Diagnosis

• Family contact

• Immunization status

• Travel history

• Nutrition (including consumption of dairy products)

• Drug history (over-the-counter medication, prescription medications, illicit substances)

• Animal contacts (including possible exposure to ticks and other vectors)

• Chemical contacts

• Previous history of surgery

• Psychiatric problems

• Symptoms from all major systems: general complaint, weight loss, night sweats, headaches, rashes etc.

• Documentation of fever and exclusion of factitious fever (may be ≤10% of cases)

• Look for signs usually accompanying fever (e.g. tachycardia and chills)

• Physical examination should be repeated daily while the patient is in hospital

• Particularly watch for:

  • Rash
  • Lymph node enlargement
  • Signs of arthritis
  • New/changing cardiac murmurs
  • Abdominal tenderness or rigidity
  • Fundoscopic changes and neurological deficits

Preliminary investigations:

• FBC and differential count

• ESR and CRP

• Malaria blood films (if travel history)

• Widal test

• Urinalysis and culture

• Blood culture

• Chest X-Ray

• Mantoux test

• USG (abdomen)

Specific investigations:

• ASO titre

• Hepatitis serology

• HIV

• VDRL/TPHA

• Viral screen - CMV, EBV

• LDH

• ANA

• RA factor

• CPK

Invasive investigations:

• CT/MRI (chest and abdomen)

• Echocardiogram

• Bone marrow aspirate

• Tissue/liver/lymph node biopsy

• Lumbar puncture

• Nuclear medicine - bone scan