furunculosis, Skin Boil, Pigsa. It usually starts as an infection of the hair follicle that spreads to deeper tissue or can be a walled-off nodule of purulent infection. When there is a coalition or a group of furuncles , it is called Carbuncle, which has a deeper and extensive involvement.
Risk factors includes increase weight or obesity, diabetes mellitus, impaired neutrophil function, or sometimes prolonged intake of corticosteroids. The most common etiologic agent or cause is Staphylococcus aureus,but may also be caused by Streptococcus or mixed bacterial infection.
Usual management includes a trial of warm compress for small abcess but considerable size may require incision and drainage.Recurrent condition warrants giving oral antibiotics ,while opened lesion may necessitate application of Povidone I2 10% solution or application of Mupirocin cream. Some clinicians give high doses of ascorbic acid 1gm daily if they suspect an impaired neutrophil function.
It should also be emphazised that proper and careful hygiene is very important.Clean draining lesions or boils often and wash hands after touching a boil since it is contagious and can be transferred to other parts as well as other individuals.



(image from graphicshunt.com)

Bell's Palsy or Facial Nerve Paralysis

A 34 year old Male,sales clerk, came to the clinic complaining of difficulty closing his right eye for 3 days prior to consultation. The symptom just appeared after waking up and he also noted that his smile and the lines in his forehead appears "uneven". He also said that his right eye feels dry and irritated.
A complete blood count and urinalysis was unremarkable . Further physical examination was done and patient was diagnosed as having Bell’s Palsy or Facial Nerve Paralysis. Patient was immediately given 30 mg Prednisone twice a day for 5 days, then 20mg 2xday for the next 5 days. Vitamin B complex was also given as well as Hypromellose Eye drops (EyeMo Moisturizing Formula) to relieve irritation and dryness of the affected eye.

Bell’s Palsy was named after Sir Charles Bell(1774-1842) who first described the syndrome and is characterized by a temporary paralysis of the facial nerve.There is a loss of facial creases and naso labial fold ,with associated incomplete closure of eyelid,decreased production of tears.The corner of the mouth may show considerable drooping and no furrow or lines over forehead.Facial sensation is usually preserved.

Bell's palsy is a form of temporary facial paralysis resulting from damage or trauma to one of the facial nerves. It is the most common cause of facial paralysis. Generally, Bell's palsy affects only one of the paired facial nerves and one side of the face, however, in rare cases, it can affect both sides. Symptoms of Bell's palsy usually begin suddenly and reach their peak within 48 hours. Symptoms vary from person to person and can range in severity from mild weakness to total paralysis. These symptoms include twitching, weakness, or paralysis, drooping eyelid or corner of the mouth, drooling, dry eye or mouth, impairment of taste, and excessive tearing in the eye. Bell’s palsy often causes significant facial distortion. Most scientists believe that a viral infection such as viral meningitis or the common cold sore virus -- herpes simplex-- can cause the disorder when the facial nerve swells and becomes inflamed in reaction to the infection.(National Institute of Neurological Disorders and Stroke)

Bulutong Tubig , Chicken Pox or Varicella Zoster

A 30 year old female consulted for low grade fever 2 days prior to consultation with associated muscle pain, sore throat and lack of appetite. A day before she developed pruritic rashes, starting from the face and scalp down to the chest and abdomen.
On examination patient had fever ,38.2 Centigrade, with red papular rashes,"tear drop",vesicles on face, trunk and in the upper extremities.Patient also had generalized lympadenopathies " kulani" and admitted that a household member exhibited similar symptoms about two weeks ago.She was diagnosed with Chicken pox or Varicella Zoster, or Bulutong Tubig
Patient was given Diphenhydramine 50mg cap, an Anti-histamine 3x day to relieve itchiness. Ascorbic acid 500mg , for faster wound healing,was also given as well as Paracetamol 500mg Tab every 4 hours for fever, in some cases Ibuprofen 400mg or Mefenamic acid 500mg may be given for pain relief. In cases where the rashes develop within 24 hours prior to consultation, anti virals, like Acyclovir 800 mg tab 5x a day for 7 days,maybe given to shorten the time of viral shedding,lessens appearance of new lesions,reduce duration of fever and for faster healing. Acyclovir cream may also be applied to lesions 5x a day , especially in the facial area, to lessen discomfort and scarring. Oral rehydrating salts (Hydrite, Glucolyte etc.) may also be given to prevent dehydration.
Varicella, commonly known as "bulutong" or chickenpox, is caused by the varicella-zoster virus. The disease is generally regarded as a mild, self-limiting viral illness with occasional complications. Usual complications are acute respitatory infections, infected skin lesions while the most serious complications are varicella pneumonia and encephalitis which are associated with a high mortality rate.
Varicella spreads primarily by airborne droplets. The infectious particles are cell-free virus particles derived from skin lesions or the respiratory tract. The disease is infectious a day before the rash appears. The incubation period is typically 10-14 days, although it may extend to 21 days.
The best option to prevent Varicella or Chikenpox is thru vaccination which is available but a bit expensive(Varilrix, Okavax, V-Z Vax).The first dose should be given when the child is 12 - 15 months old.Children should receive the second dose when they are 4 – 6 years old. However, the second dose can be given before age 4, as long as as 3 months have passed since the first dose.
People 13 and older who have not received the vaccine and have not had chickenpox should get 2 doses 4 to 8 weeks apart while people 13 and older who have had a previous dose and have not had chickenpox should receive a second dose.

Reminder: Article was written as a physician's personal experience and should be viewed for information and guide only, and was not intended to replace actual consultation with a medical practitioner.