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O P Kapoor

Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.

I have a formula to diagnose severe falciparum malaria in private practice. When the patient comes with high fever, the GP diagnoses malaria. Clinical examination and routine blood count shows presence of mild anaemia (which is abnormal specially in a male patient) and leucopenia.

After the anti-malarial therapeutic test, if the high fever continues and patient also develops constant headache, cough or diarrhoea, after 4-5 days their family physicians pronounce the diagnosis, i.e. "now his malaria has become typhoid" and start Ciprofloxacin.

After another 3-4 days, the patient continues to have fever and becomes more ill and weak. He cannot eat because of anorexia, nausea or vomiting and now he develops jaundice, which may be spotted even by the relatives, from the high coloured urine and yellow eyes. They might have already done the blood tests to show that the enzymes and bilirubin are high.

This is the stage when the "bad" family physician will make a diagnosis - "typhoid has now become viral hepatitis"! A good GP will now say - ‘Oh! I am sorry. This is a rare case of fulminant falciparum malaria’. He will inject IV Chloroquine very slowly in a dose of 10 mg/kg and advise that the patient be shifted to an Intensive Care Unit in a five star hospital since the patient can develop multi organ ‘failure’ complications which cannot be handled in private practice, Cardiac failure, Hypoglycaemic cerebral encephalopathy and septicaemic shock, etc.

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