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OP Kapoor

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

In the history taking of a patient, a complaint of malaise means:-

1. Not feeling well

2. Feeling tired and fatigued

3. Bodyache

4. Feverishness

5. Poor appetite

6. Lethargy

7. Generalised weakness

8. No energy to go to work.

All such symptoms of malaise are very important to differentiate in making the diagnosis of the following three conditions:-

1.To differentiate allergic rhinitis from a common viral cold : A patient of allergic rhinitis is often seen having heavy sneezing and severe nasal watery discharge, while the patient having common cold will have, in addition, symptoms of malaise as described above, which take about a week to subside.

2.Temporal arteritis presenting as headache in an elderly person is often diagnosed by presence of malaise, which is of few days or weeks duration (this is reflected in the blood test showing very high ESR). Presence of malaise will avoid the mistaken diagnosis of tension headache or headache due to hypertension etc.

3.Finally, in viral hepatitis, before the jaundice appears, the patient has symptoms of malaise which last for nearly a week or more and the diagnosis should be thought of, specially if loss of appetite and nausea are out of proportion and the patientís urine has become dark coloured.

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