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Question
4.5yrs young girl of 16 kgs came from shcool & develop 103 Temp with chills & typical febrile convulsion. no any abnormal physical analysis.all blood investiation suggest tc 9500;p73;l23;e 01;m 01;plat 210000 crp 6.2; MP-neg. CXR-prominant broncho-vasculor markings,widal-normal. pt. hospitalized & emperically started with ceftriaxone & artemether! & fewere came down to 100 with in 2 days but again on day 4 she got 103 tem. the repeat investigations were done for MP was normal with Hb 12.1,TC 4700;P42 L 56 E 01 M 01,ESR 15, CRP 9.9, & Urine- Normal.clinically pt occasionaly complians of pain in abdomin orelse inbetween fever pt is plyful but has loss of appetite & diet;does not appear very sick. kindly suggest possible diagnosis & managment/investigation (can it be Leptospira?) ?
Answer
Since CRP and counts are normal, it is unlikely to be a bacterial infection. Since it is first episode of febrile convulsion, one needs to rule out meningitis and Lumbar puncture would be advised.
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