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.