Jeerna Jwara


Presenting Complaints with severity and episode duration

1. Recurrent onset of fever/ rise in body temperature since 2 years
2. Easy fatigability, Angamarda (Myalgia) since 2 years
3. Kshavathu, Kasa with thick white Kapha Sthivana since 2 years

All these complaints are more during evening hours. On and off nature of the presenting complaints every 3 to 4 days, has made the patient consult.

Poorva Vyadhi Vrittanta :
H/O being underwent septoplasty for Deviated Nasal Septum

Treatment History:
Patient had taken allopathic medications for the same for a period of one week before one month. Patient has stopped as he did not observed considerable improvement.

Allergies: Dust and Pollen

Clinical Status


Allopathy Ayurveda
Vital Parameters

  • BP - 130/80mm Hg
  • Pulse - 78/min
  • Weight -75.8kgs
  • BMI - 27.86
  • WHR - >0.9
  • Temp - 1000F
Asta Sthana Pariksha

  • Nadi - P3 V3K1
  • Malam - 2 to 3 times/day, Incomplete completion/ Asamhata varchas
  • Mutra - 4 to 6/0 times/D/N
  • Jihva - Alpa liptata
  • Shabda - Prakrutha
  • Sparsha - Prakrutha
  • Drik - Prakrutha
  • Akruti - Sthoola
Examinations

  • GC - fair
  • CVS
  • CNS
  • PA

RS - URT: Bilateral Hypertrophid nasal turbinates. Congested Hyperaemic posterior pharyngeal wall.

LRT: Lung fields: clear

No crepitus/ronchi.

NVBS heard.

Dasa Vidha Pariksha

  1. Prakriti - Kapha Pitta
  2. Vikriti – Pitta Vata
  3. Sara – Madhyama
  4. Samhanana - Madhyama
  5. Pramana - Pravara
  6. Satmya - Madhyama
  7. Satva - Madhyama
  8. Aharashakti – Manda agni
  9. Vyayam Shakti - Madhyama
  10. Vaya - Madhyama
  11. Desha - Sadharana
  12. Kala – Sharad
Rogi Bala - Madhyama
Roga Bala - Madhyama
DSQ findings Rating
1. ADRS low
2. ADSS Med
NidanaPanchaka
  • Nidana -Srama, Alpagni
  • Purvaroopa - Angamarda, Klama
  • Roopa -Jwara, Kshawatu, Kasa, Kapha stewana- more during Vata Pitta Kala i.e 5 to 8 pm
  • Updrava:NIL
  • Arishta Lakshana:NIL
  • Samprapti:
    • Dosha: Vata Pitta
    • Dushya: Rasa , Rakta
    • Agni - Jataragnimandya
    • Ama - Tatjanya
    • Srotas - Rasavaha, Rakta vaha
    • Sroto Dushti Prakara - Sanga, Vimarga gamana

Differential Diagnosis with reasoning


1. Pulmonary TB:
Classical prevention is fever, haemoptysis, cough, weight loss and night sweats. Positive CXR and sputum for AFB

2. HIV related
Presents with fever, weight loss, sweats, lymphadenopathy or with opportunistic infection
Hx recurrent infection and oral thrush
History of Sexual contacts, Birthplace, Exposure events, occupation
O/E Full exam- enlarged Lymph nodes and spleen
Ix: HIV antibody test and HIV viral load, CD4 count

3. Autoimmune disorders
History of joint pain, rash and photosensitivity

4. Malignancy:
Leukaemia/Lymphoma
History of fever, sweats, weight loss, fatigue
O/E- Lymph nodes enlarged, Hepatosplenomegaly
Investigations: Bone Marrow aspirate, blood smear, Complete Blood Count

5 Infectious mononucleosis Diagnosis
Mononucleosis is characterized by fever, sore throat, fatigue, malaise, and loss of appetite. Sore throat is the first indication of sickness and in
some it is the only major symptom throughout the entire illness
Patients generally have swelling of the lymph nodes in the neck and often have an enlarged spleen is not present in this case.

Differential Diagnosis with reasoning


  • Jeerna jwara
  • Visama jwara
  • Punaravartaka jwara
  • Nirama jwara

Lab Tests:
13/07/2014

  • HBsAg – Negative
  • Anti HCV - Negative
  • TSH - 3.51U/IU/ml
  • EBV IgG – POSITIVE
  • EBV IgM- NEGATIVE.
  • FBS-95 mg/dl
  • Total bilirubin- 0.37mg/dl.
  • Direct bilirubin-0.05mg/dl
  • Indirect bilirubin-0.32mg/dl
  • Total protein-7.6 gm/dl.
  • Albumin-4.4 gm/dl
  • Globulin-3.2gm/dl
  • AG ration-1.4
  • SGOT-24 U/LT
  • SGPT-39U/LT
  • GGT-54U/LT.
  • AKP-80U/LT.
Evidence Based Diagnosis:
Infectious Mononucleosis
Presence of changes in EBV IgG – POSITIVE
EBV IgM - NEGATIVE suggest the disease is
Infective mononucleosis

Evidence Based Diagnosis: Jeerna Jwara

Chikitsa:
ChikitsaVivechana:
  • Agnideepana
  • Strotovishodhana
  • Ojovardhaka
Medication given:

1. Guduchi Ghana Vati - 2-0-2( BEFORE FOOD)
2. Chyavanaprasha Avaleha - 1 tsp at bed time.
3. Bhadradarvyadi Kashayam - 10ml twice daily with half cup of warm water before food.
4. Vaishwanara Choorna 15gms + Kamadudha Rasa 2.5gms + Shringa Bhasma 5gms + Karpooradi Choorna 15gms - ¼ tsp with honey three times a day before food
5. Gorochanadi Vati1-1-1
6. Anu Taila Pratimarsha- 4 drops to each nostrils in the early morning
7. Dashamoola Katutrayadi Kashayam- 10ml twice daily with ½ cup of warm water.
Integrated View: Infectious Mononucleosis can be understood and managed as Jeerna Jwara in Ayurveda. As the Dosas get Leena (get deep seated), the Jwara disappears for the time. So there is a chance of relapse. Hence Agni has to be constantly monitored and maintained with medications.
# Outcome Parameters / / Date-Time N 1st review 2nd Review Last Review
19/11/14 29/11/2014 9/12/2014 24/1/2015
1 Sleep (Nidra) Samyak Samyak Samyak Samyak
2 Appetite (Agni) Manda Able to digest light food Timely hunger Sama
3 Bowels (Mala) Samhata Samhata Samhata Samhata
4 Urination (Mutra) Samyak Samyak Samyak Samyak
5 Ability to cope Stress (Manas) 2/5 3/5 3/5 4/5
6 BP mm of Hg 130/80 120/80 120/80 110/80
7 Pulse 78/min 74/min 76/min 72/min
8 Weight, Kg 75.8 75.8 76 76
9 Diet (Ahara) Fair Fair Fair Fair
10 Exercise (Vyayama) Walking Walking Walking Walking
11 Lifestyle (Vihara) Fair Fair Fair Fair

Ayurveda has been able to manage effectively the condition of Infectious Mononucleiosis - Jeerna Jwara by addressing the root cause – Agni and Srotas with classical medications. This is evident by the fact that patient is not having a relapse of fever in last 4 months.


Disclaimer: * Outcomes may vary from person to person