RajivGandhiUniversity of Helth Sciences

Bangalore, Karnataka.

SYNOPSIS OF DISSERTATION

1. / Name of Candidate and Address / Dr. G.NAZEER AHMED
P.G in General Medicine
Department of Medicine
KIMSHospital
Bangalore
2 / Name of the Institution / KEMPEGOWDA INSTITUTE OF MEDICAL SCIENCES AND RESEARCH CENTERE, BANGALORE – 560 070
3 / Course of the Study & Subject /
M.D. IN GENERAL MEDICINE
4 / Date of Admission to Course / 13th June 2008
5 /

Title of the Topic

/ Clinical study of fever with thrombocytopenia with special reference to infective etiology

6. Brief Resume of intended work

6.1 Need for the study:

In recent days fever with thrombocytopenia is common clinical presentation in the medical wards.

Established infective causes like Dengue is well known for fever with thrombocytopenia1. There are not many studies elucidating other infections for thrombocytopenia. Only few studies are available for Enteric fever and Malaria.

This study has been undertaken to know the modes of clinical presentations and possible causes of fever with thrombocytopenia where in cause of infection could be established like dengue,enteric fever,malaria,leptospria,hepatitis B, and HIV infection.There may be other infective causes wherein the etiology cannot be pointed out because of lack of facilities or unaffordability.

This study might help us to correlate the clinical features and laboratory findings to come to conclusion regarding the possible infective causes for thrombocytopenia and thus diagnosis and management.

6.2 Review of literature

P.S Nair conducted study of fever with thrombocytopenia and concluded that septicemia was the commonest cause.2

A study conducted by Md Ayule et al showed that the commonest presentation was fever (100%) followed by headache (48%) myalgia (66%) and vomiting.3

Septicemia resulting from gram negative and gram positive organisms is the commonest cause of thrombocytopenia.1, 4

Causes of fever and thrombocytopenia includes viral, bacterial and protozoal.1, 4

Dengue infection in humans causes a spectrum of illness ranging from inapparent to severe and fatal Dengue haemorrhagic disease.5

In HIV+ patients, the 1-year prevalence of thrombocytopenia was 8.7% in persons with one or more AIDS-defining opportunistic illnesses(clinical AIDS), 3.1% in patients with a CD4 count <200 cells/mm3 but not clinical AIDS(immunologic AIDS), and 1.7% in persons without clinical or immunologic AIDS.6

The observations of SCOTT et al suggested that while patients with malaria may be predisposed to the development of thrombocytopenia, a reduced platelet count in some patients may also be due in part to pseudo-thrombocytopenia.7

6.3 Aims and Objectives :

1.To elucidate possible infective etiology for fever with thrombocytopenia.

2.To correlate clinical features, laboratory studies and infective etiology

7. Materials and Methods :

7.1 Source of data:

All the adult patients with fever with Thrombocytopenia admitted to KIMS hospital and

Research center from December 2008 toSeptember 2010.

7.2 Method of collection of data:

The data for this study will be collected by patient evaluation which will be done by detailed history taking, Clinical examination,and relevant investigations using a proforma specially designed for this study.

Sample size :100 cases

Study design :Prospective clinical study

Sample design : Purposive sampling

Study duration :December 2008 to September 2010.

Inclusion criteria:

All the adult patients with fever and thrombocytopenia of infective etiology.

Exclusion criteria:

Patients with fever with thrombocytopenia other than infective etiology like ITP,drug induced thrombocytopenia, HELLP Syndrome, myeloproliferative diseases,DIC of noninfective etiology(Abruptio placenta , Snake bite) are excluded from the study.

7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals ? If so, please describe briefly.

No animal studies required. All investigation to be done are routine investigation

The study requires the following investigations

Complete haemogram,

Peripheral blood picture

Platelet count,

urine rountine,

Liver function test,

Blood urea,

Serum creatinine,

Chest x-ray,

Ultrasound,

ECG,

Dengue antibodies,

QBC for MP,

HBsAg ,

Leptospira antibodies,

Widal test,

Blood culture,

HIV antibodies,

Bone Marrow.(if needed)

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes

8. List of references

  1. Firkin, Chesterman,Penangton Rush, Haemorrhagic disorders.capillary and platelet defects.In:Degruchi’s Clinical Haematology in Medical Practice,5 Ed:Oxford Blackwell Science,1989:360.
  1. Nair P S, Jain P,Khanduri U, Kumar.V, A study of fever associated thrombocytopenia, J of Asso of Physicians of India.2006;51:1173
  1. Md Ayule et al, Characteristics of Dengue fever in a large public hospital,Jeddah, Saudi Arabia,J of Ayub Med Coll Abott,2006;18(2).
  1. Risdall RJ, Bruning RD, Hermandez JL, Gordan DH, Bacterial associated haemophagocytic syndrome.Cancer.1984 Dec 15;54(12).
  1. Gubler DJ,Dengue and Dengue Haemorrhagic fever, Clin Mic Biol Rev.1998;113;480-96.
  1. Sullivan, Patrick S.; Hanson, Debra L.; Chu, Susan Y.; Jones, Jeffrey L.; Ciesielski, Carol A, Surveillance for Thrombocytopenia in Persons Infected With HIV: Results From the Multistate Adult and Adolescent Spectrum of Disease Project,J Acqu Immu Def Synd and Human Retrovirology,1997;14(4):374-9
  1. SCOTT et al, Thrombocytopenia in patients with malaria: automated analysis of optical platelet counts and platelet clumps with the Cell Dyn CD4000 analyser,Clinical and Lab Haematology,2002;24(5):295-302

9.Signature of the Candidate

______

10.Remarks of the Guide

The prevalence of fever with thrombocytopenia is increasing in its occurrence. Awareness of its infective cause is needed for timely diagnosis and management. Hence the study is undertaken.

______

11.Name & Designation of

11.1Guide Dr. SHIVALINGAIAH

M.D,

Professor of Medicine,

Department of Medicine,

KIMS, Bangalore.

11.2Signature

11.5Head of the Department Dr. M.V POORNACHANDRA Professor & Head of

Department of Medicine

KIMS, Bangalore.

11.6Signature

______

12.12.1Remarks of Chairman and Principal

12.2Signature.