“A STUDY on ACUTE UNDIFFERENTIATED FEVER – CLINICAL PROFILE & RESPONSE to TREATMENT” Dissertation Submitted to THE

“A STUDY ON ACUTE UNDIFFERENTIATED FEVER – CLINICAL

PROFILE & RESPONSE TO TREATMENT”

Dissertation Submitted to

THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY CHENNAI

In partial fulfillment of the regulations for the award of the degree of

M.D. BRANCH – I (GENERAL MEDICINE)

DEPARTMENT OF GENERAL MEDICINE

GOVERNMENT STANLEY MEDICAL COLLEGE, CHENNAI.

THE TAMIL NADU DR.M.G.R.MEDICALUNIVERSITY

TAMILNADU, INDIA

MAY 2020

CERTIFICATE

This is to certify that this dissertation entitled “A STUDY ON ACUTE

UNDIFFERENTIATED FEVER – CLINICAL PROFILE & RESPONSE TO

TREATMENT” submitted by Dr.D.SURESH to the faculty of General Medicine,

The Tamil Nadu Dr.M.G.R Medical University, Chennai, Tamilnadu, in partial fulfillment of the requirement for the award of M.D DEGREE BRANCH-I

(GENERAL MEDICINE) is a bonafide research work carried out by him under my direct supervision and guidance.

Prof. Dr. C. HARIHARAN M.D., Head of the Department, Department of Medicine, Stanley Medical College and Hospital, Chennai- 1.

PROF. DR.R.SHANTHIMALAR, M.D., D.A., DEAN Government Stanley Medical College and Hospital, Chennai-1.

CERTIFICATE BY THE GUIDE

This is to certify that Dr.D.SURESH Post Graduate student (May2017 to April 2020) in the Department of General Medicine, Government Stanley Medical College and

Hospital,Chennai-1,has done this dissertation work titled “A STUDY ON ACUTE

UNDIFFERENTIATED FEVER – CLINICAL PROFILE & RESPONSE TO

TREATMENT” under my guidance and supervision in partial fulfillment of the regulations laid down by The Tamilnadu Dr.M.G.R.Medical University, Chennai for

M.D.,(General Medicine),Degree examination to be held in May 2020.

Prof. Dr. S.GEETHA M.D., Chief, Medical Unit-4, Department of Medicine, Stanley Medical College and Hospital, Chennai - 1.

DECLARATION

I, Dr.D.SURESH, solemnly declare that the dissertation titled “A STUDY ON

ACUTE UNDIFFERENTIATED FEVER – CLINICAL PROFILE &

RESPONSE TO TREATMENT” is a bonafide work done by me at Government

Stanley Hospital, Chennai during AUGUST 2017 to JANUARY 2018 under the guidance and supervision of Prof.Dr.S.GeethaM.D., Professor of Medicine,

Government Stanley Hospital, Chennai. I also declare that this bonafide work or a part of this work was not submitted by me or any other forward degree or diploma to any other university, board either in India or abroad. This dissertation is submitted to the

Tamilnadu Dr.M.G.R. Medical University, towards the partial fulfillment of requirement for the award of M.D. Degree (Branch – I) in General Medicine.

Place: Chennai Signature of the candidate

Date: (Dr.D.SURESH)

CERTIFICATE - II

This is to certify that this dissertation work titled “A STUDY ON ACUTE

UNDIFFERENTIATED FEVER – CLINICAL PROFILE & RESPONSE TO

TREATMENT” of the candidate Dr.D.SURESH with Registration Number

201711072 for the award of M.D., DEGREE in the branch of BRANCH-I

(GENERAL MEDICINE). I personally verified the urkund.com website for the purpose of plagiarism check. I found that the uploaded thesis file contains from introduction to conclusion pages and result shows 1 (one) percentage of plagiarism in the dissertation.

Guide & Supervisor sign with Seal

SPECIAL ACKNOWLEDGEMENT

I gratefully acknowledge and thank

PROF. DR.R.SHANTHI MALAR MD, DA.,

DEAN

GOVERNMENT STANLEY MEDICAL COLLEGE AND HOSPITAL,

CHENNAI.

For granting me permission to utilize the resources of this

Institution for my study

ACKNOWLEDGEMENT

I am extremely thankful to our beloved Superintendent Prof.Dr.DHANASEKAR,

M.D., Government Stanley HospitalChennai-1, for having granted permission to do this dissertation in Government Stanley Hospital, Chennai.

I am very grateful to our Professor and Head of the Department of Medicine Prof

Dr.C.HARIHARAN, M.D., for acceptance to do this dissertation.

I am extremely grateful to my unit chief Dr.S.GEETHA, M.D., and former unit chief

Dr.M.ANUSUYA,M.D., who taught me the basic aspects and clinical skills in internal medicine which is an essential pre requisite for pursuing any dissertation work. The guidance and encouragement they provided need a special mention.

I recall with gratitude the other unit chiefs and Associate Professors of Department of

Medicine ,Prof . Dr.G. RAJAN, M.D.,Prof.Dr.C.SRIDHAR M.D.,

Prof.Dr.A.SAMUEL DINESH, M.D.,

Prof.Dr.T.B.UMADEVIM.D.,Prof.Dr.A.RAVI M.D., Prof.Dr. I. ROHINI M.D.,

Prof.Dr.R. THILAKAVATHY M.D., DCH., Prof.Dr.P. MALARVIZHI M.D.,

Prof.Dr. KALPANA M.D., for their valuable guidance.

I am extremely thankful to our Registrar Dr.N.RAVICHANDRAN M.D. DTCD., and our unit Asst. Professors Dr.C.S.GAUTHAMAN M.D.,

Dr.A.RAMALINGAM M.D., Dr. S. PRAKASH M.D., Dr.P.BHARANI, M.D., for their valuable suggestions, guidance and support.

I thank Prof.Dr. P.ARUNA LATHA, M.D., Professor and Head of the Department of Pathology, Government Stanley Hospital for allowing me in utilizing their laboratory facilities for getting the hematological parameters in the thesis work which were very crucial for the study.

I thank Prof.Dr.SHANTHI, M.D.,Professor and Head of the Department of

Biochemistry for providing me with facilities for accurate measurement of the biochemical parameters involved in the thesis work which were very crucial for the study.

I also thank Prof.Dr.AMARNATH, Professor and Head of the Department,

Department of Radiology, for allowing me to utilise the USG and CT IMAGING of their department to image the patients, and also in helping to interpret them.

I also thank all our patients and their attenders, without whom the study would not be possible.

I extend my love and gratitude to my family and friends for their immense help for this study.

I owe my thanks to almighty for successful completion of this study.

PLAGIARISM

CONTENTS

S. PAGE TITLE NO NO.

1 INTRODUCTION 1

2 REVIEW OF LITERATURE 3

3 AIMS AND OBJECTIVES 53

4 MATERIALS AND METHODS 54

5 OBSERVATION & RESULTS 58

6 DISCUSSION 75

7 CONCLUSION 78

BIBLIOGRAPHY

 ANNEXURES 80  ABBREVIATIONS 90 8  PROFORMA 93  PATIENT CONSENT FORM 97  ETHICAL COMMITTEE CLEARANCE 99  MASTER CHART 100

LIST OF TABLES

S.No. TITLE PAGE NO

1 INVESTIGATIONS OF AUF 15

2 TREATMENT OF AUF 16

3 GENDER DISTRIBUTION 59

4 AGE DISTRIBUTION 62

5 DURATION OF FEVER 63

6 TRENDS OF AUF 65

7 AETIOLOGY OF AUF 66

8 OVERLAP INFECTION 71

LIST OF FIGURES

S.No TITLE PgNo.

1 INTERMITTENT AND CONTINOUS FEVER 6

2 REMITTENT FEVER 7

3 QUARTIAN FEVER 8

4 FALLS BY CRISIS 9

5 FALLS BY LYSIS 10

6 NOSOCOMIAL FUO 18

7 NEUTROPENIC FUO 19

8 DIFFERENT CAUSES OF AUF 20

9 TREATMENT PROTOCOL FOR AUF 22

10 TREATMENT FOR DENGUE 30

11 DENGUE WITH WARNING SIGNS 31

12 DENGUE WITH COMPENSATED SHOCK 32

13 DENGUE WITH HYPOTENSIVE SHOCK 33

14 LIFE CYCLE OF PLASMODIUM 34

15 PATHOGENESIS OF PLASMODIUM 35

16 BUFFY COAT 37

17 TREATMENT FOR LEPTOSPIROSI 45

18 ESCHAR OF SCRUB TYPHUS 46

19 GENDER DISTRIBUTION 60

20 AGE DISTRIBUTION 61

21 GEOGRAPHICAL DISTRIBUTION 63

22 DURATION OF AUF 64

23 TRENDS OF AUF 65

24 AETIOLOGY OF AUF 67

25 THROMBOCYTOPENIA 68

26 MALARIAL INFECTION 69

27 OUTCOME OF MALARIAL FEVER 69

28 DENGUE 70

29 OVERLAP INFECTION 71

30 TREATMENT OF AUF 72

31 OUTCOME OF AUF 73

32 CAUSES OF DEATH 74

INTRODUCTION

Infectious disease are the leading cause of morbidity and death in India .Acute presentation of fever, myalgia, headache, chills and fatigue are common in many infections in India. Many infections are endemic in India. These include malaria, dengue fever, enteric fever, leptospirosis, scrub typhus which causes significant mortality and morbidity. Limitations of diagnostics tests make aetiologies of acute undifferentiated fever remain unknown. Physicians make the diagnosis through proper clinical history, detailed examination and with relevant investigations. These infections are indistinguishable clinically and the choice of antibiotics based on the aetiology, specific location and specific seasons. Malaria and dengue fever are arthropod – borne infections which are endemic in many parts of India during specific season. Scrub typhus and leptospirosis infections are prevalent during specific monsoon and during heavy rainfall. So it is most important to identify the epidemiology, prevalence and manifestations of various infections to frame the protocol for empirical antibiotics.

The primary objectives of this study is to identify the cause of AUF by dengue, malaria, enteric fever, leptospirosis, scrub typhus and flu virus. The secondary objectives is to analyse the course of the disease and its response to the treatment. So, we have conducted a cross sectional prospective study to identify the cause, course and trends of the various disease.

We have framed the protocol for fever wards patients under which, we are not initiating irrelevant antibiotics, anti malarials or antivirals for the patients, unless it is indicated.

Empirical antibiotics has been started only after taking culture and sensitivity. By this protocol, we able to identify the course of the infections and its response to the treatment. We have analysed the overlap infection associated with coinfection, subclinical infection and cross reactivity.

Large samples of around 1012 were included in our study. We have obtained consent from the patients. We have explained the diagnosis, prognosis, complication to all patients. The results were plotted in the master chart.

REVIEW OF LITERATURE

NORMAL BODY TEMPERATURE:

Human body temperature is maintained by anterior hypothalamus.

Hypothalamic thermoregulatory centre balances the excess heat produced during metabolic activity from muscle and lever via heat dissipation through lungs and skin.

Normal core body temperature varies over the course of day, especially in females highest body temperature is noted during the luteal phase.

Core body temperature is measured either peripherally or by central methods.

Peripheral measurement is done from oral cavity, axilla, and tympanic membrane.

Centrally body temperature is measured by pulmonary artery catheter, oesophageal and rectal thermometry.

The mean body temperature varies between 35.3 to 37.7 degree Celsius. Towards evening the body temperature raises by 0.5 degree Celsius.

Fever is defined as rise of core body temperature. Fever is an important clue for most underlying infectious condition. Apart from infectious cause, lot of non- infectious conditions like autoimmune and auto inflammatory disease also presents with fever.

MAXIMUM NORMAL ORAL TEMPERATURE:

The normal diurnal variation is 1 F, more in the evening because of skeletal muscle activity and basal metabolic rate (BMR). Normally, rectal temperature is 1 F greater than oral temperature which is greater than axillary temperature by 1 F.

PHYSIOLOGICAL VARIATIONS OF TEMPERATURE:

In menstruating women the temperature is subnormal during follicular phase. At the time of ovulation, there will be a rise in temperature of 1F till menstruation. It is due to the thermogenic property of progesterone.

Chill is a cold sensation perceived by the individuals during fever. Rigor is a severe chill with piloerection associated with shivering and cutaneous vasoconstriction.

Every 1 F rise results in,

1. Pulse rate rise of 10.

2. Respiratory rate by 4.

3. Basal metabolic rate by 7.

4. Oxygen consumption increases by 13%.

Fever without rise of pulse rate are seen in typhoid fever, Influenza, brucellosis, leptospirosis, drug induced fever.

Fever with exanthems:

1. Rash presents on 1 st day of fever - varicella

2. Rash presents on 4th day of fever – Measles

3. Rash presents on 7th day of fever – Typhoid.

PATTERN OF FEVER:

1. Continuous fever –

Elevation of temperature above normal without touching the baseline and

fluctuation not exceeds 1 degree F.

Example- infective endocarditis, enteric fever

2. Intermittent fever-

Elevation of temperature above normal which touches the baseline.

Example: Malaria

Figure 1: Intermittent fever and continuous fever

3. Remittent fever-

Elevation of temperature above normal without touching the baseline and fluctuation exceeds 1 degree F.

Example- Brucellosis

Figure 2: Remittent fever

4. Relapsing fever- febrile episodes followed by afebrile period for more than one day, example- Borreliosis, rat bite fever

NAMED FEVER:

1. Saddle back fever: fever lasting for two to three days with remission for two days and reappearance of the fever for two to three days, example- dengue fever

2. Tertian fever: fever occurring on first and third day, example-malarial fever caused by Plasmodium vivax and Plasmodium falciparum.

3. Quartan fever- fever occurring on first and fourth day, example- fever caused by

Plasmodium malarial fever.

Figure 3: Quartan fever

4. Step ladder pattern of fever: continuous fever characterized by increasing raise of temperature

5. Pel- Ebstein fever: fever lasting for three to ten days followed by afebrile period for three to ten days, example- fever occurring Hodgkin’s lymphoma

CLASSIFICATION OF FEVER BASED ON NORMALIZATION OF

TEMPERATURE:

1. False by crisis- temperature elevation reaches the baseline after starting

treatment, example- pneumonia.

Figure 4:fever – falls by crisis

2. False by lysis- temperature elevation reaches the baseline in a step ladder

pattern after starting treatment, example- enteric fever.

Figure 5:fever - fall by lysis

Infections without fever:

1.Diabetic mellitus

2. chronic renal failure.

3. Newborn.

4. steroids.

ACUTE UNDIFFERENTIATED FEVER [AUF]:

AUF is one of the most common causes among patient visiting to the hospital

for treatment especially during the month of June to September. AUF is

defined as Short febrile illness with temperature range of 38 c or more.

Duration of fever lasts for two weeks or shorter, It generally lacks localizable

or organ specific clinical features.

AUF is further classified as diagnosed AUF and Undiagnosed Undifferentiated

Fever (UUF).Among AUF patient who tests negative for malaria are further

classified as non malarial AUF.

Among the causes of AUF malaria ranks the first. The other causes of AUF are

dengue, leptospirosis, influenza, rickettsial infections and typhoid fever. The

causes of AUF vary in different region according to the regional disease

burden, health care accessibility, availability of diagnostic investigations, and

seasonality of infectious disease.

In contrary to general belief among practitioners, bacterial infection are less

common cause of acute undifferentiated fever. Even after detailed investigation

cause remains unknown in one-third to quarter of patient.

MANAGEMNET ALGORITHM:

1. Assess severity of symptoms and recognize sepsis.

2. Detailed history and clinical examination- localization of fever

3. Rapid diagnostic test for malaria and dengue.

4. Use antipyretics alone if fever < 3 days and initial RDT are negatives

5. Relevant investigation if fever persists longer and initial RDT are negative

6. Start empirical antibiotics only after blood or urine culture.

1 – 3 DAYSINVESTIGATIONS

INVESTIGATION:

Days - 1 to 3 Days - 4 to 7 Days - 8 to 14

CBC LFT CRP – POSITIVE &

TITRE

Urine R/E USG ABDOMEN & KUB LEPTO – Ig M, MSAT

RFT/LFT REPEAT BASIC Ig M SCRUB

INVESTIGATIONS AS

REQUIRED

ECG OTHER RELEVANT TEST FOR ARBOVIRUS

IMAGING STUDIES

X-ray CHEST WIDAL

PERIPHERAL SMEAR BLOOD & URINE C/S

IF TC , PLATELET are decreased – NS1

ANTIGEN

Table 1: Investigations of AUF

TREATMENT

Days - 1 to 3 Days –4 to 7 Days -8 to 10

No antibiotics Start Antibiotics-azithromycin, Empirically start

doxycycline or parenteral third antibiotics

cephalosporin’s

Increased Total count with Oral/ IV Fluids Neutrophilia

Antipyretics Preferably Urine Pus cells plenty

Paracetamol

Table 2: Treatment protocol for AUF

FEVER OF UNKNOWN ORIGIN (FUO)

According to Petersdorf and Beeson,

Pyrexia of unknown origin is defined as persistent elevation of temperature of more than 38.4 degree Celsius for more than 3 weeks with no diagnosis inspiteof 1 week of investigation. PUO is further classified into low and high grade PUO

DURACK AND STREET CLASSIFIACTION

1. CLASSIC PUO.

Fever of more than 3 weeks with no diagnosis after 3 days of hospitalization or three op visits without detection of cause or one week of invasive ambulant investigation.

AETIOLOGY:

CLASSIC FUO:

1. Infection - 30 – 40 %

2. Neoplasms - 20-30%

3. Collagen vascular disease - 10-15%

4. Miscellaneous - 10- 15%.

Infections are mostly due to tuberculosis, abscesses, bacterial endocarditis.

Neoplasms include Hodgkin’s lymphoma, non-Hodgkin’s lymphoma and leukemia.

Collagen vascular disease include SLE, takayasu arteritis and mixed connective tissue disorder.

2. NOSOCOMIAL PUO

Temperature >_ 38.3 c on several occasion in a hospitalized patients receiving acute

care , infection was not manifested or incubating an infection on admission with 3

days of investigation including at least two days incubation of cultures.

Figure 6: Nosocomial PUO

3. NEUTROPENIC PUO

Temp of >_38.3 c in a neutropenic patients (absolute neutrophil count less than 500

cells/mm3 or expected to fall in this level 1 to 2 days ).patients with no diagnosis after

3 days of investigation, including at least two days of incubation of cultures.

Figure 7: Neutropenic fever

4. HIV associated PUO.

Temperature of more than >_ 38.3 (101 F) over a period of more than 4 weeks for outpatients or more than 3 days for in patients with HIV, with 3 days of investigations including 2 days of incubation of cultures.

Infections are mostly due to tuberculosis, abscesses, bacterial endocarditis.

Neoplasms include Hodgkin’s lymphoma, non-Hodgkin’s lymphoma and leukemia.

Collagen vascular disease include SLE, takayasu arteritis and mixed connective tissue disorder.

Figure 8: Different causes of AUF

INVESTIGATION

1. ESR –Platelet correlation.

2. Elevated alkaline phosphatase

3. Blood culture

4.seological test.

Enteric fever, CMV infection, hepatitis, Tularemia, secondary syphilis, brucellosis, amoebiasis.

5. Imaging technique .

.CXR – PA view

Contrast films

6. CSF study.

7. Bone marrow examination.

Figure 9: Treatment protocol of FUO

DENGUE:

Dengue is an acute febrile illness caused by infection with one of the one of four dengue viruses (DENV) .It is transmitted by the Aedesaegyptiduring blood meal. It has four subtypes DV -1, DV-2.DV-3 and DV-4 belong to flaviviridae. Dengue virus isanencapsulated RNA virus and is composed of three structural genes, which encode nucleocapsid core protein(c), M protein, an enveloped glycoprotein (E) and nonstructural protein. There is a cross protection among four types which weaken which several months following infection.

All four subtypes can cause disease from sub clinical to fatal, denguehemorrhagic

/dengue shock syndrome.

1997 WHO classification divided dengue into

1. Dengue fever

It is also known as break borne fever.

It is defined as acute febrile illness with the presence of fever and two or more of the features, it includes

1. Retroorbital pain

2. Headache

3. Myalgia

4. Arthralgia

5. Rash.

6. Leukopenia

2. Dengue hemorrhagic fever:

The most characteristics features of dengue hemorrhagic fever is plasma leakage.it is due to increased vascular permeability evidenced by hemoconcentration(rise in hematocrit), pleural effusion or ascites.DHF is also manifested by fever

,thrombocytopenia and hemorrhagic manifestation.

The clinical manifestation of DHF with the presence of abdominal pain, persistent vomiting, lethargy, alert the clinician to the possible impending dengue shock syndrome (DSS).

Criteria for DHF:

1. Fever or occasionally acute fever lasting 2 to 7 days.

2. A positive tourniquet test

The tourniquet test is done by inflating the blood pressure cuff on the upper arm to a midpoint between the systolic and diastolic for 5 minutes. The positive test means 10 or more petechiae per 2.5 cm.

. Petechiae, ecchymosis, purpura.

Haemetemesis or melaena.

Bleeding from the mucosa, gastrointestinal tract or other locations

3. Thrombocytopenia. – Less than 1 lakh cells per mm3.

4. Evidenceof plasma leakage, manifested by at least one of the following

- Rise in the hematocrit equal to or greater than twenty percent.

- Fall in hematocrit following volume replacement treatment equal to or greater than

20 percent of baseline.

- Signs of plasma leakage such as pleural effusion, hypoproteinemia or ascites.

3. Dengue shock syndrome

It consists of DHF with marked plasma leakage that leads to shock,

Four main characteristics of DHF plus evidence of circulatory failure,

1. Continuous fever – 2 to 7 days.

2 .Hemorrhagic tendency as shown by positive tourniquet test.

3 .Thrombocytopenia.

4. Evidence of plasma leakage,

.Rapid weak pulse.

Narrow pulse pressure (20 mm Hg) or manifested by

.Hypotension for age.

Cold, clammy skin and restlessness.

WHO 2009 classification

1. Dengue without warning signs.

2. Dengue with warning signs.

3. Severe Dengue.

CLINICAL FEATURES:

The incubation period of DENV infection ranges with 3 to 14 days.

Symptoms typically develops between 4 and 7 days after the bite of infected mosquito.

Phases of infection

1. Febrile phase.

2. Critical phase

3 .Convalescent phase.

Febrile phase:

The febrile phase includes high grade fever, headache, myalgia, arthralgia and transient macular rash. Children’s are less symptomatic than adults.it lasts for 3 to 7 days.

Saddle back fever occurs in 5% of cases where fever remits and then recurs one to two days later. Second febrile phase lasts for 1 to 2 days.

Physical examination may reveals conjunctival injection, lymphadenopathy, hepatomegaly and pharyngeal edema.

Leucopenia and thrombocytopenia are common. Serum AST and ALT are increased.

Between 3 and 7 days, chance of vascular leakage is high.

CRITICAL PHASE:

Around 3 to 7 days, 20 – 30 % of peoples develop systemic vascular leak syndrome

Characterized by compensated shock, resulting in narrow pulse pressure, systolic pressure falls rapidly and this leads to irreversible shock.

Hemorrhagic manifestations are common.

Imaging like USG and CT shows pleural effusion, ascites.

Moderate to severe thrombocytopenia are common. A transient increase in activated partial thromboplastin time and decrease in fibrinogen levels are common.

CONVALESCENT PHASE:

During this phase, hemorrhage and plasma leakage resolves. Vitals stabilizes. This phase lasts for 2 to 4 days.

Others system involvement;

1. CNS involvement.

Seizures, encephalopathy, headache, guillin barre syndrome, transverse myelitis are reported.

CVS involvement:

Incidence of myocarditis and ventricular systolic and diastolic dysfunctions are common.

Renal involvement:

Acute kidney injury

Rare features include retinal vasculitis, hempophagocytic lymphohistiocytosis are common.

Laboratory diagnosis

During the first week of illness, sensitivity of RT- PCR and NS -1 antigen are high.Ig

M dengue detection of antibodies are useful from second week of infection.

DIFFERENTIAL DIAGNOSIS:

1. Malaria.

2. Otherarbovirus infection.

3. Typhoid fever

4. Chikungunya.

4. Influenza fever

Primary infection induce lifelong immunity.to the inciting serotype. Individuals are protected from clinical illness with a different serotype within 2 – 3 months of primary infection.

Treatment for dengue is usually symptomatic.

Figure 10 : Treatment for dengue

MANAGEMENT OF DENGUE WITH WARNING SIGNS:

Figure 11: Dengue with warning signs

MANAGEMENT OF DENGUE WITH COMPENSATED SHOC

Figure 12: Dengue with compensated shock

MANAGEMNET OF DENGUE WITH HYPOTENSIVE SHOCK:

Figure 13: Dengue with Hypotensive shock

MALARIA:

Malaria is a most important parasitic disease caused by genus plasmodium. It is transmitted by mosquito bite belonging to anopheles family. More than 200 species of plasmodium are known, most important among there are Plasmodium falciparum,

Plasmodium vivax, Plasmodium malariae, Plasmodium ovale.

Figure 14: Life cycle of plasmodium

Human infections starts when female anopheles mosquito transmits sporozoite from its salivary gland during blood meal. Rarely malaria will be transmitted through blood transfusion, needle sharing, vertical transmission. In India P.vivax contributes 55%

and P.falcipuram accounts for 45% of malarial infection.

Figure 15: pathogenesis of plasmodium

Clinical features:

1. Uncomplicated malaria:

It is characterized by headache, fatigue, abdominal discomfort and myalgia. Classic malarial paroxysms are common in P.vivax infection. Fever often rises above 40 degree Celsius with tachycardia and delirium. Mild hepatosplenomegaly are common.

P.falciparum infection may presents with seizures. Uncomplicated malaria infection resolves over one to three weeks

2. Severe malaria: It is a medical emergency, more common with P.falciparum infection. Major

clinical manifestation are severe anemia, thrombocytopenia, respiratory distress,

hepatic dysfunction, renal failure, shock and seizures.

3. Cerebral malaria:

It is characterized by deep coma with Glasgow coma scale [GCS] score of less

than 7/15. Clinical symptoms develop either gradually or present with sudden

onset seizures. Mortality rate in this type of malaria is about 20%. Neurological

examination will be suggestive of diffuse symmetric encephalopathy without

meningeal signs.

Chronic complication of malaria:

1. Tropical splenomegaly

2. Quartan malarial nephropathy

3. Burkitt’s lymphoma

Investigations:

1. Demonstration of parasite:

It requires both thin and thick peripheral blood smear. Thick film helps in

screening the presence or absence of parasite whereas in thin film specific

species can be detected.

Figure 16: BUFFY COAT

2.Rapid diagnostic test [RDT]:

RDT includes P.falciparum specific histidine rich protein 2 or lactate

dehydrogenase. These are rapid and simple tests to detect malarial infection.

3. PCR:

It is the most sensitive and specific test. It can detect 5 parasite / microlitrre.

Limitation includes high cost and skilled personnel.

TREATMENT:

P.vivax - Chloroquine sensitive strains:

Chloroquine (1omg base/kg body weight stat, 24 hours, followed by 5mg/kg at

48 hours)

Radical treatment:

T. Primaquine (0.25mgbase/kg body weight) OD for 14 days- contraindicated

in G-6PD deficiency

Uncomplicated P.falciparum malaria:

1. Artimether - lumifantrine (1.5/9mg /kg body weight at hours 0 and 8, BD

on day 2 and 3)

2. Artisunate plus mefloqiune

3. Artisunate plus sulphadoxine

4. Artisunate plus amodiaquine

MALARIA IN PREGNANCY:

PREVENTION:

1. Mosquito avoidance

2 .Preventive drug therapy

Residents of endemic areas;

1. Intermittent preventive treatment in pregnancy(IptP)

It includes Sulfadoxine – primethamine, mefloquine and

dihydroartemesininpipraquine (DP)

Anti-malarial safe in pregnancy:

Uncomplicated Falciparum infection:

1. chloroquine sensitive P. falciparum infection:

Any trimester

Chloroquine (600 mg base)

2 .chloroquine resistant P. falciparum infection:

First trimester:

Quinine plus clindamycin

Second or third trimester

Artemisinin combination therapy

Severe falciparum infection:

Artemisinin combination therapy

SAFETY OF ANTIMALRIALS IN PREGNANACY:

1. Chloroquine.

2. Quinine.

3. Artemisinin.

4. Mefloquine.

6. Amadiaquine.

7. Primaquine and tefenoquine.

PREGNANCY MANAGEMENT:

During an acute episode, ultrasound is necessary to monitor amniotic fluid volume, fetal size and fetal wellbeing. Iron deficiency appears to be protective against malaria.

ENTERIC FEVER:

It is a systemic bacterial infection caused by Salmonella entericatyphi and

Salmonella entericaparatyphi A, B, C. Children and young adults are commonly affected with increased prevalence among males. It is more common in lower

Socioeconomic society with poor sanitation and unsafe water supply.

Incubation period ranges between 10 to 14 days. The most common mode of transmission is faeco oral route. Human are the natural host for both typhoid and paratyphoid fever. Typhoid fever prevalence is observed throughout the year.

Clinical features:

It is characterized by prolonged fever, initially low grade and rises progressively and by the end of second week fever will be high and sustained.

This pattern of fever is known as step ladder fever. Fever is preceded by prodromal symptoms. Physical examination signs include coated tongue, tender hepatosplenomegaly, relative bradycardia and dichrotic pulse.

Skin manifestation includes rose spots, which occur at the end of first week and it is seen 30% of patients. Complications includes intestinal bleeding or bowel perforation and this occurs at the end of third week. Typhoid encephalopathy with shock is associated with high mortality.

Investigations:

Definitive diagnosis is confirmed by isolation of organisms in blood, urine, stool, bone marrow. Blood culture positivity is more during first week of infection.

Widal test:

It is tube agglutination test. It has low sensitivity and specificity. Test values will be significant only if there is four fold rise in titre between the sera.

TREATMENT:

Multidrug resistant strains are common with enteric fever. Hence third generation cephalosporin- injection ceftriaxone (1 to 2gm IV/IM for 10 to 15 days) or T. Azithromycin 1gm orally for 5 days are the drug of choice.

Ciprofloxacin is the drug of choice for salmonella paratyphi infection.

PREVENTION:

Vaccines- parentralVi polysaccharide antigen suitable for adult and older children. Proper sanitation and good hygiene practices.

Leptospirosis:

Leptospirosis is a zoonotic disease caused by spirochetes of genus leptospira.Leptospires are motile helical bacteria ischaracterised by flexion, extension and rotation about the longitudinal axis. Pathogenic species include

L.interrogans, l.kirshneri, l.borgpetersenii, l.santarosai, L.weiilii, L.noguchi,

L.alexandrei.L.interrogans species causes icterohemorrhagic fever .leptospires

are aerobes utilizing long chain fatty acids as source of energy and carbon.

Culture media commonly used include EMJH media.Mccullogh Johnson Harris medium containing bovine serum albumin. Stuart and Fletcher medium containing rabbit serum as fatty acid detoxifiers.

EPIDEMIOLOGY

Mammals can be a potential carriers of leptospira,but rodents are the potential reservoir. Infections in rodents are asymptomatic in warm and wet temp

,organisms survive for long and also multiply. Infection may occur directly through animals or through environmental contamination. Peoples such as sewage workers, farmers, abattoir workers, veterinarians are at risk of infection. India are endemic of leptospira. Costal areas include Tamilnadu,

Andhra, Gujarat are endemic.

PATHOGENESIS:

Incubation period of one to two weeks, but may be two to three months. It is spread by systemic haematogenous dissemination. Vascular endothelial lesions are the primary lesions and leads to capillary damage, hemorrhage, vasculitis and localized ischaemia. It leads to DIC. Renal involvement includes TIN.

Pulmonary features include leptospirosis associated pulmonary hemorrhage syndrome.

CLINICAL FEATURES:

Majority of the patients are asymptomatic.15- 20% presents with mild febrile illness. A small percentage progress to multi organ dysfunction syndrome.

Severe disease has two phase a leptospiraemic and immune phase.

Leptospiraemic phase begins with remittent fever, chills, rigors, and myalgia.

Conjunctival suffusion without purulent discharge and muscle tenderness are characteristics. Organomegaly are less common.

Immune phase coincides with the appearance of antibodies and disappearance of organisms from blood. It is characterized by manifestation of organ damage includes acute renal failure, fulminant hepatic failure. Cardiac arrhythmias and aseptic meningitis can occur. In endemic areas, LPHS is the most common cause of mortality .Uveitis is a recognized delayed complications of leptospirosis.

DIAGNOSIS:

1. Anaemia

2. Thrombocytopenia.

3. Elevation of ESR.

4.Urine analysis;

- Shows Erythrocytes, leucocytes, granular or hyaline casts and proteinuria.

5. CPK elevation.

6. Deranged LFT and RFT.

7. CSF Analysis

Elevated protein and normal glucose with predominant polymorphs.

INVESTIGATIONS:

1. Microscopic Agglutination Test (MAT)

It is the most reliable sensitive test. A fourfold rise in titres on two occasion of blood samples after 5 to 10 days confirms the diagnosis.

2. Ig M ELISA and other rapid diagnostics test are available for presumptive diagnosis.

3. Isolation of leptospires from blood, urine or CSF is a definite proof for identification.

TREATMENT:

Figure 17: Treatment for leptospirosis

PREVENTION:

Rodent control, decontamination of environmental sources, chemoprophylaxis

are useful.

SCRUB TYPHUS

Scrub typhus is an important cause of acute febrile illness in rural areas of

India. It is caused by Orientiatsutsugamushi and it spread through bite of

chigger (larval stage). Mite are found in paddy field, bamboo patches, primary

forest and garden. The obligate intracellular O. tsutsugamushi is maintained

transovarally in the mite population and in rodents. Humans are accidental

host.

CLINICAL FEATURES:

It is characterized by vasculitis like features, symptoms occur between sixth

and tenth day after bite of the mite. Symptoms include fever, generalized or

regional lymphadenopathy, maculopapular rash. The most important sign is

eschar. Eschar is a painless papule which occur at the bite site, which later

ulcerate and transform in to black crust. Complications include myocarditis,

acute respiratory distress syndrome, renal failure, hepatic failure and

meningoencephalitis.

Figure 18: Eschar of scrub typhus

INVESTIGATIONS:

1. Immunofluorescence assay (IFA) and indirect immunoperoxidase test (IIP)

- these are the gold standard test. These test are based on cell culture

derived antigen of O. tsutsugamushi.

2. ELISA – Anti O. tsutsugamushi Ig G and Ig M based rapid diagnostic test.

3. Polymerase chain reaction- detect different target gene of O. tsutsugamushi.

4. Blood culture

DIFFERENTIAL DIAGNOSIS:

Typhus, Malaria, Arbovirus infections, Relapsing fever

TREATMENT:

1. Drug of choice-T. Doxycycline 100mg BD for 7 days

2. In pregnancy and in young children – Azithromycin 100 to 500mg OD for five days is an effective alternative

INFLUENZA VIRUS INFECTION:

It belongs to orthomyxoviridiae family. There are three genera A, B, and C.

Influenza A are the most variable among the respiratory viruses. These are subtyped into hemagglutinin (H1-H16) and neuraminidase (N1 –N9). H and N are responsible for the host receptor binding, cell entry, cleavage of receptor complex, multiplication and release of new virions.

Natural reservoir of this infection are aquatic birds. It harbours all subtypes. People who handle with this reservoirs like veterinarians and poultry workers are at risk of infection. Currently H3N2 and H5N1 are endemic in

India. Viruses exhibit antigen shift and drift. Antigenic shift results in global pandemic whereas antigenic drift results in epidemic.

CLINICAL FEATURES:

It is transmitted through droplets via coughing or sneezing. Incubation period ranges from 24 to 72 hours after which flu like Symptoms (fever, rhinitis, myalgia, sore throat and cough) develops. The clinical presentation varies from mild illness to severe pneumonia, ARDS, and respiratory failure. Myocarditis and pulmonary emboli can occur. Mortality rate is high among age below 5 years and above 65 years, asthmatics, pregnancy, immunosuppressed individuals.

INVESTIGATIONS:

1. RT-PCR – recommended investigation for confirmation

2. Throat swab for H1N1

3. Culture

4. New test- CD Influenza 2009 A (H1N1) pdm real test PCR panel. It uses

molecular biological technique to detect influenza avirus.

TREATMENT:

Category A: Mild infection- no antiviral, symptomatic treatment, no investigation, home isolation

Category B1- symptoms of category A + high grade fever severe sore throat- home isolation, antiviral drug may be given, no investigation

Category B2 – symptoms of category A + major high risk groups- home isolation, antiviral drug should be given, no investigations

Category C- signs and symptoms of category A and B + breathlessness, chest pain, drowsiness, low BP, sputum with blood, bluish discoloration of nail, irritable child, worsening of underlying chronic condition- immediate testing , hospitalization and treatment.

OSELTAMIVIR MEDICATION:

It is the recommended medication for both prophylaxis and treatment.

DOSAGE:

1. by weight:

<15 kgs- 30mg BD for 5 days

15 – 32 kgs – 45mg BD for 5 days

24 – 40 kgs – 60mg BD for 5 days

>40 kgs- 75 mg BD for 5 days

2. for infants:

<3months: 12mg BD for 5 days

3-5 months-20mg BD for 5 days

6-11 months-25mg BD for 5 days

VACCINATION:

Vaccines protect against pandemic strains H1N1/09. Two forms are available.

1. Injectable killed vaccine- pregnant women and immunocompromised

2. Nasal spray live vaccine

JAPANESE ENCEPHALITIS:

It is caused by ssRNA virus belonging to flamiviridae family. Humans who lives or travels coincidentally to enzootic cycle of JEV develop this infection. It is more common in rural and urban area with pig and mosquito breeding. In endemic region

children are the susceptible age group whereas in non-endemic region both adult and children are affected.

CLINICAL FEATURES:

Incubation period is 6 – 16 days. Virus replicate at site of mosquito bite, then spread through blood and lymphatics and affects the central nervous system. Initial flu like nonspecific symptoms occurs followed by development of encephalitis syndrome.

Encephalitis syndrome is characterized by behavioral disturbance, altered sensorium, seizures, acute flaccid paralysis, hemiplegia, quadriplegia, cerebellar signs and movement disorders like dystonia, chorea, and athetosis.

INVESTIGATIONS:

1. Ig M capture ELISA- Ig M antibodies in CSF has most sensitivity and specificity.

2. CT and MRI brain shows involvement of thalamus, brainstem and basal ganglion

TREATMENT:

No specific antiviral treatment is available. Symptomatic management of fever, seizures, prevention of aspiration pneumonia, bed sore and urinary tract infection.

Seriously ill patient needs artificial respiration.

PREVENTION:

Use of larvicidal spray in the rice fields, insecticidal spray in the community helps to combat JEV infection. Live virus and attenuated viral vaccines are available.

CHIKUNGUNYAVIRUS (CHIKV)

Chikungunya is an alphaviridae seen in the semliki Forest complex .The main vector is Aedes. aegypti and other species. During the recent outbreak in the Indian

Ocean, there was an n early maternal fetal transmission, results in death in utero.

PATHOLOGY:

CHIKV fever has been misdiagnosed as dengue because of similarities of symptoms.

A hallmark of this disease is intolerable arthralgia. The arthralgia appears to be symmetrical bilateral involvement involving small joints such as toes, ankle, fingers, elbows, wrists, knees. Chronic arthralgia can persist for months and even years. Other symptoms include lymphopenia, hypocalcaemia, photophobia, lumbar back pain, nausea, vomiting, chills and weakness.

CHIKV fever, is generally a self-limiting fever. However complications like myocarditis, meningoencephalitis, mild hemorrhage also been reported.

CHIKV can be detected in the synovial macrophages of chronic patients. Arthralgia induced by the virus resembles rheumatoid arthritis, mainly attributed to the dysregulation of pro- inflammatory cytokines, causing inflammation and tissue destruction at the affected joints.

Clinical features:

The incubation period of CHIKV is 3 – 12 days, average of 2 – 7 days. Classical illness include severe arthralgia, myalgia, high fever, conjunctivitis and lymphadenopathy. This is followed by the onset of generalized maculopapular rash.

Fever may recurs after 2 -3 days. More severe hemorrhagic manifestation occurs and are common in children. Someexperience chronic pain for months to years.

Investigation:

1. Ig M chikungunya can be detected by IFA or EIA in acute sera.

2. PCR methods.

Highly sensitive and specific.

Acute infection can be confirmed by showing increasing titres of HI or N antibody.

TREATMENT:

No specific treatment.

Hydroxychloroquine can be used for arthralgia.

AIMS AND OBJECTIVES

AIM OF THE STUDY:

To study the clinical profile of acute undifferentiated fever and its response to treatment.

Primary objectives:

To study the clinical epidemiological profile of acute undifferentiated fever

Secondary objectives:

1. To study the course of AUF.

2. To study the cause of Acute undifferentiated fever

3. To study the response to treatment without unnecessary antibiotics and

antimalarial

MATERIALS AND METHODS

METHODS AND MATERIAL

STUDY CENTRE:

This prospective study was conducted at the fever ward of Department of general medicine, Stanley Medical College, Chennai-01. All Patients admitted in the fever ward at Department of general medicine, Stanley Medical College.

STUDYPERIOD:

Six months period study from August 2017 –January 2018’

INCLUSION CRITERIA:

1. Age group above 12 yrs.

2. Both sexes.

3. Patients with infectious cause of fever.

EXCLUSION CRITERIA:

1. Patients with localising foci of fever.

2. Patients with autoimmune causes.

3. Patients with malignancy

4. Patients with immune deficiency

5. Patients with more than two weeks of fever

The study population will be selected as per inclusion and exclusion criteria from fever ward department of general medicine. Study population will be evaluated with detailed history, clinical examination and laboratory investigations. The initial investigations includes complete blood count, peripheral smear, MP QBC, renal function test, electrolytes, ultra sonogram of abdomen. Further investigations will be done based the clinical presentation and basic investigation reports. Specific treatment is given according to the etiological if diagnosed or else patients will be treated symptomatically.

Statistical analysis will be done as described below,

1. Frequency

Mean of age group affected

Mean of duration of illness

2. Association

1. Fever with chills and rigors

2. Fever with rashes/eschar

3. Fever with thrombocytopenia

4. Fever with hepatomegaly

5. Fever with splenomegaly

3. Proportion and chi square test.

All data will be entered into excel format and statistical analysis will be done through spss version 16 and P value less than 0.05 will be considered significant .charts and graphs will be expressed using MS excel 2013 .

OBSERVATIONS AND RESULTS

OBSERVATION AND RESULTS

During the study period from august 2017 to January 2018, 1012 patients were diagnosed with acute undifferentiated fever.

GENDER DISTRIBUTION:

• Among the 1012 number of patient evaluated, 571(56%) were Male and 441

(44%) were Females. Total number of children in the age group 12 to 18 years

were 185 (18% )

Table 3 - Gender distribution

Gender Number Percentage

Male 571 56%

Female 441 44%

GENDER DISTRIBUTION

44, 44% Male

56, 56% Female

Figure 19: Gender distribution

AGE GROUP:

The youngest patients in this study was 12-year old and the eldest

Patient was 80-year-old. Mean age in the study was 34. Highest number of patients (32.5%) were in the age group of 20 - 39 years.

Figure 20: Age distribution

Table 4:Age distribution

Age Male Female Percentage

12-19 84 101 18.3%

20-39 195 125 31.8%

40-59 166 105 26.4%

>=60 126 110 23.5%

GEOGRAPHIC DISTRIBUTION:

Among the patients, 64% were from rural population and 36% were from urban area

Figure 21: Geographic distribution

Duration of fever:

Total duration of fever ranged from 2 to 14 days and Average duration of fever was 4 to 6 days

Table 5: Duration of fever

Days Number Percentage %

2 to 4 230 22.9

4 to 6 336 33.5

6 to 10 274 27.4

10 to 14 172 17.2

Figure 22: Duration of fever

DURATION OF FEVER 40 35 30 25 20 15 10

0 2 to 4 4 to 6 6 to 10 10 to 14

Trend of fever:

During the study period, maximum number of fever cases were reported during the month of October and November.

300 250 200 150 100 50 0

Figure 23: Trends of AUF

Table 6: Trends of AUF

MONTH NUMBER OF CASES

AUGUST 101

SEPTEMBER 154

OCTOBER 252

NOVEMBER 266

DECEMBER 153

JANUARY 84

AETIOLOGY: Among 1012 patients, 36% had acute undiagnosed undifferentiated fever and remaining 64 % had acute diagnosed undifferentiated fever.

Among AUF 35.9% had malaria, 28 %had dengue. Overlap infections were seen in

14%. H1N1 (6.2%) and scrub typhus (6.2%) was the least cause of AUF.

Table 7: Aetiology of AUF CAUSES PERCENTAGE (%)

Acute undiagnosed 35 undifferentiated fever

Malaria 23

Dengue 18

Leptospirosis 6

Enteric fever 10

Scrub typhus 4

H1N1 4

Figure 24:Aetiology of AUF

CLINICAL PRESENTATION: Among 1012 patients, 376 patients presented with chills and rigor, bleeding manifestation were seen in 123 patients of which 65% were diagnosed to have dengue fever. Splenomegaly was noted among 124 of 1012 patients of which malaria accounts for 75%, other infections like enteric fever (10%), scrub typhus (5%) and leptospirosis (5%) also had splenomegaly.

About 70 patients were presented with fever and hypotension of which dengue accounts for more than 50%. Fever with respiratory dysfunction were seen in 103 patients of which H1N1 accounts for 60%. Fever with multiorgandysfunction were seen in 94 patients. Among scrub typhus, eschar was seen in 30%. Thrombocytopenia was seen in 35% (362 out of 1012) of which 60% was due to dengue infection and the rest 40% was due to UUF, malaria, leptospirosis, and scrub typhus.

Thrombocytopenia 70%

60%

50%

40%

30%

20%

10%

0% dengue other infections

Figure 25: Thrombocytopenia

MALARIA: Out of 1012 patients, 232 were diagnosed with malarial infection. In this 232 patients

185 (80%) patients were affected with Plasmodium vivax whereas 47 (20%) patients had Falciparum infection.

malaria infecetion 90

0 UNCOMPLICATED MALARIA COMPLICATED

Figure 26: malaria infection

Among 232 patients, 191(85%) of patients recovered without any complications, the rest 42 (15%) patients had complications like cerebral malaria, acute renal failure and hepatic dysfunction, multiorgan dysfunction.

OUTCOME OF MALARIAL INFECTION

90 80 70 60 50 40 30 20 10 0 UNCOMPLICATED MALARIA COMPLICATED CEREBRAL MALARAI

Figure 27: Outcome of malarial fever

DENGUE FEVER: Among 182 dengue patients, 134 (73.5%) of patients had dengue fever, 31 (17%) had dengue haemorrhagic fever and 17(9.3%) were diagnosed with dengue shock syndrome.

DENGUE

9.30%

17%

73.50%

DENGUE FEVER DHF DSS

Figure 28: Dengue

OVERLAP INFECTIONS:

Overlap infections were seen in 14.5% of patients. Malarial infection (10.5%) was most commonly associated with other infections like dengue, leptospirosis, enteric fever and H1N1. Next to malarial infection, dengue viral fever has the overlap infection percentage rate of about 8.

Table 8: Overlap infection

Overlap infection Percentage

(%)

Malaria + dengue 4

Malaria + leptospirosis 2

Malaria + enteric fever 4

Dengue + leptospirosis 2

Dengue + scrub 2

Malaria + H1N1 0.5

OVERLAP INFECTIONS

MALARIA + H1N1 0.5

DENGUE + SCRUB 2

DENGUE + LEPTO 2

MALARIA + ENTERIC FEVER 4

MALARIA + LEPTOSPIROSIS 2

MALARIA + DENGUE 4

0 1 2 3 4 5

Figure 29: Overlap infection

Treatment of acute undiagnosed undifferentiated fever:

• Among UUF - 354 patients, 60% were treated symptomatically.26% were

treated with antimalarials. 10% required antibiotics and 4% were treated with

antivirals.

• Symptomatic treatment include analgesics and i.v fluids

Figure 30: Treatment of AUF

OUTCOME OF AUF:

Among 1012, 993(98.23%) patients completely recovered, whereas the mortality rate was1.87%.

Chart Title

COMPLETELY RECOVERED MORTALITY

98%

Figure 31: Outcome of AUF

CAUSES OF MORTALITY

Various causes of mortality were hypovolemic shock (in 6 patients), septic shock (5 patients), ARDS (4 patients), aspiration pneumonia (2 patients) and meningoencephalitis (2 patients)

FIGURE 32; Causes of Mortality

DISCUSSION This study conducted among patients, admitted in fever ward in tertiary care hospital is one of the largest prospective study involving 1012 patients. This study was conducted during the fever epidemic period in Tamilnadu. Patients has been enrolled over a period of six months. Among patients, male gender (56%) contributes to the maximum number of cases. The probable reason being the men are more commonly exposed to the outdoor environment ,hence the transmission of vector borne illness are more common in men. The study by Kristine merch et al and zawmyotun et al also showed male sex (57%) predominance of fever.

Trends of cases showed dramatic increase in the prevalence of malaria, dengue, leptospirosis and scrub typhus during the month of October and November, which coincides with onset of north east monsoon in tamilnadu. Breeding of mosquito is facilitated during these months and water contamination is also common during these months. The study by Abhilash KPP et al also showed scrub typhus and dengue fever peaked during the monsoon whereas malaria and leptospirosis didn’t showed any seasonal variation.

The mean age group in this study was 34, similar mean age group was reported in the study by Kristine merch et al (34) and zawmyotun et al (36.6)

AUF was more commonly reported in rural population (64%) similar rural population

(78%) prepordance was reported in study by Kristine merch et al

The most common infectious cause of AFI in this study was malaria (23%) whereas in study by Abilash KPP et al scrub typhus is the most common cause of fever. This can

be explained by the fact malaria is endemic in our study population whereas study by

Abilash KPP et al was done in hilly area hence scrub typhus was the most common cause in that study.

Another study by Kristine merch et al showed malaria (17%) was the most common cause of AFI followed by dengue (16%) which is similar to our study finding. In our study also next to AUUF, malaria (23%) was the most common cause of AFI followed by dengue (18%)

Among the overlap infection, malaria infection (10.5%) had overlapped with other infections like dengue, leptospirosis and H1N1. Next to malaria, dengue infection had overlap rate of 8%. The study by Kristine merch et al showed higher rate of overlap infection then our study, malaria had 20% and chikungunya infection had 56% overlap with other infections like leptospirosis, scrub typhus and bacteremia.

Average duration of fever was 4 to 6 days, similar finding was observed in study by abhilash KPP et al (4.2 days)

Bleeding manifestation was seen in 12.1 % whereas in study by Abhilash et al had bleeding manifestation in 7.4%. Both in our study and Abhilash study the most common cause of bleeding manifestation was dengue fever.

The eschar which is a characteristic feature of scrub typhus was seen in 30% of patients whereas it was seen in 57.9 % in study by Abilash KPP et al.

In Malarial infection 80% was caused by P.vivax and 20% caused by P.falciparum infection, whereas in study by Kristine merch et al reported higher incidence of

P.falciparuminfection (54%).

Severe manifestation of dengue fever was seen in 26%, similar findings was reported in population of Delhi by Siddiqui O et al. Severe dengue manifestation included dengue haemorrhagic fever (17%) and dengue shock syndrome (9.3%) in our study.

The study by Abhilash KPP et al showed dengue haemorrhagic fever in 11% and dengue shock syndrome in 3.3%

Mortality rate in our study was 1.87% whereas in study by Abhilash KPP et al showed higher mortality rate of 3.3%.

Conclusion:

1. The microbiological cause of AUF were identified in around 65.5 % of the patients.

2. High prevalence of malaria and dengue were found on this study

3. .Overlap infection-not due to coinfection alone

1. Subclinical infection.

2. Cross reactivity

3. Undefined and untreated previous infection.

4. Around 50% of total 1012 patients were treated symptomatically with fluids and antipyretics and outcome of patients were good.

5. High occurrence of acute undifferentiated fever was due to limitation of

Diagnostic test in India.

6. Around 98.25 % of the patients were recovered well. Mortality were only 1.75

%.Most of the death were due to the delayed referral. So early referral with appropriate protocol management can prevent mortality.

7. Detailed history taking, clinical examination and relevant investigation can avoid irrational use of antibiotics, antimalarial and antivirals.

8. Clinical presentation similarity, etiological agents diversity and an inability to identify an infection, makes the complexity of diagnosis.

9. The etiological profile of the diseases will be useful in framing the rational guidelines for infectious disease and can control the infection from primary level through proper sanitation and hygiene environment.

CONFLICT OF INTEREST:

There are no conflict of interest.

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ABBREVATIONS:

AFI – Acute Febrile Illness

ARDS – Acute Respiratory Distress Syndrome

AUF – Acute Undifferentiated Fever

BMR – Basal Metabolic Rate

CHIKV – Chikungunya Virus

DIC – Disseminated Intravascular Coagulation

ECG- Electrocardiogram

ELISA – Enzyme Linked Immuno Sorbent Assay

ESR – Erythrocyte Sedimentation Rate

HIV – Human Immune Deficiency Virus

IFA – Immunofluorescent Assay

IIP – Indirect Immunoperoxidase Test

JEV – Japanese Encephalitis Virus

LFT – Liver Function Test

PUO – Pyrexia Of Unknown Origin

RBS- Random Blood Sugar

RDT – Rapid Dignositic Test

RFT – Renal Function Test

USG – Ultrasonogram

UUF – Undiagnosed Undifferentiated Fever

GOVERNMENT STANLEY MEDICAL COLLEGE DEPARTMENT OF INTERNAL MEDICINE FEVER WARD CASE SHEET NAME : AGE/SEX: IP NO : ADDRESS : BLOOD GROUP :

DATE OF ADMN : TIME : UNIT : REFERRAL(IF ANY) : COMPLAINTS : DURATION : ONSET OF FEVER : H/O PI: FEVER  DURATION :  HIGH GRADE / LOW GRADE  PATTERN : INTERMITTENT /CONTINUOUS  PERIODICITY : YES / NO (IF ‘YES’ SPECIFY...... )  DIURNAL VARIATION : YES / NO  ASSOCIATED WITH CHILLS /RIGOR : YES / NO  RELIEVING FACTOR : ASSOCIATED WITH : (PLEASE „TICK „ AT PRESENTING SYMPTOMS) HEADACHE : YES NO COUGH WITH EXPECTORATION : YES NO RUNNING NOSE : YES NO SORE THROAT : YES NO

CONJUNCTIVAL CONGESTION : YES NO

JAUNDICE : YES NO MYALGIA : YES NO JOINT PAIN : YES NO RETRO/PERI ORBITAL PAIN : YES NO ABDOMINAL PAIN : YES NO NAUSEA AND VOMITING : YES NO DIARRHOEA : YES NO RASHES : YES NO ESCHAR : YES NO LYMPHADENOPATHY : YES NO BLEEDING MANIFESTATION : YES NO ALTERED SENSORIUM : YES NO LOSS OF CONSCIOUSNESS / SEIZURES : YES NO REDUCED URINATION : YES NO BLOOD IN VOMITING : YES NO BLEEDING GUMS : YES NO BLACK TARRY STOOLS : YES NO ANY OTHER SYMPTOMS : 1. 2. 3. PAST HISTORY : HTN DM TB CAD BA EPILEPSY THYROID

HISTORY OF BLOOD TRANSFUSION :

PERSONAL HISTORY :

FAMILY HISTORY :

OCCUPATIONAL HISTORY :

GENERAL EXAMINATION : (PLEASE „TICK „ APPROPRIATELY)  CONSCIOUS / UNCONSCIOUS / DROWSY  ORIENTED / ALTERED SENSORIUM  FEBRILE / AFEBRILE  BUILT – WELL / MODERATE / THIN  HYDRATION - ADEQUATE / DEHYDRAYED  PALLOR - PRESENT / ABSENT  ICTERUS - PRESENT / ABSENT  CYANOSIS - PRESENT / ABSENT  CLUBBING - PRESENT / ABSENT  PEDAL EDEMA - PRESENT / ABSENT  GENERALISED LYMPHADENOPATHY

VITALS ON ADMISSION

TEMP

PR PULSE PRESSURE RR

SPO2

SYSTEM EXAMINATION : CVS -

RS -

P/A -

CNS -

TO DO : ADVICE: 1.CBC 2.RFT,LFT,S.ELECTROLYTES 3.URINE ROUTINE 4.PS FOR MP,MF 5.MP-QBC 6.LEPTO –IGM /MSAT 7.DENGUE IGM SEROLOGY 8.WIDAL TEST

INFORMED CONSENT

“A STUDY ON ACUTE UNDIFFERENTIATED FEVER – CLINICAL

PROFILE & RESPONSE TO TREATMENT”

Place of study: Govt. Stanley medical college, Chennai I …………………………………….……………………. have been informed about the details of the study in my own language. I have completely understood the details of the study. I am aware of the possible risks and benefits, while taking part in the study. I agree to collect samples of blood/saliva/urine/tissue if study needs. I understand that I can withdraw from the study at any point of time and even then, I can receive the medical treatment as usual. I understand that I will not get any money for taking part in the study. I will not object if the results of this study are getting published in any medical journal, provided my personal identity is not revealed. I know what I am supposed to do by taking part in this study and I assure that I would extend my full cooperation for this study.

Volunteer: Witness:

Name and address Name and address

Signature/thumb impression: Signature/thumb impression

99 s.no NAME AGE/SEX PLACEDurationchills of fever &vomiting/diarrhoea rigor joint pain/myalgiableedingjaundice manifestationeschar/skinURI symptoms rashesvitals general inv specific inv Treatmeent final diagnosiscomplication/outcome 1 deepa 23/f U 7 days + ------stable thrombocytopeniaIgM dengue+,GBsymptomatic wall edemadengue fevernil 2 sunitha 30/f U 12 days + - + + - - - stable thrombocytopeniaIgM dengue+,GBsymptomatic wall edemadengue fevernil 3 santhi 21/f R 5 days ------+ stable normal negative symptomaticAUF nil 4 harini 17/f R 8 days ------stable normal negative symptomaticAUF nil 5 baby 40/f R 9 days ------stable normal negative symptomaticAUF nil 6 valliyammal 54/f U 8 days - - - + - - - hypotensionthrombocytopeniaIgM dengue+,GBsymptomatic wall edema,splenomegalydengue haemorrhagicseptic shock/sepsis fever 7 monisha 19/f R 7 days ------stable normal negative symptomaticAUF nil 8 kaviya 18/f U 5 days ------stable normal negative symptomaticAUF nil 9 nagammal 50/f R 3 days ------+ stable normal negative symptomaticAUF nil 10 sivagami 50/f R 12 days - - + - - - - stable thrombocytopeniaIgM dengue+symptomaticdengue fevernil 11 krishnamary 23/f R 3 days - - + - - - - stable normal negative symptomaticAUF nil 12 sundar 57/m U 5 days + ------stable thrombocytopeniaP.vivax + antimalarialsmalaria nil 13 rafiq 23/m U 6 days + - - - + - - stable thrombocytopenianegative symptomaticAUF nil 14 nithianandham 30/m U 10 days + ------stable thrombocytopeniaP.vivax + antimalarialsmalaria nil 15 chakaravarthy 21/m U 7 days + + + - - - + stable normal negative symptomaticAUF nil 16 ragul 17/m R 12 days + + - - - - - bradycardia normal widal+,splenomegalyceftriaxone injEnteric fevernil 17 banu 40/f R 6 days + + + + + - - hypotensionLFT&RFT derangedIgM lepto+,hepatomegalydoxycycline leptospirosisAKI/metabolic acidosis/sepsis 18 suman 54/m R 4 days + + - - - - - stable normal negative symptomaticAUF nil 19 ajith 19/m R 2 days - + + - - - - stable normal negative symptomaticAUF nil 20 vishanth 18/m R 6 days + + - - - - - stable normal P.vivax +,splenomegalyantimalarialsmalaria nil 21 fathima 50/f R 5 days + ------stable normal negative symptomaticAUF nil 22 lokesh 50/m R 5 days ------+ stable normal negative symptomaticAUF nil 23 mithesh 23/m U 5 days - + - - - - + stable normal negative symptomaticAUF nil 24 ayubkhan 19/m R 7 days + + + + - + - tachypnea+K29LFT&RFT derangedIgM scrub typhus+doxycycline scrub typhusMODS/SEPSIS/SEPTIC SHOCK 25 suganthy 11/m U 2 days + - - - + symptomaticsymptomaticsymptomaticsymptomaticsymptomaticsymptomaticAUF nil 26 krishnan 12/m pl.falciparumantimalarialsmalaria nil 27 nithianandham 19/m U 4 days + ------stable thrombocytopeniapl.falciparumantimalarialsmalaria nil 28 iyyappan 12/m R 4 days - - + + - - - stable thrombocytopeniapl.falciparumantimalarialsmalaria nil 29 venkatesh 12/m U 4 days ------+ stable normal pl.falciparumantimalarialsmalaria nil 30 ramesh 12/m R 4 days ------stable normal pl.falciparumantimalarialsmalaria nil 31 sabitha 12/m R 6 days ------stable normal pl.falciparumantimalarialsmalaria nil 32 tamilselvi 12/m R 10 days - - - + - - - hypotensionthrombocytopeniapl.falciparumantimalarialsmalaria nil 33 kannadasan 19/m R 11 days ------stable normal pl.falciparumantimalarialsmalaria nil 34 lakshmi 14/m R 4 days ------stable normal pl.falciparumantimalarialsmalaria nil 35 ganesh 14/m U 10 days ------+ stable normal pl.falciparumantimalarialsmalaria nil 36 elumalai 14/m U 3 days - - + - - - - stable thrombocytopeniapl.falciparumantimalarialsmalaria nil 37 usha 13/m U 6 days + - + - - - - stable normal pl.falciparumantimalarialsmalaria nil 38 valarmathy 13/m R 4 days + ------stable thrombocytopeniapl.falciparumantimalarialsmalaria nil 39 rakesh 13/m U 5 days + - - - + - - stable thrombocytopeniapl.falciparumantimalarialsmalaria nil 40 nandhakumar 13/m R 7 days + + - - - - - stable thrombocytopeniapl.falciparumantimalarialsmalaria nil 41 maheswari 19/m R 3 days + + + - - - + stable normal pl.falciparumantimalarialsmalaria nil 42 vinoth 17/m R 5 days + + - - - - - bradycardia normal pl.falciparumantimalarialsmalaria nil 43 suresh 17/m R 10 days + + + + + - - hypotensionLFT&RFT derangedpl.falciparumantimalarialsmalaria nil 44 prabhu 17/m R 12 days - + - - - - - stable normal pl.falciparumantimalarialsmalaria nil 45 selvaraj 17/m R 4 days + + + - - - - stable normal pl.falciparumantimalarialsmalaria nil 46 muniyammal 16/m U 11 days + ------stable normal pl.falciparumantimalarialsmalaria nil 47 subramani 17/m U 7 days ------stable normal pl.falciparumantimalarialsmalaria nil 48 ramachandran 15/m U 6 days - + - - - - + stable normal pl.falciparumantimalarialsmalaria nil 49 masthan 17/m U 8 days + + - - - - + stable normal pl.falciparumantimalarialsmalaria nil 50 vanitha 19/m R 9 days + - + + - + - tachypnea+K29LFT&RFT derangedpl.falciparumantimalarialsmalaria crbral malria/acute encephalopathy/aspiration pneumonia 51 sudha 15/m R 3 days 0 0 - - + symptomaticsymptomaticsymptomaticsymptomaticpl.falciparumantimalarialsmalaria nil 52 sengaiyan 15/m R 6 days + - 0 0 0 0 0 0 0 pl.falciparumantimalarialsmalaria nil 53 banu priya 15/m R 5 days ------stable thrombocytopeniapl.vivax antimalarialsmalaria nil 54 arulselvam 19/m R 12 days - - + + - - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 55 srinivasan 19/m R 10 days ------+ stable normal pl.vivax antimalarialsmalaria nil 56 mouli 16/m U 2 days ------stable normal pl.vivax antimalarialsmalaria nil 57 sailsa 19/m R 11 days ------stable normal pl.vivax antimalarialsmalaria nil 58 saraswathi 15/m U 4 days - - - + - - - hypotensionthrombocytopeniapl.vivax antimalarialsmalaria nil 59 shanthi 17/m U 5 days ------stable normal pl.vivax antimalarialsmalaria nil 60 panimala 19/m U 5 days ------stable normal pl.vivax antimalarialsmalaria nil 61 rajesh 19/m R 6 days ------+ stable normal pl.vivax antimalarialsmalaria nil 62 vivegananthan 19/m R 11 days + - + - - - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 63 selvam 19/m R 8 days + - + - - - - stable normal pl.vivax antimalarialsmalaria nil 64 manigandan 19/m R 5 days + ------stable thrombocytopeniapl.vivax antimalarialsmalaria nil 65 esther 19/m U 9 days + + - - + - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 66 srinisha 12/m R 10 days + + - - - - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 67 divyashri 12/m R 2 days + + + - - - + stable normal pl.vivax antimalarialsmalaria nil 68 adharsh 12/m U 6 days + + - - - - - bradycardia normal pl.vivax antimalarialsmalaria nil 69 asitha 12/m U 3 days - + + + + - - hypotensionLFT&RFT derangedpl.vivax antimalarialsmalaria nil 70 sakthivel 19/m U 4 days + + - - - - - stable normal pl.vivax antimalarialsmalaria nil 71 harish 19/m R 9 days + - + - - - - stable normal pl.vivax antimalarialsmalaria nil 72 ayesha 19/m R 11 days ------stable normal pl.vivax antimalarialsmalaria nil 73 dinesh 13/m R 4 days - + - - - - - stable normal pl.vivax antimalarialsmalaria nil 74 vijay 13/m R 7 days + + - - - - + stable normal pl.vivax antimalarialsmalaria nil 75 madhesh 13/m U 5 days + - - - - - + stable normal pl.vivax antimalarialsmalaria nil 76 prem kumar 19/m U 3 days 0 0 + + - + - tachypnea+K29LFT&RFT derangedpl.vivax antimalarialsmalaria nil 77 jothisri 19/m U 8 days + - - - + symptomaticsymptomaticsymptomaticsymptomaticpl.vivax antimalarialsmalaria nil 78 jaikanth 19/m R 6 days - - 0 0 0 0 0 0 0 pl.vivax antimalarialsmalaria nil 79 komathi 19/m R 5 days ------stable thrombocytopeniapl.vivax antimalarialsmalaria nil 80 govindamma 19/m R 13 days - - + + - - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 81 deepa 19/m R 12 days ------+ stable normal pl.vivax antimalarialsmalaria nil 82 kavitha 19/m R 11 days ------stable normal pl.vivax antimalarialsmalaria nil 83 joyesh 18/m R 6 days ------stable normal pl.vivax antimalarialsmalaria nil 84 sharmila 18/m R 7 days - - - + - - - hypotensionthrombocytopeniapl.vivax antimalarialsmalaria nil 85 ramana 18/m R 3 days ------stable normal pl.vivax antimalarialsmalaria nil 86 munuswamy 19/m R 9 days ------stable normal pl.vivax antimalarialsmalaria nil 87 chellamma 19/m R 7 days + - - - - - + stable normal pl.vivax antimalarialsmalaria nil 88 mari 17/m R 9 days + - + - - - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 89 kasinathan 17/m R 4 days + - + - - - - stable normal pl.vivax antimalarialsmalaria nil 90 usharani 19/m R 5 days + + - - - - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 91 vignesh 19/m U 2 days + + - - + - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 92 sasi 19/m R 11 days + + - - - - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 93 logeswari 19/m R 12 days + + + - - - + stable normal pl.vivax antimalarialsmalaria nil 94 dhanasekar 16/m U 6 days - + - - - - - bradycardia normal pl.vivax antimalarialsmalaria nil 95 udhyabharathi 16/m R 8 days + + + + + - - hypotensionLFT&RFT derangedpl.vivax antimalarialsmalaria nil 96 kumar 19/m R 10 days + ------stable normal pl.vivax antimalarialsmalaria nil 97 suguna 14/m U 6 days - - + - - - - stable normal pl.vivax antimalarialsmalaria nil 98 annapoorni 14/m U 4 days - + - - - - - stable normal pl.vivax antimalarialsmalaria nil 99 shireen 15/m U 7 days + + - - - - - stable normal pl.vivax antimalarialsmalaria nil 100 deepa 15/m R 7 days + - - - - - + stable normal pl.vivax symptomaticmalaria nil 101 sunitha 19/m U 12 days 0 0 - - - - + stable normal pl.vivax symptomaticmalaria nil 102 - 13/m R - + - + + - + - tachypnea+K29LFT&RFT derangedpl.vivax symptomaticmalaria nil 103 harini 13/m R 8 days - - - - + symptomaticsymptomaticsymptomaticsymptomaticpl.vivax symptomaticmalaria nil 104 baby 13/m R 9 days - - 0 0 0 0 0 0 0 pl.vivax symptomaticmalaria nil 105 valliyammal 20/f R 8 days ------stable thrombocytopeniapl.vivax symptomaticmalaria nil 106 monisha 20/f R 7 days - - + + - - - stable thrombocytopeniapl.vivax symptomaticmalaria nil 107 kaviya 20/f U 5 days ------+ stable normal pl.vivax symptomaticmalaria nil 108 nagammal 20/f R 3 days ------stable normal pl.vivax symptomaticmalaria nil 109 sivagami 20/f R 12 days ------stable normal pl.vivax symptomaticmalaria nil 110 krishnamary 20/f R 3 days - - - + - - - hypotensionthrombocytopeniapl.vivax symptomaticmalaria nil 111 sundar 20/f R 5 days ------stable normal pl.vivax symptomaticmalaria nil 112 rafiq 20/f R 6 days + ------stable normal pl.vivax symptomaticmalaria nil 113 nithianandham 20/f R 10 days + - - - - - + stable normal pl.vivax symptomaticmalaria nil 114 chakaravarthy 20/f U 7 days + - + - - - - stable thrombocytopeniapl.vivax symptomaticmalaria nil 115 ragul 20/f U 12 days + + + - - - - stable normal pl.vivax symptomaticmalaria nil 116 banu 20/f U 6 days + + - - - - - stable thrombocytopeniapl.vivax symptomaticmalaria nil 117 suman 20/f U 4 days + + - - + - - stable thrombocytopeniapl.vivax symptomaticmalaria nil 118 ajith 20/f U 2 days + + - - - - - stable thrombocytopeniapl.vivax symptomaticmalaria nil 119 vishanth 20/f U 6 days - + + - - - + stable normal pl.vivax symptomaticmalaria nil 120 fathima 20/f U 5 days + + - - - - - bradycardia normal pl.vivax symptomaticmalaria nil 121 lokesh 20/f 5 days + - + + + - - hypotensionLFT&RFT derangedpl.vivax symptomaticmalaria nil 122 mithesh 20/f R 5 days ------stable normal pl.vivax symptomaticmalaria nil 123 ayubkhan 20/f R 7 days - + + - - - - stable normal pl.vivax symptomaticmalaria nil 124 suganthy 20/f R 2 days + + - - - - - stable normal pl.vivax antimalarialsmalaria nil 125 krishnan 20/f R 4 days + ------stable normal pl.vivax antimalarialsmalaria nil 126 nithianandham 34/f R 4 days 0 0 - - - - + stable normal pl.vivax antimalarialsmalaria nil 127 iyyappan 34/f U 4 days + - - - - - + stable normal pl.vivax antimalarialsmalaria nil 128 venkatesh 34/f U 4 days - - + + - + - tachypnea+K29LFT&RFT derangedpl.vivax antimalarialsmalaria nil 129 ramesh 20/f U 4 days - - - - + symptomaticsymptomaticsymptomaticsymptomaticpl.vivax antimalarialsmalaria nil 130 sabitha 20/f U 6 days - - 0 0 0 0 0 0 0 pl.vivax antimalarialsmalaria nil 131 tamilselvi 20/f R 10 days ------stable thrombocytopeniapl.vivax antimalarialsmalaria nil 132 kannadasan 35/f R 11 days - - + + - - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 133 lakshmi 35/f R 4 days ------+ stable normal pl.vivax antimalarialsmalaria nil 134 ganesh 35/f R 10 days ------stable normal pl.vivax antimalarialsmalaria nil 135 elumalai 35/f R 3 days ------stable normal pl.vivax antimalarialsmalaria nil 136 usha 20/f R 6 days - - - + - - - hypotensionthrombocytopeniapl.vivax antimalarialsmalaria nil 137 valarmathy 20/f U 4 days + ------stable normal pl.vivax antimalarialsmalaria nil 138 rakesh 20/f U 5 days + ------stable normal pl.vivax antimalarialsmalaria nil 139 nandhakumar 20/f U 7 days + - - - - - + stable normal pl.vivax antimalarialsmalaria nil 140 maheswari 20/f U 3 days + + + - - - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 141 vinoth 20/f R 5 days + + + - - - - stable normal pl.vivax antimalarialsmalaria nil 142 suresh 20/f R 10 days + + - - - - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 143 prabhu 20/f R 12 days + + - - + - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 144 selvaraj 20/f R 4 days - + - - - - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 145 muniyammal 20/f R 11 days + + + - - - + stable normal pl.vivax antimalarialsmalaria nil 146 subramani 20/f R 7 days + ------bradycardia normal pl.vivax antimalarialsmalaria nil 147 ramachandran 20/f U 6 days - - + + + - - hypotensionLFT&RFT derangedpl.vivax antimalarialsmalaria nil 148 masthan 20/f U 8 days - + - - - - - stable normal pl.vivax antimalarialsmalaria nil 149 vanitha 20/f U 9 days + + + - - - - stable normal pl.vivax antimalarialsmalaria nil 150 sudha 20/f U 3 days + ------stable normal pl.vivax antimalarialsmalaria nil 151 sengaiyan 20/f R 6 days 0 0 - - - - - stable normal pl.vivax antimalarialsmalaria nil 152 banu priya 20/f R 5 days + - - - - - + stable normal pl.vivax antimalarialsmalaria nil 153 arulselvam 20/f R 12 days ------+ stable normal pl.vivax antimalarialsmalaria nil 154 srinivasan 20/f R 10 days - - + + - + - tachypnea+K29LFT&RFT derangedpl.vivax antimalarialsmalaria nil 155 mouli 20/f R 2 days - - - - + symptomaticsymptomaticsymptomaticsymptomaticpl.vivax antimalarialsmalaria nil 156 sailsa 20/f R 11 days - - 0 0 0 0 0 0 0 pl.vivax antimalarialsmalaria nil 157 saraswathi 20/f U 4 days ------stable thrombocytopeniapl.vivax antimalarialsmalaria nil 158 shanthi 20/f U 5 days - - + + - - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 159 panimala 20/f R 5 days ------+ stable normal pl.vivax antimalarialsmalaria nil 160 rajesh 20/f U 6 days ------stable normal pl.vivax antimalarialsmalaria nil 161 vivegananthan 20/f R 11 days ------stable normal pl.vivax antimalarialsmalaria nil 162 selvam 20/f U 8 days + - - + - - - hypotensionthrombocytopeniapl.vivax antimalarialsmalaria nil 163 manigandan 20/f R 5 days + ------stable normal pl.vivax antimalarialsmalaria nil 164 esther 20/f R 9 days + ------stable normal pl.vivax antimalarialsmalaria nil 165 srinisha 20/f R 10 days + + - - - - + stable normal pl.vivax antimalarialsmalaria nil 166 divyashri 32/f R 2 days + + + - - - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 167 adharsh 32/f U 6 days + + + - - - - stable normal pl.vivax antimalarialsmalaria nil 168 asitha 32/f U 3 days + + - - - - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 169 sakthivel 32/f U 4 days - + - - + - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 170 harish 32/f U 9 days + + - - - - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 171 ayesha 32/f R 11 days + - + - - - + stable normal pl.vivax antimalarialsmalaria nil 172 dinesh 20/f R 4 days ------bradycardia normal pl.vivax antimalarialsmalaria nil 173 vijay 20/f R 7 days - + + + + - - hypotensionLFT&RFT derangedpl.vivax antimalarialsmalaria nil 174 madhesh 20/f R 5 days + + - - - - - stable normal pl.vivax antimalarialsmalaria nil 175 prem kumar 20/f R 3 days + - + - - - - stable normal pl.vivax antimalarialsmalaria nil 176 j+A177:A245othisri 20/f R 8 days 0 0 - - - - - stable normal pl.vivax antimalarialsmalaria nil 177 jaikanth 20/f U 6 days + ------stable normal pl.vivax antimalarialsmalaria nil 178 komathi 20/f U 5 days ------+ stable normal pl.vivax antimalarialsmalaria nil 179 govindamma 20/f U 13 days ------+ stable normal pl.vivax antimalarialsmalaria nil 180 deepa 20/f U 12 days - - + + - + - tachypnea+K29LFT&RFT derangedpl.vivax antimalarialsmalaria nil 181 kavitha 28/f R 11 days - - - - + symptomaticsymptomaticsymptomaticsymptomaticpl.vivax antimalarialsmalaria nil 182 joyesh 28/f R 6 days - - 0 0 0 0 0 0 0 pl.vivax antimalarialsmalaria nil 183 sharmila 20/f R 7 days ------stable thrombocytopeniapl.vivax antimalarialsmalaria nil 184 ramana 20/f R 3 days - - + + - - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 185 munuswamy 30/f R 9 days ------+ stable normal pl.vivax antimalarialsmalaria nil 186 chellamma 30/f U 7 days ------stable normal pl.vivax antimalarialsmalaria nil 187 NAME 30/f R 5 + ------stable normal pl.vivax antimalarialsmalaria nil 188 umashankari 30/f U 5 + - - + - - - hypotensionthrombocytopeniapl.vivax antimalarialsmalaria nil 189 umarani 21/f U 6 + ------stable normal pl.vivax antimalarialsmalaria nil 190 thariammal 24/f U 6 + + - - - - - stable normal pl.vivax antimalarialsmalaria nil 191 thare 24/f R 4 + + - - - - + stable normal pl.vivax antimalarialsmalaria nil 192 swathi 20/f R 4 + + + - - - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 193 swathi 20/f R 7 + + + - - - - stable normal pl.vivax antimalarialsmalaria nil 194 sutharani 20/f U 4 - + - - - - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 195 sutharani 25/f U 8 + + - - + - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 196 sunthi 25/f R 5 + ------stable thrombocytopeniapl.vivax antimalarialsmalaria nil 197 sunganya 25/f R 3 - - + - - - + stable normal pl.vivax antimalarialsmalaria nil 198 sumetha 20/f R 13 - + - - - - - bradycardia normal pl.vivax antimalarialsmalaria nil 199 sumathi 20/f U 7 + + + + + - - hypotensionLFT&RFT derangedpl.vivax antimalarialsmalaria nil 200 sumathi 20/f U 13 + ------stable normal pl.vivax antimalarialsmalaria nil 201 sumathi 29/f R 5 0 0 + - - - - stable normal pl.vivax antimalarialsmalaria nil 202 sukumanri 20/f R 4 + ------stable normal pl.vivax antimalarialsmalaria nil 203 sugunarani 26/f R 6 ------stable normal pl.vivax antimalarialsmalaria nil 204 suguna 26/f U 14 ------+ stable normal pl.vivax antimalarialsmalaria nil 205 suganya 20/f U 4 ------+ stable normal pl.vivax antimalarialsmalaria nil 206 suba 20/f R 3 - - + + - + - tachypnea+K29LFT&RFT derangedpl.vivax antimalarialsmalaria nil 207 suaganya 30/f R 6 - - - - + symptomaticsymptomaticsymptomaticsymptomaticpl.vivax antimalarialsmalaria nil 208 sowmiya 20/f R 5 - - 0 0 0 0 0 0 0 pl.vivax antimalarialsmalaria nil 209 shnmugavalle 20/f U 8 ------stable thrombocytopeniapl.vivax antimalarialsmalaria nil 210 Shanthini 20/f U 5 - - + + - - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 211 selvirani 20/f R 10 ------+ stable normal pl.vivax antimalarialsmalaria nil 212 selvirani 20/f R 6 + ------stable normal pl.vivax antimalarialsmalaria nil 213 sarowja 20/f U 11 + ------stable normal pl.vivax antimalarialsmalaria nil 214 sangeetha 20/f U 12 + - - + - - - hypotensionthrombocytopeniapl.vivax antimalarialsmalaria nil 215 rewathiammal 20/f R 7 + + - - - - - stable normal pl.vivax antimalarialsmalaria nil 216 rewathi 20/f R 7 + + - - - - - stable normal pl.vivax antimalarialsmalaria nil 217 renugampal 25/f U 7 + + - - - - + stable normal pl.vivax antimalarialsmalaria nil 218 renuga 20/f R 8 + + + - - - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 219 rani 20/f U 6 - + + - - - - stable normal pl.vivax antimalarialsmalaria nil 220 Ps Saravanan 20/f R 5 + + - - - - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 221 Ps Saravanan 34/m R 7 + - - - + - - stable thrombocytopeniapl.vivax antimalarialsmalaria nil 222 ms suguna 24/f R 6 ------stable thrombocytopeniaIg M lepto doxycycline LEPTOSPIROSISnil 223 mariammal 20/f R 7 - + + - - - + stable normal Ig M lepto doxycycline LEPTOSPIROSISnil 224 magalakshmi 20/f U 6 + + - - - - - bradycardia normal Ig M lepto doxycycline LEPTOSPIROSISnil 225 lakshmirani 20/f U 8 + - + + + - - hypotensionLFT&RFT derangedIg M lepto doxycycline LEPTOSPIROSISARDS/RESPIRATORY FAILURE 226 kupu 24/f R 5 0 0 - - - - - stable normal Ig M lepto doxycycline LEPTOSPIROSISnil 227 Kumathavali 20/f R 6 + - + - - - - stable normal Ig M lepto doxycycline LEPTOSPIROSISnil 228 koviammal 20/f R 8 ------stable normal Ig M lepto doxycycline LEPTOSPIROSISnil 229 kokeela 35/f U 8 ------stable normal Ig M lepto doxycycline LEPTOSPIROSISnil 230 jothiammal 12/m U 6 ------+ stable normal Ig M lepto doxycycline LEPTOSPIROSISnil 231 jayavani 37/m R 7 ------+ stable normal Ig M lepto doxycycline LEPTOSPIROSISnil 232 jayanthijayashankari 37/m R 7 - - + + - + - tachypnea+K29LFT&RFT derangedIg M lepto doxycycline LEPTOSPIROSISnil 233 januammal 34/m R 8 - - - - + + + Tachypneic MODS Ig M lepto doxycycline LEPTOSPIROSISsepsis/mods/septic shock 234 janthi 34/m R 7 - - 0 0 0 0 0 0 0 Ig M lepto doxycycline LEPTOSPIROSISnil 235 janagi 39/m R 5 ------stable thrombocytopeniaIg M lepto doxycycline LEPTOSPIROSISnil 236 janagi 39/m R 7 - - + + - - - stable thrombocytopeniaIg M lepto doxycycline LEPTOSPIROSISnil 237 jamu 33/m U 8 + - - - - - + stable normal Ig M lepto doxycycline LEPTOSPIROSISnil 238 chinaponu 39/m U 8 + ------stable normal Ig M lepto doxycycline LEPTOSPIROSISnil 239 chetharani 34/m U 9 + ------stable normal Ig M lepto doxycycline LEPTOSPIROSISnil 240 banumathi 34/m U 4 + + - + - - - hypotensionthrombocytopeniaIg M lepto doxycycline LEPTOSPIROSISnil 241 Babyamma 34/m R 11 + + - - - - - stable normal Ig M lepto doxycycline LEPTOSPIROSISnil 242 ammalu 30/m R 13 + + - - - - - stable normal Ig M lepto doxycycline LEPTOSPIROSISnil 243 ammalu 30/m R 12 + + - - - - + stable normal Ig M lepto doxycycline LEPTOSPIROSISnil 244 ambhiga 25/m R 10 - + + - - - - stable thrombocytopeniaIg M lepto doxycycline LEPTOSPIROSISnil 245 manikam 34/m U 6 + + + - - - - stable normal Ig M lepto doxycycline LEPTOSPIROSISnil 246 manivanan 33/m U 6 + ------stable thrombocytopeniaIg M lepto doxycycline LEPTOSPIROSISnil 247 ramamoorthi 33/m U 5 - - - - + - - stable thrombocytopeniaIg M lepto doxycycline SCRUB TYPHUSnil 248 Rajubai 33/m R 7 days - + - - - - - stable thrombocytopeniaIg M lepto doxycycline SCRUB TYPHUSnil 249 sureyaprakesh 34/m R 12 days + + + - - - + stable normal Ig M lepto doxycycline SCRUB TYPHUSnil 250 shanmugavel 30/m R 5 days + ------bradycardia normal Ig M lepto doxycycline SCRUB TYPHUSnil 251 vasudevan 30/m U 8 days 0 0 + + + - - hypotensionLFT&RFT derangedIg M lepto doxycycline SCRUB TYPHUSnil 252 rajalingam 34/m R 9 days + ------stable normal Ig M lepto doxycycline SCRUB TYPHUSnil 253 sengutavan 34/m U 8 days - - + - - - - stable normal Ig M lepto doxycycline SCRUB TYPHUSnil 254 mohan 33/m R 7 days ------stable normal Ig M lepto doxycycline SCRUB TYPHUSnil 255 balaji 33/m U 5 days ------stable normal Ig M lepto doxycycline SCRUB TYPHUSnil 256 AMIT BHUSAHN 34/m R 3 days ------+ stable normal Ig M lepto doxycycline SCRUB TYPHUSnil 257 M Muthu Kumar 34/m U 12 days ------+ stable normal Ig M lepto doxycycline SCRUB TYPHUSnil 258 Ramesh G 34/m R 3 days - - + + - + - tachypnea+K29LFT&RFT derangedIg M lepto doxycycline SCRUB TYPHUSnil 259 John Britto 35/m R 5 days - - - - + + + Tachypneic MODS Ig M lepto doxycycline SCRUB TYPHUSnil 260 Sujitha Prakash 35/m R 6 days - - 0 0 0 0 0 0 0 Ig M lepto doxycycline SCRUB TYPHUSnil 261 Gopala Krishnan 34/m U 10 days ------stable thrombocytopeniaIg M lepto doxycycline SCRUB TYPHUSnil 262 Prasanna V 34/m U 7 days + - + + - - - stable thrombocytopeniaIg M lepto doxycycline SCRUB TYPHUSnil 263 M Rajesh Kumar 34/m U 12 days + - - - - - + stable normal Ig M lepto doxycycline SCRUB TYPHUSnil 264 Prasath M C 37/m R 6 days + ------stable normal Ig M lepto doxycycline SCRUB TYPHUSnil 265 Murugan A 37/m U 4 days + + - - - - - stable normal Ig M lepto doxycycline SCRUB TYPHUSnil 266 Usha 37/m R 2 days + + - + - - - hypotensionthrombocytopeniaIg M lepto doxycycline SCRUB TYPHUSnil 267 Vijaya Kumari 37/m R 6 days + + - - - - - stable normal Ig M lepto doxycycline SCRUB TYPHUSnil 268 G Ramaswamy 34/m R 5 days + + - - - - - stable normal Ig M lepto doxycycline SCRUB TYPHUSnil 269 Chittu Nagarajan 34/m R 5 days - + - - - - + stable normal Ig M lepto doxycycline SCRUB TYPHUSnil 270 Shoaib Yunus 34/m R 5 days + + + - - - - stable thrombocytopeniaIg M lepto doxycycline SCRUB TYPHUSnil 271 UMESH PRANAV 34/m R 7 days + - + - - - - stable normal Ig M lepto doxycycline SCRUB TYPHUSnil 272 Gopalakrishnan 34/m U 2 days ------stable thrombocytopeniaIg M lepto doxycycline SCRUB TYPHUSnil 273 Anbazhagan A 34/m U 0 - + - - + - - stable thrombocytopeniaIg M scrub doxycycline SCRUB TYPHUSnil 274 P Rajendran . 34/m U 4 days + + - - - - - stable thrombocytopeniaIg M scrub doxycycline SCRUB TYPHUSnil 275 Rajendra Paul V 34/m U 4 days + - + - - - + stable normal Ig M scrub doxycycline SCRUB TYPHUSnil 276 Gewinn Management 34/mAnd Co R 4 days 0 0 - - - - - bradycardia normal Ig M scrub doxycycline SCRUB TYPHUSnil 277 Shaick Hyder 34/m R 4 days + - + + + - - hypotensionLFT&RFT derangedIg M scrub doxycycline SCRUB TYPHUSnil 278 Ankit Jain 34/m R 6 days ------stable normal Ig M scrub doxycycline SCRUB TYPHUSnil 279 Jayakodi R 34/m U 10 days - - + - - - - stable normal Ig M scrub doxycycline SCRUB TYPHUSnil 280 S S Hariharan 34/m U 11 days ------stable normal Ig M scrub doxycycline SCRUB TYPHUSnil 281 A Jayaganesh 34/m U 4 days ------stable normal Ig M scrub doxycycline SCRUB TYPHUSnil 282 C Prasad 34/m U 10 days ------+ stable normal Ig M scrub doxycycline SCRUB TYPHUSnil 283 Pattabiraman . 34/m R 3 days ------+ stable normal Ig M scrub doxycycline SCRUB TYPHUSnil 284 Kavitha Sankaran 34/m R 6 days - - + + - + - tachypnea+K29LFT&RFT derangedIg M scrub doxycycline SCRUB TYPHUSnil 285 Udaya Prakash 34/m R 4 days - - - - + + + Tachypneic MODS Ig M scrub doxycycline SCRUB TYPHUSARDS/RESPIRATORY FAILURE 286 Vishal Shah M 34/m R 5 days - - 0 0 0 0 0 0 0 Ig M scrub doxycycline SCRUB TYPHUSnil 287 Vineetha T 34/m R 7 days + ------stable thrombocytopeniaIg M scrub doxycycline SCRUB TYPHUSnil 288 N M Rajendran 34/m U 3 days + - + + - - - stable thrombocytopeniaIg M scrub doxycycline SCRUB TYPHUSnil 289 Maithili Shaan Katari 34/m R 5 days + - - - - - + stable normal Ig M scrub doxycycline SCRUB TYPHUSnil 290 Gopinath G 34/m U 10 days + + - - - - - stable normal Ig M scrub doxycycline SCRUB TYPHUSnil 291 Lakshmi K 34/m R 12 days + + - - - - - stable normal Ig M scrub doxycycline SCRUB TYPHUSnil 292 Krishnamoorthy 34/m U 4 days + + - + - - - hypotensionthrombocytopeniaIg M scrub doxycycline SCRUB TYPHUSnil 293 Jinesh Baid 34/m R 11 days + + - - - - - stable normal Ig M scrub doxycycline SCRUB TYPHUSnil 294 Venkataraaman S 34/m U 7 days - + - - - - - stable normal Ig M scrub doxycycline SCRUB TYPHUSnil 295 MOHMED ISMAYIL N 34/m R 6 days + + - - - - + stable normal Ig M scrub doxycycline SCRUB TYPHUSnil 296 HUMAYUN KABEER A 34/m R 8 days + - + - - - - stable thrombocytopeniaIg M scrub doxycycline SCRUB TYPHUSnil 297 Santha A 34/m R 9 days - - + - - - - stable normal Ig M scrub doxycycline SCRUB TYPHUSnil 298 Raj Inbasegar 34/m R 3 days - + - - - - - stable thrombocytopeniaIg M scrub doxycycline SCRUB TYPHUSnil 299 Ravi Ranganathan . 34/m R 6 days + + - - + - - stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 300 Sree Medi Systems 34/m U 5 days + ------stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 301 Gopinath G 34/m U 12 days 0 0 + - - - + stable normal H1N1 throat tamifluswab H1NIFLU nil 302 V Ravi 34/m U 10 days + ------bradycardia normal H1N1 throat tamifluswab H1NIFLU nil 303 Arun J 34/m U 2 days - - + + + - - hypotensionLFT&RFT derangedH1N1 throat tamifluswab H1NIFLU nil 304 Krishnaswamy Sridharan34/m R 11 days ------stable normal H1N1 throat tamifluswab H1NIFLU nil 305 RAMESH V 34/m U 4 days - - + - - - - stable normal H1N1 throat tamifluswab H1NIFLU nil 306 P S Viswanathan 34/m R 5 days ------stable normal H1N1 throat tamifluswab H1NIFLU nil 307 Pushpa D 34/m R 5 days ------stable normal H1N1 throat tamifluswab H1NIFLU nil 308 Sridhar 34/m R 6 days ------+ stable normal H1N1 throat tamifluswab H1NIFLU nil 309 Anucia 34/m U 11 days ------+ stable normal H1N1 throat tamifluswab H1NIFLU nil 310 Rajesh 34/m U 8 days - - + + - + - tachypnea+K29LFT&RFT derangedH1N1 throat tamifluswab H1NIFLU nil 311 Viswanat 34/m U 5 days - - - - + + + Tachypneic MODS H1N1 throat tamifluswab H1NIFLU nil 312 RAMJI S 26/m R 9 days + - 0 0 0 0 0 0 0 H1N1 throat tamifluswab H1NIFLU nil 313 R Krishnaswamy 34/m U 10 days + ------stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 314 KARTHIK ANNAMALAI34/m R 2 days + - + + - - - stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 315 Prakash Kumar Bohara23/m U 6 days + + - - - - + stable normal H1N1 throat tamifluswab H1NIFLU nil 316 Yasodha C 34/m R 3 days + + - - - - - stable normal H1N1 throat tamifluswab H1NIFLU nil 317 Elangovan P 34/m U 4 days + + - - - - - stable normal H1N1 throat tamifluswab H1NIFLU nil 318 Shreniklal G 34/m R 9 days + + - + - - - hypotensionthrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 319 Ambika Rajendra Prasad34/m U 11 days - + - - - - - stable normal H1N1 throat tamifluswab H1NIFLU nil 320 S V Kumar 34/m R 4 days + + - - - - - stable normal H1N1 throat tamifluswab H1NIFLU nil 321 Srinivasan D . 34/m U 7 days + - - - - - + stable normal H1N1 throat tamifluswab H1NIFLU nil 322 Thomas 34/m R 5 days - - + - - - - stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 323 Thomas 34/m U 3 days - + + - - - - stable normal H1N1 throat tamifluswab H1NIFLU nil 324 S Muthusubramanian34/m R 8 days + + - - - - - stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 325 Jolly 24/m R 6 days + - - - + - - stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 326 Krishna Kumar Rastogi34/m R 5 days 0 0 - - - - - stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 327 RAHAMATHULLA M 28/m R 13 days + - + - - - + stable normal H1N1 throat tamifluswab H1NIFLU nil 328 Sembian 34/m R 12 days ------bradycardia normal H1N1 throat tamifluswab H1NIFLU nil 329 Sairam S 34/m R 11 days - - + + + - - hypotensionLFT&RFT derangedH1N1 throat tamifluswab H1NIFLU nil 330 Kumar G Vinod 20/m R 6 days ------stable normal H1N1 throat tamifluswab H1NIFLU nil 331 Ramesh Subramaniam34/m And Co U 7 days - - + - - - - stable normal H1N1 throat tamifluswab H1NIFLU nil 332 Jaimahaprabhu 34/m U 3 days ------stable normal H1N1 throat tamifluswab H1NIFLU nil 333 Narayanan 34/m U 9 days ------stable normal H1N1 throat tamifluswab H1NIFLU nil 334 Sri Vidhya Sathish 34/m U 7 days ------+ stable normal H1N1 throat tamifluswab H1NIFLU nil 335 Gajendra Kumar Jain 34/m R 9 days ------+ stable normal H1N1 throat tamifluswab H1NIFLU nil 336 Jaya Kumar Siringula 34/m R 4 days - - + + - + - tachypnea+K29LFT&RFT derangedH1N1 throat tamifluswab H1NIFLU nil 337 Kojiro Uchiyama 34/m U 5 days + - - - + + + Tachypneic MODS H1N1 throat tamifluswab H1NIFLU nil 338 SUBRAMANIAN R 34/m U 2 days + - 0 0 0 0 0 0 0 H1N1 throat tamifluswab H1NIFLU nil 339 Chandrakala . 34/m R 11 days + ------stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 340 Maithree Na 34/m R 12 days + + + + - - - stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 341 Riyasudeen A 32/m U 6 days + + - - - - + stable normal H1N1 throat tamifluswab H1NIFLU nil 342 Valkan Engineering Pvt34/m Ltd U 8 days + + - - - - - stable normal H1N1 throat tamifluswab H1NIFLU nil 343 RAHAMATHULLA M 34/m R 10 days + + - - - - - stable normal H1N1 throat tamifluswab H1NIFLU nil 344 Lakshmi Narayanan 34/m R 6 days - + - + - - - hypotensionthrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 345 R D R D R Karthikeyan34/m R 4 days + + - - - - - stable normal H1N1 throat tamifluswab H1NIFLU nil 346 GURUDEV MOTORS PVT34/m LTD R 7 days + ------stable normal H1N1 throat tamifluswab H1NIFLU nil 347 Venkata Subramnian V34/m C R 7 days ------+ stable normal H1N1 throat tamifluswab H1NIFLU nil 348 Sivanantham G 34/m R 12 days - + + - - - - stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 349 Sharmila 34/m R 6 + + + - - - - stable normal H1N1 throat tamifluswab H1NIFLU nil 350 Meiyappan M 34/m R 8 days + ------stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 351 Ks Raj Kumar K 34/m U 9 days 0 0 - - + - - stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 352 Kavitha S Jai Kumar 34/m U 8 days + ------stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 353 Gowrishankar T K 34/m U 7 days - - + - - - + stable normal H1N1 throat tamifluswab H1NIFLU nil 354 Vimal Lunawath L 34/m U 5 days ------bradycardia normal H1N1 throat tamifluswab H1NIFLU ARDS/RESPIRATORY FAILURE 355 Vishwanathan 34/m R 3 days - - + + + - - hypotensionLFT&RFT derangedH1N1 throat tamifluswab H1NIFLU nil 356 Mohamed Zarook 34/m U 12 days ------stable normal H1N1 throat tamifluswab H1NIFLU nil 357 Mukesh Jain 28/m U 3 days - - + - - - - stable normal H1N1 throat tamifluswab H1NIFLU nil 358 Kalyanaraman 34/m R 5 days ------stable normal H1N1 throat tamifluswab H1NIFLU nil 359 Abdulhanzhal 34/m R 6 days ------stable normal H1N1 throat tamifluswab H1NIFLU nil 360 J Kanthilal 34/m R 10 days ------+ stable normal H1N1 throat tamifluswab H1NIFLU nil 361 Rahamathunisha 34/m R 7 days ------+ stable normal H1N1 throat tamifluswab H1NIFLU nil 362 R Hariharan 34/m R 12 days + - + + - + - tachypnea+K29LFT&RFT derangedH1N1 throat tamifluswab H1NIFLU nil 363 MAHALAKSHMI NC 36/m U 6 days + - - - + + + Tachypneic MODS H1N1 throat tamifluswab H1NIFLU ARDS/respiratory failure 364 J Kanthilal 34/m U 4 days + - 0 0 0 0 0 0 0 H1N1 throat tamifluswab H1NIFLU nil 365 Rahamathulla S 34/m R 2 days + + - - - - - stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 366 Abdulhanzhal 39/m U 6 days + + + + - - - stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 367 Badri Narayana 34/m R 5 days + + - - - - + stable normal H1N1 throat tamifluswab H1NIFLU nil 368 Rajabather 34/m U 5 days + + - - - - - stable normal H1N1 throat tamifluswab H1NIFLU nil 369 Sridhar E 34/m U 5 days - + - - - - - stable normal H1N1 throat tamifluswab H1NIFLU nil 370 Balaji Dhanamoorthy 38/m R 7 days + + - + - - - hypotensionthrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 371 Chetty DVM 34/m U 2 days + ------stable normal H1N1 throat tamifluswab H1NIFLU nil 372 A Kumar 34/m R 4 days ------stable normal H1N1 throat tamifluswab H1NIFLU nil 373 RAMJAN BEEVI 34/m U 4 days - + - - - - + stable normal H1N1 throat tamifluswab H1NIFLU nil 374 R Arsha Vidya Mandir34/m R 4 days + + + - - - - stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 375 Lourduraj D 34/m R 4 days + - + - - - - stable normal H1N1 throat tamifluswab H1NIFLU nil 376 Rajesh Jain 34/m R 4 days 0 0 - - - - - stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 377 Kesavan 34/m U 6 days + - - - + - - stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 378 Selvakumar Nagarajan32/mm U 10 days ------stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 379 Aaquiib Syed Amiruddin34/m U 11 days - - + - - - + stable normal H1N1 throat tamifluswab H1NIFLU nil 380 Venkatesh Raman 34/m U 4 days ------bradycardia normal H1N1 throat tamifluswab H1NIFLU nil 381 Suryaparvathavarthini24/m R 10 days - - + + + - - hypotensionLFT&RFT derangedH1N1 throat tamifluswab H1NIFLU nil 382 Satishkumar J 34/m R 3 days ------stable normal H1N1 throat tamifluswab H1NIFLU nil 383 Rajabather 34/m R 6 days - - + - - - - stable normal H1N1 throat tamifluswab H1NIFLU nil 384 Ravi & Ravi 34/m R 4 days ------stable normal H1N1 throat tamifluswab H1NIFLU nil 385 Veeraragavan 34/m R 5 days ------stable normal H1N1 throat tamifluswab H1NIFLU nil 386 Kumathavali 28/m R 7 days ------+ stable normal H1N1 throat tamifluswab H1NIFLU nil 387 Mahaveer M 34/m R 3 days + - - - - - + stable normal H1N1 throat tamifluswab H1NIFLU nil 388 S Venkatesan 34/m U 5 days + - + + - + - tachypnea+K29LFT&RFT derangedH1N1 throat tamifluswab H1NIFLU nil 389 Shanthini 25/m U 10 days + - - - + + + Tachypneic MODS H1N1 throat tamifluswab H1NIFLU nil 390 K Deena Dayalan 25/m U 12 days + + 0 0 0 0 0 0 0 H1N1 throat tamifluswab H1NIFLU nil 391 K Deena Dayalan 34/m U 4 days + + - - - - - stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 392 Lalitha Raghavan 34/m R 11 days + + + + - - - stable thrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 393 Muthuramalingam R 34/m R 7 days + + - - - - + stable normal H1N1 throat tamifluswab H1NIFLU nil 394 Narasimhan V 34/m R 6 days - + - - - - - stable normal H1N1 throat tamifluswab H1NIFLU nil 395 N Vijay 34/m R 8 days + + - - - - - stable normal H1N1 throat tamifluswab H1NIFLU nil 396 N Vijay 34/m R 9 days + - - + - - - hypotensionthrombocytopeniaH1N1 throat tamifluswab H1NIFLU nil 397 K Radhakrishnan 34/m U 3 days ------stable normal H1N1 throat tamifluswab H1NIFLU nil 398 Anish Fathima 32/m U 6 days - + - - - - - stable normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 399 Radhakrishnan 34/m U 5 days + + - - - - + stable normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 400 SARASUMANI 22/m U 12 days + - + - - - - stable thrombocytopeniaIg M lepto ceftriaxone LEPTOSPIROSISnil 401 Amit Shukla 34/m R 10 days 0 0 + - - - - stable normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 402 Mohan Raj 34/m U 2 days + ------stable thrombocytopeniaIg M lepto ceftriaxone LEPTOSPIROSISnil 403 Senthil Kumar 24/m U 11 days - - - - + - - stable thrombocytopeniaIg M lepto ceftriaxone LEPTOSPIROSISnil 404 Niveditha Arhun 34/m U 4 days ------stable thrombocytopeniaIg M lepto ceftriaxone LEPTOSPIROSISnil 405 Anish Fathima 34/m R 5 days - - + - - - + stable normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 406 Senthil Kumar 23/m U 5 days ------bradycardia normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 407 P Sindhu U 34/m R 6 days - - + + + - - hypotensionLFT&RFT derangedIg M lepto ceftriaxone LEPTOSPIROSISMODS/SEPSIS/ASPIARTION pneumonia 408 P Sindhu U 32/m R 11 days ------stable normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 409 Shahul Hameed S 34/m R 8 days - - + - - - - stable normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 410 Ramasubramaniam 27/m R 5 days ------stable normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 411 K V Narasimhan 34/m R 9 days ------stable normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 412 V Kesavan 34/m R 10 days + - - - - - + stable normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 413 SaiPriya Guhan 34/m U 2 days + - - - - - + stable normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 414 Sg Kothandaraman 29/m U 6 days + - + + - + - tachypnea+K29LFT&RFT derangedIg M lepto ceftriaxone LEPTOSPIROSISnil 415 Ranganathan G 34/m R 3 days + + - - + + + Tachypneic MODS Ig M lepto ceftriaxone LEPTOSPIROSISacute fulminant hepatic failure/viral hepatis 416 V C Usha 34/m R 4 days + + 0 0 0 0 0 0 0 Ig M lepto ceftriaxone LEPTOSPIROSISnil 417 Mariyappan K 34/m R 9 days + + - - - - - stable thrombocytopeniaIg M lepto ceftriaxone LEPTOSPIROSISnil 418 Subash B 34/m R 11 days + + + + - - - stable thrombocytopeniaIg M lepto ceftriaxone LEPTOSPIROSISnil 419 K V Narasimhan 34/m U 4 days - + - - - - + stable normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 420 V Kesavan 34/m U 7 days + + - - - - - stable normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 421 Rajalakshmi K 34/m R 5 days + ------stable normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 422 G Seshadri 34/m R 3 days - - - + - - - hypotensionthrombocytopeniaIg M lepto ceftriaxone LEPTOSPIROSISnil 423 Shahul Hameed S 34/m R 8 days - + - - - - - stable normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 424 V C Usha 34/m U 6 days + + - - - - - stable normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 425 Subash B 34/m U 5 days + - - - - - + stable normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 426 Ganapathy V 34/m U 13 days 0 0 + - - - - stable thrombocytopeniaIg M lepto ceftriaxone LEPTOSPIROSISnil 427 V Karthikeyan 34/m R 12 days + - + - - - - stable normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 428 Prabu Bulgaanin 34/m R 11 days ------stable thrombocytopeniaIg M lepto ceftriaxone LEPTOSPIROSISnil 429 Ramesh G 34/m R 6 days - - - - + - - stable thrombocytopeniaIg M lepto ceftriaxone LEPTOSPIROSISnil 430 Murugan A 32/m R 7 days ------stable thrombocytopeniaIg M lepto ceftriaxone LEPTOSPIROSISnil 431 P S Viswanathan 34/m R 3 days - - + - - - + stable normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 432 Vijaya Kumari 34/m U 9 days ------bradycardia normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 433 M Rajesh Kumar 34/m R 7 days - - + + + - - hypotensionLFT&RFT derangedIg M lepto ceftriaxone LEPTOSPIROSISnil 434 Gopala Krishnan 34/m R 5 ------stable normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 435 AMIT BHUSAHN 34/m U 5 - - + - - - - stable normal Ig M lepto ceftriaxone LEPTOSPIROSISnil 436 G Ramaswamy 34/m U 6 ------stable normal WIDAL ceftriaxone ENTERIC FEVERnil 437 Ganesh 36/m U 6 + ------stable normal WIDAL ceftriaxone ENTERIC FEVERnil 438 RAMESH V 34/m U 4 + - - - - - + stable normal WIDAL ceftriaxone ENTERIC FEVERnil 439 RAMJI S 34/m R 4 + - - - - - + stable normal WIDAL ceftriaxone ENTERIC FEVERnil 440 Sujitha Prakash 33/m R 7 + + + + - + - tachypnea+K29LFT&RFT derangedWIDAL ceftriaxone ENTERIC FEVERnil 441 V Ravi 34/m R 4 + + - - + + + Tachypneic MODS WIDAL ceftriaxone ENTERIC FEVERnil 442 Vineetha T 34/m R 8 + + 0 0 0 0 0 0 0 WIDAL ceftriaxone ENTERIC FEVERnil 443 John Britto 34/m R 5 + + - - - - - stable thrombocytopeniaWIDAL ceftriaxone ENTERIC FEVERnil 444 S Muthusubramanian34/m R 3 - + + + - - - stable thrombocytopeniaWIDAL ceftriaxone ENTERIC FEVERnil 445 P Lisha 32/m R 13 + + - - - - + stable normal WIDAL ceftriaxone ENTERIC FEVERnil 446 Prasath M C 34/m U 7 + ------stable normal WIDAL ceftriaxone ENTERIC FEVERnil 447 Usha 26/m U 13 ------stable normal WIDAL ceftriaxone ENTERIC FEVERnil 448 M Muthu Kumar 34/m U 5 - + - + - - - hypotensionthrombocytopeniaWIDAL ceftriaxone ENTERIC FEVERnil 449 Raj Inbasegar 26/m R 4 + + - - - - - stable normal WIDAL ceftriaxone ENTERIC FEVERnil 450 Pattabiraman . 26/m U 6 + ------stable normal WIDAL ceftriaxone ENTERIC FEVERnil 451 Sharmila 26/m R 14 0 0 - - - - + stable normal WIDAL ceftriaxone ENTERIC FEVERnil 452 Ambika Rajendra Prasad26/m U 4 + - + - - - - stable thrombocytopeniaWIDAL ceftriaxone ENTERIC FEVERnil 453 S S Hariharan 34/m R 3 - - + - - - - stable normal WIDAL ceftriaxone ENTERIC FEVERnil 454 Arun J 34/m R 6 ------stable thrombocytopeniaWIDAL ceftriaxone ENTERIC FEVERnil 455 Elangovan P 25/m U 5 - - - - + - - stable thrombocytopeniaWIDAL ceftriaxone ENTERIC FEVERnil 456 Jayakodi R 22m U 8 ------stable thrombocytopeniaWIDAL ceftriaxone ENTERIC FEVERnil 457 Maha Lingan . 25/m U 5 - - + - - - + stable normal WIDAL ceftriaxone ENTERIC FEVERnil 458 Jinesh Baid 25/m U 10 ------bradycardia normal WIDAL ceftriaxone ENTERIC FEVERnil 459 Karthikeyan M 25/m R 6 - - + + + - - hypotensionLFT&RFT derangedWIDAL ceftriaxone ENTERIC FEVERnil 460 Gopalakrishnan 25/m R 11 ------stable normal WIDAL ceftriaxone ENTERIC FEVERnil 461 Chittu Nagarajan 34/m R 12 - - + - - - - stable normal WIDAL ceftriaxone ENTERIC FEVERnil 462 Sree Medi Systems 60/m R 7 + ------stable normal WIDAL ceftriaxone ENTERIC FEVERnil 463 Pushpa D 65/m R 7 + ------stable normal WIDAL ceftriaxone ENTERIC FEVERnil 464 P Rajendran . 65/m R 7 + - - - - - + stable normal WIDAL ceftriaxone ENTERIC FEVERnil 465 Ravi Ranganathan . 65/m U 8 + + - - - - + stable normal WIDAL ceftriaxone ENTERIC FEVERnil 466 Shaick Hyder 61/m R 6 + + + + - + - tachypnea+K29LFT&RFT derangedblood c/s ceftriaxone ENTERIC FEVERnil 467 Kavitha Sankaran 66/m R 5 + + - - + + + Tachypneic MODS blood c/s ceftriaxone ENTERIC FEVERnil 468 MOHMED ISMAYIL N 68/m R 7 + + - 0 0 0 - - eosinopenia blood c/s ceftriaxone ENTERIC FEVERnil 469 Lakshmi K 63/m R 6 - + - - - - - stable thrombocytopeniablood c/s ceftriaxone ENTERIC FEVERnil 470 Anucia 60/m R 7 + + + + - - - stable thrombocytopeniablood c/s ceftriaxone ENTERIC FEVERnil 471 G L Baskaran 60/m U 6 + - - - - - + stable normal blood c/s ceftriaxone ENTERIC FEVERnil 472 Venkataraaman S 66/m R 8 ------stable normal blood c/s ceftriaxone ENTERIC FEVERnil 473 C Prasad 60/m R 5 - + - - - - - stable normal blood c/s ceftriaxone ENTERIC FEVERnil 474 Ganesan A 68/m U 6 + + - + - - - hypotensionthrombocytopeniablood c/s ceftriaxone ENTERIC FEVERnil 475 Krishnamoorthy 70/m U 8 + ------stable normal blood c/s ceftriaxone ENTERIC FEVERnil 476 Krishna Kumar Rastogi72/m U 8 0 0 - - - - - stable normal blood c/s ceftriaxone ENTERIC FEVERnil 477 Rajesh 67/m R 6 + - - - - - + stable normal blood c/s ceftriaxone ENTERIC FEVERnil 478 Prakash Kumar Bohara68/m U 7 - - + - - - - stable thrombocytopeniablood c/s ceftriaxone ENTERIC FEVERnil 479 Shreniklal G 60/m R 7 - - + - - - - stable normal negative symptomaticUUF nil 480 Udaya Prakash 60/m U 8 ------stable thrombocytopenianegative symptomaticUUF nil 481 Ramesh Subramaniam66/m And Co U 7 - - - - + - - stable thrombocytopenianegative symptomaticUUF nil 482 Gewinn Management 69/mAnd Co R 5 ------stable thrombocytopenianegative symptomaticUUF nil 483 Krishnaswamy Sridharan60/m R 7 - - + - - - + stable normal negative symptomaticUUF nil 484 Santha A 60/m R 8 ------bradycardia normal negative symptomaticUUF nil 485 Sridhar 60/m R 8 - - + + + - - hypotensionLFT&RFT derangednegative symptomaticUUF nil 486 Viswanat 63/m R 9 ------stable normal negative symptomaticUUF nil 487 Vishal Shah M 62/m R 4 + - + - - - - stable normal negative symptomaticUUF nil 488 R Krishnaswamy 60/m R 11 + ------stable normal negative symptomaticUUF nil 489 Yasodha C 67/m R 13 + ------stable normal negative symptomaticUUF nil 490 UMESH PRANAV 67/m U 12 + + - - - - + stable normal negative symptomaticUUF nil 491 KARTHIK ANNAMALAI68/m U 10 + + - - - - + stable normal negative symptomaticUUF nil 492 Prasanna V 60/m U 6 + + + + - + - tachypnea+K29LFT&RFT derangednegative symptomaticUUF nil 493 A Jayaganesh 60/m U 6 + + - - + + + Tachypneic MODS negative symptomaticUUF nil 494 Valkan Engineering Pvt60/m Ltd U 5 - + - 0 0 0 - - eosinopenia negative symptomaticUUF nil 495 Lalitha Raghavan 69/m R 7 days + + - - - - - stable thrombocytopenianegative symptomaticUUF nil 496 Chandrakala . 60/m R 12 days + - + + - - - stable thrombocytopenianegative symptomaticUUF nil 497 S Ragavendran 60/m R 5 days ------+ stable normal negative symptomaticUUF nil 498 Thomas 60/m R 8 days - + - - - - - stable normal negative symptomaticUUF nil 499 Srinivasan D . 60/m U 9 days + + - - - - - stable normal negative symptomaticUUF nil 500 Rajendra Paul V 60/m R 8 days + - - + - - - hypotensionthrombocytopenianegative symptomaticUUF nil 501 Venkataraman 60/m U 7 days 0 0 - - - - - stable normal negative symptomaticUUF nil 502 Karthikeyan M 65/m U 5 days + ------stable normal negative symptomaticUUF nil 503 Jaimahaprabhu 60/m U 3 days ------+ stable normal negative symptomaticUUF nil 504 Ranganathan G 60/m R 12 days - - + - - - - stable thrombocytopenianegative symptomaticUUF nil 505 Kumar G Vinod 66/m R 3 days - - + - - - - stable normal negative symptomaticUUF nil 506 Riyasudeen A 60/m R 5 days ------stable thrombocytopenianegative symptomaticUUF nil 507 Jaya Kumar Siringula 60/m R 6 days - - - - + - - stable thrombocytopenianegative symptomaticUUF nil 508 Sembian 69/m R 10 days ------stable thrombocytopenianegative symptomaticUUF nil 509 Mukesh Jain 60/m U 7 days - - + - - - + stable normal negative symptomaticUUF nil 510 Narayanan 65/m R 12 days ------bradycardia normal negative symptomaticUUF nil 511 S Venkatesan 60/m U 6 days - - + + + - - hypotensionLFT&RFT derangednegative symptomaticUUF acute meningoencephalitis 512 P Lisha 60/m R 4 days + ------stable normal negative symptomaticUUF nil 513 Suryaparvathavarthini64/m U 2 days + - + - - - - stable normal negative symptomaticUUF nil 514 Karthikeyan 60/m U 6 days + ------stable normal negative symptomaticUUF nil 515 Radhakrishnan 65/m U 5 days + + - - - - - stable normal negative symptomaticUUF nil 516 Kalyanaraman 60/m U 5 days + + - - - - + stable normal negative symptomaticUUF nil 517 G L Baskaran 60/m R 5 days + + - - - - + stable normal negative symptomaticUUF nil 518 Lakshmi Narayanan 65/m R 7 days + + + + - + - tachypnea+K29LFT&RFT derangednegative symptomaticUUF nil 519 S Ragavendran 60/m R 2 days - + - - + + + Tachypneic MODS negative symptomaticUUF nil 520 Raj Inbasegar 61/m R 0 + + - 0 0 0 - - eosinopenia negative symptomaticUUF nil 521 Shanthini 60/m U 4 days + ------stable thrombocytopenianegative symptomaticUUF nil 522 Sri Vidhya Sathish 60/m R 4 days - - + + - - - stable thrombocytopenianegative symptomaticUUF nil 523 GURUDEV MOTORS PVT61/m LTD R 4 days - + - - - - + stable normal negative symptomaticUUF nil 524 Kesavan 60/m R 4 days + + - - - - - stable normal negative symptomaticUUF nil 525 Venkata Subramnian V60/m C R 6 days + ------stable normal negative symptomaticUUF nil 526 Ravi & Ravi 62/m R 10 days 0 0 - + - - - hypotensionthrombocytopenianegative symptomaticUUF nil 527 R D R D R Karthikeyan60/m R 11 days + ------stable normal negative symptomaticUUF nil 528 SARASUMANI 60/m U 4 days ------stable normal negative symptomaticUUF nil 529 Kojiro Uchiyama 60/m U 10 days ------+ stable normal negative symptomaticUUF nil 530 K Radhakrishnan 64/m U 3 days - - + - - - - stable thrombocytopenianegative symptomaticUUF nil 531 Muthuramalingam R 60/m R 6 days - - + - - - - stable normal negative symptomaticUUF nil 532 N M Rajendran 65/m R 4 days ------stable thrombocytopenianegative symptomaticUUF nil 533 Veeraragavan 60/m U 5 days - - - - + - - stable thrombocytopenianegative symptomaticUUF nil 534 Narasimhan V 67/m U 7 days ------stable thrombocytopenianegative symptomaticUUF nil 535 Prabu Bulgaanin 60/m R 3 days - - + - - - + stable normal negative symptomaticUUF nil 536 Sridhar E 66/m R 5 days ------bradycardia normal negative symptomaticUUF nil 537 Ganapathy V 60/m R 10 days + - + + + - - hypotensionLFT&RFT derangednegative symptomaticUUF nil 538 Ramasubramaniam 61/m R 12 days + ------stable normal negative symptomaticUUF nil 539 Ganesh 64/m U 4 days + - 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- - stable thrombocytopenianegative symptomaticUUF nil 575 Ks Raj Kumar K 62/m U 12 days + - - - - + stable normal negative symptomaticUUF nil 576 Sathish S 60/m U 11 days 0 0 - - - - - stable normal negative symptomaticUUF nil 577 Ankit Jain 63/m U 6 days + ------stable normal negative symptomaticUUF nil 578 Vimal Lunawath L 64/m U 7 days - - - + - - - hypotensionthrombocytopenianegative symptomaticUUF nil 579 Rahamathulla S 60/m U 3 days ------stable normal negative symptomaticUUF nil 580 Mariyappan K 64/m R 9 days ------stable normal negative symptomaticUUF nil 581 J Kanthilal 67/m R 7 days ------+ stable normal negative symptomaticUUF nil 582 Ps Saravanan 60/m R 9 days - - + - - - - stable thrombocytopenianegative symptomaticUUF nil 583 R Arsha Vidya Mandir63/m U 4 days - - + - - - - stable normal negative symptomaticUUF nil 584 Ps Saravanan 62/m R 5 days ------stable thrombocytopenianegative symptomaticUUF nil 585 Sairam S 67/m R 2 days - - - - + - - stable thrombocytopenianegative symptomaticUUF nil 586 Balaji Dhanamoorthy 60/m R 11 days ------stable thrombocytopenianegative symptomaticUUF nil 587 Gajendra Kumar Jain 70/m U 12 days + - + - - - + stable normal negative symptomaticUUF nil 588 RAMJAN BEEVI 61/m R 6 days + ------bradycardia normal negative symptomaticUUF nil 589 V Karthikeyan 45/f R 8 days + - + + + - - hypotensionLFT&RFT derangednegative symptomaticUUF nil 590 Meiyappan M 45/f R 10 days + + - - - - - stable normal negative symptomaticUUF nil 591 Mohamed Zarook 45/f U 6 days + + + - - - - stable normal negative symptomaticUUF nil 592 Jolly 48/f U 4 days + + - - - - - stable normal negative symptomaticUUF nil 593 Thomas 45/f U 7 days + + - - - - - stable normal negative symptomaticUUF nil 594 Kavitha S Jai Kumar 47/f U 7 days - + - - - - + stable normal negative symptomaticUUF nil 595 Anbazhagan A 45/f R 12 days + + - - - - + stable normal negative symptomaticUUF nil 596 kavitharani 46/f U 6 + - + + - + - tachypnea+K29LFT&RFT derangednegative symptomaticUUF nil 597 sumathi 45/f R 8 days - - - - + + + Tachypneic MODS negative symptomaticUUF nil 598 revathi 47/f R 9 days - + - 0 0 0 - - eosinopenia negative symptomaticUUF nil 599 ramiya 45/f R 8 days + + - - - - - stable thrombocytopenianegative symptomaticUUF nil 600 Radika 56/f R 7 days + + + + - - - stable thrombocytopenianegative symptomaticUUF nil 601 Rajalakshmi K 45/f R 5 days 0 0 - - - - + stable normal negative symptomaticUUF nil 602 lakshmi 55/f R 3 days + ------stable normal negative symptomaticUUF nil 603 Kuttiammal 45/f R 12 days ------stable normal negative symptomaticUUF nil 604 sumathi 45/f U 3 days - - - + - - - hypotensionthrombocytopenianegative symptomaticUUF nil 605 Sangeetha 45/f U 5 days ------stable normal negative symptomaticUUF nil 606 sangave 45/f U 6 days ------stable normal negative symptomaticUUF nil 607 Renuga 45/f R 10 days ------+ stable normal negative symptomaticUUF nil 608 veeraammal 45/f U 7 days - - + - - - - stable thrombocytopenianegative symptomaticUUF nil 609 vijashanthi 45/f R 12 days - - + - - - - stable normal negative symptomaticUUF nil 610 lakshmiammal 45/f R 6 days ------stable thrombocytopenianegative symptomaticUUF nil 611 ambhiga 45/f R 4 days - - - - + - - stable thrombocytopenianegative symptomaticUUF nil 612 ammalu 45/f R 2 days + ------stable thrombocytopenianegative symptomaticUUF nil 613 ammalu 46/f R 6 days + - + - - - + stable normal negative symptomaticUUF nil 614 Babyamma 47/f R 5 days + ------bradycardia normal negative symptomaticUUF nil 615 banumathi 48/f R 5 days + + + + + - - hypotensionLFT&RFT derangednegative symptomaticUUF nil 616 chetharani 45/f U 5 days + + - - - - - stable normal negative symptomaticUUF nil 617 chinaponu 50/f R 7 days + + + - - - - stable normal negative symptomaticUUF nil 618 jamu 45/f U 2 days + + - - - - - stable normal negative symptomaticUUF nil 619 janagi 51/f U 4 days - + - - - - - stable normal negative symptomaticUUF nil 620 janagi 45/f U 4 days + + - - - - + stable normal negative symptomaticUUF nil 621 janthi 54/f U 4 days + - - - - - + stable normal negative symptomaticUUF nil 622 januammal 45/f U 4 days - - + + - + - tachypnea+K29LFT&RFT derangednegative symptomaticUUF nil 623 jayanthijayashankari 52/f R 4 days - + - - + + + Tachypneic MODS negative symptomaticUUF nil 624 jayavani 45/f R 6 days + + - 0 0 0 - - eosinopenia negative symptomaticUUF nil 625 jothiammal 55/f R 10 days + ------stable thrombocytopenianegative symptomaticUUF nil 626 kokeela 45/f U 11 days 0 0 + + - - - stable thrombocytopenianegative symptomaticUUF nil 627 koviammal 51/f R 4 days + - - - - - + stable normal negative symptomaticUUF nil 628 Kumathavali 45/f R 10 days ------stable normal negative symptomaticUUF nil 629 kupu 55/f R 3 days ------stable normal negative symptomaticUUF nil 630 lakshmirani 45/f R 6 days - - - + - - - hypotensionthrombocytopenianegative symptomaticUUF nil 631 magalakshmi 45/f R 4 days ------stable normal negative symptomaticUUF nil 632 mariammal 45/f R 5 days ------stable normal negative symptomaticUUF nil 633 ms suguna 45/f U 7 days ------+ stable normal Ig M denguesymptomaticdengue fevernil 634 Ps Saravanan 45/f U 3 days - - + - - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 635 Ps Saravanan 45/f U 5 days - - + - - - - stable normal Ig M denguesymptomaticdengue fevernil 636 rani 45/f U 10 days ------stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 637 renuga 56/f R 12 days + - - - + - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 638 renugampal 58/f R 4 days + ------stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 639 rewathi 45/f R 11 days + - + - - - + stable normal Ig M denguesymptomaticdengue fevernil 640 rewathiammal 56/f R 7 days + + - - - - - bradycardia normal Ig M denguesymptomaticdengue fevernil 641 sangeetha 45/f R 6 days + + + + + - - hypotensionLFT&RFT derangedIg M denguesymptomaticdengue feversepsis/septic shock 642 sarowja 55/f R 8 days + + - - - - - stable normal Ig M denguesymptomaticdengue fevernil 643 selvirani 45/f R 9 days + + + - - - - stable normal Ig M denguesymptomaticdengue fevernil 644 selvirani 45/f R 3 days - + - - - - - stable normal Ig M denguesymptomaticdengue fevernil 645 Shanthini 50/f U 6 days + + - - - - - stable normal Ig M denguesymptomaticdengue fevernil 646 shnmugavalle 45/f U 5 days + - - - - - + stable normal Ig M denguesymptomaticdengue fevernil 647 sowmiya 52/f U 12 days ------+ stable normal Ig M denguesymptomaticdengue fevernil 648 suaganya 45/f U 10 days - + + + - + - tachypnea+K29LFT&RFT derangedIg M denguesymptomaticdengue fevernil 649 suba 45/f U 2 days + + - - + + + Tachypneic MODS Ig M denguesymptomaticdengue fevernil 650 suganya 47/f R 11 days + + - 0 0 0 - - eosinopenia Ig M denguesymptomaticdengue fevernil 651 suguna 45/f R 4 days 0 0 - - - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 652 sugunarani 45/f R 5 days + - + + - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 653 sukumanri 48/f R 5 days ------+ stable normal Ig M denguesymptomaticdengue fevernil 654 sumathi 45/f R 6 days ------stable normal Ig M denguesymptomaticdengue fevernil 655 sumathi 45/f U 11 days ------stable normal Ig M denguesymptomaticdengue fevernil 656 sumathi 52/f U 8 days - - - + - - - hypotensionthrombocytopeniaIg M denguesymptomaticdengue fevernil 657 sumetha 51/f U 5 days ------stable normal Ig M denguesymptomaticdengue fevernil 658 sunganya 59/f R 9 days ------stable normal Ig M denguesymptomaticdengue fevernil 659 sunthi 45/f R 10 days ------+ stable normal Ig M denguesymptomaticdengue fevernil 660 sutharani 59/f R 2 days - - + - - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 661 sutharani 54/f U 6 days - - + - - - - stable normal Ig M denguesymptomaticdengue fevernil 662 swathi 51/f U 3 days + ------stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 663 swathi 52/f R 4 days + - - - + - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 664 thare 50/f R 9 days + ------stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 665 thariammal 45/f R 11 days + + + - - - + stable normal Ig M denguesymptomaticdengue fevernil 666 umarani 57/f U 4 days + + - - - - - bradycardia normal Ig M denguesymptomaticdengue fevernil 667 umashankari 45/f U 7 days + + + + + - - hypotensionLFT&RFT derangedIg M denguesymptomaticdengue fevernil 668 kannagi 45/f R 5 days + + - - - - - stable normal Ig M denguesymptomaticdengue fevernil 669 seetha 55/f R 3 days - + + - - - - stable normal Ig M denguesymptomaticdengue fevernil 670 faheema 45/f R 8 days + + - - - - - stable normal Ig M denguesymptomaticdengue fevernil 671 zara 55/f U 6 days + ------stable normal Ig M denguesymptomaticdengue fevernil 672 zahara 45/f U 5 days ------+ stable normal Ig M denguesymptomaticdengue fevernil 673 shajitha 46/f R 13 days - + - - - - + stable normal Ig M denguesymptomaticdengue fevernil 674 shamseeya 45/f R 12 days + + + + - + - tachypnea+K29LFT&RFT derangedIg M denguesymptomaticdengue fevernil 675 vinitha 49/f U 11 days + - - - + + + Tachypneic MODS Ig M denguesymptomaticdengue fevernil 676 vimala 45/f U 6 days 0 0 - 0 0 0 - - eosinopenia Ig M denguesymptomaticdengue fevernil 677 vijaya 44/f R 7 days + ------stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 678 seema 45/f R 3 days - - + + - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 679 monika 42/f U 9 days ------+ stable normal Ig M denguesymptomaticdengue fevernil 680 monisha 45/f U 7 days ------stable normal Ig M denguesymptomaticdengue fevernil 681 deepika 41/f R 5 ------stable normal Ig M denguesymptomaticdengue fevernil 682 deepa 45/f R 5 - - - + - - - hypotensionthrombocytopeniaIg M denguesymptomaticdengue fevernil 683 usha 53/f R 6 ------stable normal Ig M denguesymptomaticdengue fevernil 684 uma 45/f R 6 ------stable normal Ig M denguesymptomaticdengue fevernil 685 usha 45/f R 4 ------+ stable normal Ig M denguesymptomaticdengue fevernil 686 asha 50/f R 4 - - + - - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 687 preethi 45/f R 7 + - + - - - - stable normal Ig M denguesymptomaticdengue fevernil 688 kannatha 457/f U 4 + ------stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 689 ponnamma 45/f R 8 + - - - + - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 690 solimmal 46/f U 5 + + - - - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 691 parvathy 45/f U 3 + + + - - - + stable normal Ig M denguesymptomaticdengue fevernil 692 prema 53/f U 13 + + - - - - - bradycardia normal Ig M denguesymptomaticdengue fevernil 693 kanimozhi 46/f R 7 + + + + + - - hypotensionLFT&RFT derangedIg M denguesymptomaticdengue fevernil 694 thenmozhi 50/f R 13 - + - - - - - stable normal Ig M denguesymptomaticdengue fevernil 695 regina 45/f R 5 + + + - - - - stable normal Ig M denguesymptomaticdengue fevernil 696 thara 15/f R 4 + ------stable normal Ig M denguesymptomaticdengue fevernil 697 kamini 13/f R 6 ------stable normal Ig M denguesymptomaticdengue fevernil 698 yamini 14/f R 14 - + - - - - + stable normal Ig M denguesymptomaticdengue fevernil 699 yasodha 15/f U 4 + + - - - - + stable normal Ig M denguesymptomaticdengue fevernil 700 sharmila 16/f U 3 + + + + - + - tachypnea+K29LFT&RFT derangedIg M denguesymptomaticdengue fevernil 701 shamili 15/f U 6 0 + - - + + + Tachypneic MODS Ig M denguesymptomaticdengue fevernil 702 Shanthini 15/f U 5 + - - 0 0 0 - - eosinopenia Ig M denguesymptomaticdengue fevernil 703 santhi 18/f R 8 ------stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 704 shenbha 15/f R 5 - - + + - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 705 sheema 15/f R 10 ------+ stable normal Ig M denguesymptomaticdengue fevernil 706 uma 15/f R 6 ------stable normal Ig M denguesymptomaticdengue fevernil 707 maheswari 13/f U 11 ------stable normal Ig M denguesymptomaticdengue fevernil 708 subha 15/f U 12 - - - + - - - hypotensionthrombocytopeniaIg M denguesymptomaticdengue feverMASSIVE ICH 709 su;ochana 15/f R 7 ------stable normal Ig M denguesymptomaticdengue fevernil 710 sugumaari 17/f R 7 ------stable normal Ig M denguesymptomaticdengue fevernil 711 inbhavalli 15/f R 7 ------+ stable normal Ig M denguesymptomaticdengue fevernil 712 snehavalli 18/f U 8 + - + - - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 713 babitha 15/f U 6 + - + - - - - stable normal Ig M denguesymptomaticdengue fevernil 714 angel 15/f U 5 + ------stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 715 diana 15/f R 7 + + - - + - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 716 fathima 15/f R 6 + + - - - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 717 suveetha 15/f R 7 + + + - - - + stable normal Ig M denguesymptomaticdengue fevernil 718 sangeetha 15/f R 6 + + - - - - - bradycardia normal Ig M denguesymptomaticdengue fevernil 719 jacqueline 15/f R 8 - + + + + - - hypotensionLFT&RFT derangedIg M denguesymptomaticdengue fevernil 720 jenifer 15/f R 5 + + - - - - - stable normal Ig M denguesymptomaticdengue fevernil 721 shobana 19/f U 6 + - + - - - - stable normal Ig M denguesymptomaticdengue fevernil 722 shanthi 15/f U 8 ------stable normal Ig M denguesymptomaticdengue fevernil 723 snanmugapriya 15/f U 8 - + - - - - - stable normal Ig M denguesymptomaticdengue fevernil 724 seethammal 15/f U 6 + + - - - - + stable normal Ig M denguesymptomaticdengue fevernil 725 chengam 15/f R 7 + _ - - - - + stable normal Ig M denguesymptomaticdengue fevernil 726 thangamani 15/f R 7 0 + + + - + - tachypnea+K29LFT&RFT derangedIg M denguesymptomaticdengue fevernil 727 vairam 15/f R 8 + - - - + + + Tachypneic MODS Ig M denguesymptomaticdengue fevernil 728 saroja 15/f R 7 - - - 0 0 0 - - eosinopenia Ig M denguesymptomaticdengue fevernil 729 savithri 15/f R 5 ------stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 730 keerthi 15/f R 7 - - + + - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 731 preethi 15/f R 8 ------+ stable normal Ig M denguesymptomaticdengue feverhypovolaemic shock 732 shivi 15/f U 8 ------stable normal Ig M denguesymptomaticdengue fevernil 733 suganya 15/f U 9 ------stable normal Ig M denguesymptomaticdengue fevernil 734 viji 15/f U 4 - - - + - - - hypotensionthrombocytopeniaIg M denguesymptomaticdengue fevernil 735 vijaya 15/f U 11 ------stable normal Ig M denguesymptomaticdengue fevernil 736 vedha 15/f U 13 ------stable normal Ig M denguesymptomaticdengue fevernil 737 sathya 15/f R 12 + - - - - - + stable normal Ig M denguesymptomaticdengue fevernil 738 satmeera 15/f R 10 + - + - - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 739 sanchana 15/f R 6 + - + - - - - stable normal Ig M denguesymptomaticdengue fevernil 740 shakeela 15/f R 6 + + - - - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 741 manju 15/f R 5 + + - - + - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 742 mahima 15/f R 7 days + + - - - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 743 karuthamma 15/f R 12 days + + + - - - + stable normal Ig M denguesymptomaticdengue fevernil 744 azhagi 15/f R 5 days - + - - - - - bradycardia normal Ig M denguesymptomaticdengue fevernil 745 abitha 15/f R 8 days + + + + + - - hypotensionLFT&RFT derangedIg M denguesymptomaticdengue fevernil 746 indhmathy 15/f R 9 days + ------stable normal Ig M denguesymptomaticdengue fevernil 747 uma 15/f R 8 days - - + - - - - stable normal Ig M denguesymptomaticdengue fevernil 748 yoganavalli 15/f U 7 days - + - - - - - stable normal Ig M denguesymptomaticdengue fevernil 749 sivayogana 15/f U 5 days + + - - - - - stable normal Ig M denguesymptomaticdengue fevernil 750 mohanavalli 15/f U 3 days + - - - - - + stable normal Ig M denguesymptomaticdengue fevernil 751 yatra 15/f U 12 days 0 + - - - - + stable normal Ig M denguesymptomaticdengue fevernil 752 tazhini 15/f U 3 days + - + + - + - tachypnea+K29LFT&RFT derangedIg M denguesymptomaticdengue fevernil 753 hasini 15/f R 5 days - - - - + + + Tachypneic MODS Ig M denguesymptomaticdengue fevernil 754 yazhibi 15/f U 6 days - - - 0 0 0 - - eosinopenia Ig M denguesymptomaticdengue fevernil 755 yogeshwari 15/f R 10 days ------stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 756 rajeshwari 15/f R 7 days - - + + - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 757 geetha 15/f R 12 days ------+ stable normal Ig M denguesymptomaticdengue fevernil 758 kalpana 15/f R 6 days ------stable normal Ig M denguesymptomaticdengue fevernil 759 hema 15/f R 4 days ------stable normal Ig M denguesymptomaticdengue fevernil 760 vanaja 15/f R 2 days - - - + - - - hypotensionthrombocytopeniaIg M denguesymptomaticdengue fevernil 761 girija 15/f R 6 days ------stable normal Ig M denguesymptomaticdengue fevernil 762 sivaranjini 15/f R 5 days + ------stable normal Ig M denguesymptomaticdengue fevernil 763 muthumani 14/f U 5 days + - - - - - + stable normal Ig M denguesymptomaticdengue fevernil 764 jagedheeswari 15/f U 5 days + - + - - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 765 jameela 15/f U 7 days + + + - - - - stable normal Ig M denguesymptomaticdengue fevernil 766 suveetha begum 15/f U 2 days + + - - - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 767 saveetha 18/f R 0 + + - - + - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 768 swetha 15/f R 4 days + + - - - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 769 swathy 15/f U 4 days - + + - - - + stable normal Ig M denguesymptomaticdengue fevernil 770 sandhiya 15/f R 4 days + + - - - - - bradycardia normal Ig M denguesymptomaticdengue fevernil 771 dulasi 18/f U 4 days + - + + + - - hypotensionLFT&RFT derangedIg M denguesymptomaticdengue fevernil 772 vidhya 15/f U 6 days ------stable normal Ig M denguesymptomaticdengue fevernil 773 vindhiya 15/f R 10 days - + + - - - - stable normal Ig M denguesymptomaticdengue fevernil 774 vijitha 15/f U 11 days + + - - - - - stable normal Ig M denguesymptomaticdengue fevernil 775 veerammal 16/f U 4 days + + - - - - - stable normal Ig M denguesymptomaticdengue fevernil 776 muthumalar 15/f U 10 days 0 + - - - - + stable normal Ig M denguesymptomaticdengue fevernil 777 thamizh 15/f R 3 days + - - - - - + stable normal Ig M denguesymptomaticdengue fevernil 778 kuzhali 12/f R 6 days - - + + - + - tachypnea+K29LFT&RFT derangedIg M denguesymptomaticdengue fevernil 779 samanthi 15/f R 4 days - - - - + + + Tachypneic MODS Ig M denguesymptomaticdengue fevernil 780 mullai 15/f R 5 days - - - 0 0 0 - - eosinopenia Ig M denguesymptomaticdengue fevernil 781 malli 13/f R 7 days ------stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 782 valli 15/f U 3 days - - + + - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 783 vanitha 15/f U 5 days ------+ stable normal Ig M denguesymptomaticdengue fevernil 784 muthazhagi 15/f R 10 days ------stable normal Ig M denguesymptomaticdengue fevernil 785 oorvasi 16/f R 12 days ------stable normal Ig M denguesymptomaticdengue fevernil 786 nirmala 15/f R 4 days - - - + - - - hypotensionthrombocytopeniaIg M denguesymptomaticdengue fevernil 787 poovammal 15/f R 11 days + ------stable normal Ig M denguesymptomaticdengue fevernil 788 dholly 15/f R 7 days + ------stable normal Ig M denguesymptomaticdengue fevernil 789 lalitha 19/f U 6 days + - - - - - + stable normal Ig M denguesymptomaticdengue fevernil 790 padmini 15/f U 8 days + + + - - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 791 fathima 15/f U 9 days + + + - - - - stable normal Ig M denguesymptomaticdengue fevernil 792 faheema 15/f U 3 days + + - - - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 793 joshva 13/f R 6 days + + - - + - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 794 mirunalini 15/f U 5 days - + - - - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 795 jeshima 14/f R 12 days + + + - - - + stable normal Ig M denguesymptomaticdengue fevernil 796 srividya 15/f U 10 days + ------bradycardia normal Ig M denguesymptomaticdengue fevernil 797 MUTHURAMALINGAM15/f S U 2 days - - + + + - - hypotensionLFT&RFT derangedIg M denguesymptomaticdengue fevernil 798 Gmcks Light Workers 34/m R 11 days - + - - - - - stable normal Ig M denguesymptomaticdengue fevernil 799 NAGARJUN GANESH 34/m R 4 days + + + - - - - stable normal Ig M denguesymptomaticdengue fevernil 800 Santhosh S 34/m R 5 days + + - - - - - stable normal Ig M denguesymptomaticdengue fevernil 801 Rathna Cools Pvt Ltd 34/m R 5 days 0 + - - - - - stable normal Ig M denguesymptomaticdengue fevernil 802 Jayanthi 34/m R 6 days + - - - - - + stable normal Ig M denguesymptomaticdengue fevernil 803 Mathimaaran T 34/m U 11 days ------+ stable normal Ig M denguesymptomaticdengue fevernil 804 B SRIRAM 38/m R 8 days - - + + - + - tachypnea+K29LFT&RFT derangedIg M denguesymptomaticdengue fevernil 805 Kalpesh Davey 34/m U 5 days - - - - + + + Tachypneic MODS Ig M denguesymptomaticdengue fevernil 806 Madhavan 34/m U 9 days - - - 0 0 0 - - eosinopenia Ig M denguesymptomaticdengue fevernil 807 V Ananta Mouli 34/m R 10 days ------stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 808 R Ramesh 34/m R 2 days - - + + - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 809 Sridhar M 34/m R 6 days ------+ stable normal Ig M denguesymptomaticdengue fevernil 810 CP ARUNKUMAR 39/m R 3 days ------stable normal Ig M denguesymptomaticdengue fevernil 811 Kirupakaran E 34/m U 4 days ------stable normal Ig M denguesymptomaticdengue fevernil 812 Nisma Hashim 34/m R 9 days + - - + - - - hypotensionthrombocytopeniaIg M denguesymptomaticdengue fevernil 813 Sasikala Saravanan 34/m R 11 days + ------stable normal Ig M denguesymptomaticdengue fevernil 814 SRIDHAR S 37/m U 4 days + ------stable normal Ig M denguesymptomaticdengue fevernil 815 D Ramani 34/m R 7 days + + - - - - + stable normal Ig M denguesymptomaticdengue fevernil 816 Vinay Vincent 34/m U 5 days + + + - - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 817 Gokulakrishnan Siva 34/m R 3 days + + + - - - - stable normal Ig M denguesymptomaticdengue fevernil 818 Hariharan 32/m R 8 days + + - - - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 819 N Vijay 34/m U 6 days - + - - + - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 820 Ravi & Ravi 34/m U 5 days + + - - - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 821 Priya Enterprises 37/m R 13 days + - + - - - + stable normal Ig M denguesymptomaticdengue fevernil 822 K S Guruvayurappan 34/m U 12 days ------bradycardia normal Ig M denguesymptomaticdengue fevernil 823 Niangsommang 34/m U 11 days - + + + + - - hypotensionLFT&RFT derangedIg M denguesymptomaticdengue fevernil 824 MP Loan Factiry 34/m R 6 days + + - - - - - stable normal Ig M denguesymptomaticdengue fevernil 825 Varalakshmi . 34/m U 7 days + - + - - - - stable normal Ig M denguesymptomaticdengue fevernil 826 Palaniappan L 37/m U 3 days 0 + - - - - - stable normal Ig M denguesymptomaticdengue fevernil 827 Yuvaraj R 34/m U 9 days + ------stable normal Ig M denguesymptomaticdengue fevernil 828 S Krishnamachari . 39/m R 7 days ------+ stable normal Ig M denguesymptomaticdengue fevernil 829 Akbaralil Sahul Hameed34/m R 9 days ------+ stable normal Ig M denguesymptomaticdengue fevernil 830 D S Geethanjali 34/m U 4 days - - + + - + - tachypnea+K29LFT&RFT derangedIg M denguesymptomaticdengue fevernil 831 Tharachand 34/m R 5 days - - - - + + + Tachypneic MODS Ig M denguesymptomaticdengue fevernil 832 M R Rajan 34/m R 2 days - - - 0 0 0 - - eosinopenia Ig M denguesymptomaticdengue fevernil 833 Jayadurai Da 36/m U 11 days ------stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 834 K S Guruvayurappan 34/m R 12 days - - + + - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 835 Manickam 26/m U 6 days ------+ stable normal Ig M denguesymptomaticdengue fevernil 836 Ashish Kumar Surana 34/m U 8 days ------stable normal Ig M denguesymptomaticdengue fevernil 837 Giridhar Gopal C J 32/m R 10 days + ------stable normal Ig M denguesymptomaticdengue fevernil 838 Mohan Gandhi V 34/m R 6 days + - - + - - - hypotensionthrombocytopeniaIg M denguesymptomaticdengue fevernil 839 India Factoring And Finan34/m SolutionR Pvt4 daysLtd + ------stable normal Ig M denguesymptomaticdengue fevernil 840 Rajendran BG 34/m R 7 days + + - - - - - stable normal Ig M denguesymptomaticdengue fevernil 841 Venkatachalam Veerappan38m R 7 days + + - - - - + stable normal Ig M denguesymptomaticdengue fevernil 842 J Karthik 34/m R 12 days + + + - - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 843 M Parvezkhan 34/m R 6 + + + - - - - stable normal Ig M denguesymptomaticdengue fevernil 844 Dheerandra D 34/m R 8 days - + - - - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 845 Janakiraman 34/m R 9 days + + - - + - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 846 Murudeshwar Ceramics28/m Ltd R 8 days + ------stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 847 ASHWIN T T 34/m R 7 days - - + - - - + stable normal Ig M denguesymptomaticdengue fevernil 848 Sagubar Sathik S 39/m U 5 days - 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0 0 0 - - eosinopenia Ig M denguesymptomaticdengue fevernil 859 Vijayaprabha Ramanujam31/m U 2 days ------stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 860 Prasanna 34/m U 6 days - - + + - - - stable thrombocytopeniaIg M denguesymptomaticdengue fevernil 861 Raja Gopal 34/m R 5 days ------+ stable normal Ig M denguesymptomaticdengue fevernil 862 C Alagappan 38/m U 5 days + ------stable normal negative symptomaticUUF nil 863 Shyam Sundar T 31/m U 5 days + ------stable normal negative symptomaticUUF nil 864 R Sampath 34/m U 7 days + - - + - - - hypotensionthrombocytopenianegative symptomaticUUF nil 865 Arunagiri 34/m R 2 days + + - - - - - stable normal negative symptomaticUUF nil 866 Arul Prakash C 34/m U 4 days + + - - - - - stable normal negative symptomaticUUF nil 867 Harikumar 34/m U 4 days + + - - - - + stable normal negative symptomaticUUF nil 868 Vidyasagar . 34/m U 4 days + + + - - - - stable thrombocytopenianegative symptomaticUUF nil 869 Mohan G 34/m R 4 days - + + - 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R 10 days + - + + + - - hypotensionLFT&RFT derangednegative symptomaticUUF nil 876 BALACHANDER G 33/m R 3 days 0 + - - - - - stable normal negative symptomaticUUF nil 877 Apparao Sharan 34/m U 6 days + - + - - - - stable normal negative symptomaticUUF nil 878 AbSolute Barbeque Private34/m LimitedU 4 days ------stable normal negative symptomaticUUF nil 879 RAVI KATARI 34/m R 5 days ------stable normal negative symptomaticUUF nil 880 P Mailavelan 84/m U 7 days ------+ stable normal negative symptomaticUUF nil 881 Ayyappan 34/m R 3 days ------+ stable normal negative symptomaticUUF nil 882 Reliance Corporate It Park34/m Ltd U 5 days - - + + - + - tachypnea+K29LFT&RFT derangednegative symptomaticUUF nil 883 PRABHU GEORGE G 37/m U 10 days - - - - + + + Tachypneic MODS negative symptomaticUUF nil 884 Reliance Corporate It Park34/m Ltd R 12 days - - - 0 0 0 - - eosinopenia negative symptomaticUUF HYPOVOLAEIC SHOCK 885 Jagan V 34/m R 4 days ------stable thrombocytopenianegative symptomaticUUF nil 886 P N Subramaniam 34/m R 11 days - 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