Jeerna Jwara

Vital Parameters
BP – 130/80 mm 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
Hypertrophied nasal turbinates.
Congested Hyperaemic posterior pharyngeal wall.
LRT: Lung fields: clear
No crepitus/ronchi.
NVBS heard.

Dasa Vidha Pariksha
Prakriti - Kapha Pitta
Vikriti – Pitta Vata
Sara – Madhyama
Samhanana - Madhyama
Pramana - Pravara
Satmya - Madhyama
Satva - Madhyama
Aharashakti – Manda agni
Vyayam Shakti - Madhyama
Vaya - Madhyama
Desha - Sadharana
Kala – Sharad

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- 0.37 mg/dl.
Direct bilirubin-0.05 mg/dl
Indirect bilirubin-0.32 mg/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:

Chikitsa Vivechana:
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 nostril in the early morning
7. Dashamoola Katutrayadi Kashayam- 10ml twice daily with ½ cup of warm water.