Parasitic
A usual suspect in patients presenting with an acute febrile illness during the monsoon is malaria. With India contributing 77% of the total malaria burden in Southeast Asia [9]. However, our patient’s cutaneous manifestation would not be explained by this diagnosis [10]. Though the protozoal disease most commonly caused by Leishmania Donovani locally known a Kala Azar since the 1800’s [11], would explain some symptoms, its common cutaneous manifestations of nodules, ulcers and in severe cases leonine faces were not to be found [12]. Only 2 cases of human babesiosis has been reported in the country, the last one being from within the state in 2022 [13], that long with the lack of hemolysis or the classic “Maltese cross” cross appearance on blood smear male it highly unlikely. Adult trypanosomal infections have not been reported in India.
The diagnosis of enteric fever is mainly clinical, among the Salmonella enterica serovars, human-restricted serovars Typhi and Paratyphi A, B, and C cause enteric fever, with more than half of the world cases occurring in India in 2017 [21]. Therefore, the diagnosis sits at the forefront of most clinician’s minds during the history and examination. Lab reports of hepatitis, bicytopenia along mild pulmonary findings serve to corroborate the diagnosis. The crucial decision to be made in the treatment of enteric fever is the choice of anti-microbial agent(s) as disease progression beyond the first week often implies a poor prognosis; The following paragraph serves as the basis for our choice.