1. HOMOEOPATHIC APPROACH TO ERUPTIVE FEVERS

2. A four year old female child came with complaints of fever with vesicular eruptions all over the body since 1 day with severe burning pains on slightest touch. CASE 1

3. Complaints started with throat pains since 3 days. A/F oily food. 2 days later started with fever which was high grade with chilliness. Since 1 day vesicular eruptions started on face and now spread to trunk back and upper extremity. Burning pains < 3 slightest touch > 2 draft of air Itching minimal. Has become cranky and weepy due to pain. Appetite decreased. Thirst – increased sips of water frequently. EVOLUTION

4. General Examination: Temp :- 101 O F Pulse :- 110/min Chest :- Clear CVS:- S1, S2 normal. Throat- Congested Local Examination:- Vesicular discrete eruptions on back,face and upper extremity. EXAMINATION FINDINGS

6. 1.Placebo 2.Orientation of mother regarding diagnosis. ACTION:-

7. FOLLOW UP IN 2 DAYS:- Weepiness SQ. Appetite- Decreased Thirst – Desire to drink but refuses to drink due to throat pain, takes only sips of water. Fever – Same,high grade. Vesicle – Now spread to legs. Eruptions increasing in size having a bluish hue. Burning pains increased- Fear of being touched 3+

8. EXAMINATION FINDINGS:- Temp:- 102 o F Pulse:- 130/min Throat :- Pus pockets bilateral Tongue :- Coated Skin :- Bluish vesicular eruptions +

9. TOTALITY:- Irritability fever during Irritability pain during Fear of being touched 3+ Thirst :small quantities often Burning pains < touch 3+ > draft of air 2+ Throat pain < swallowing. Eruptions – bluish vesicle.

11. ACTION ARS ALB 200 1P STAT

12. FOLLOW UP AFTER 2 DAYS ACTIVE,PLAYFUL NO FEVER NO THROAT PAIN NO BURNING PAIN SKIN- LARGE ERUPTIONS STILL NOT DRIED ACTION- ARS ALB 200 1P STAT

13. FOLLOW UP AFTER 6 DAYS SKIN LESSIONS HEALED NO OTHER COMPLAINTS ACTION- Placebo Later on follow up with constitutional remedy- NATRUM MUR 200 1P

14. 1 year old child comes with high grade fever with cough since 10 days. Case 2

15. Chief Complaint Location SensationModalityConcomitant Respiratory system Sing 10 days Coryza watery Cough wet Rattling, ends in vomiting Vomitus Sticky A/F: ? < Night 2 Irritability 2 Desire to be carried on shoulder Activity  2 Thirst  2 Lachrymation Since 7 days High grade fever < night Not > allopathic Medicine 25-2-06

16. Child moaning continuously Crying on being examined Temp: 103 o F Weight9 kg RR60/min Tg:Thick white coated RS:Crepitations ++ bilateral P/ALiver 1 finger palpablespleen Not palpable CVSS1 S2NAD Skin Mild Maculopapular rash on chest. EXAMINATION FINDINGS

18. INVESTIGATION on 25-2-06 Hb9.9 TC8400 N59 L37 E2 M2 MPNAD WidalO: 1:30 H: 1:30 X-Ray: chest Bil lower zone broncho pneumonia

19. DIAGNOSIS Complicated measles with bilateral broncho pneumonia

20. INDICATIONS FOR ADMISSION 1.Measles overall decreases the immunity and hence predisposes to infective illness and its complications. Broncho pneumonia is one of them. Measles pneumonia is known to spread rapidly. MONITOR VITAL SIGNS IN VIEW OF IMPENDING COMPLICATION 2.High grade fever, high respiratory rate and decreased thirst and appetite will lead to water, electrolyte and nutrition imbalance 3.To observe remedy reaction in a case of eruptive fever

21. ANCILLARY MEASURES 1.ISOLATION: As it is an infective illness and also to prevent cross infection from other patient as the immunity is low 2.TPR: two hrly. 3.Plenty of oral fluids 4.I.V. fluids

22. TOTALITY 1.A/F: Eruption fail to appear 2.Irritability fever during 3.Carried desire to be on shoulder 4.Thirstlessness heat during 5.Vomiting coughing on 6.Rattling cough < night

24. Ant. Tart, Sulph, Cham, Cina and Lach Cham and Cina:Not covering cause Lach:Not covering mental concomitant of carried desire to be Sulph: Suppression of eruption Ant. Tart:Eruption fails to appear REMEDIES FOR DIFFERENTIATION

25. Within few dose Rash appeared all over body Within 24 hr fever settled 3-4 days cough settled completely X-Ray on 27-2-06Resolving patch X-Ray on 2-3-06Normal FOLLOW UP

26. IMPORTANT LEARNING 1.Importance of examination 2.Clinico Pathological Co-relation 3.Susceptibility assessment 4.Remedy response evaluation

27. COURSE OF ERUPTIVE FEVER Viral infections Specific well defined course Self limiting illness If the course is tampered  protracted illness  complications

28. Eruptive fevers (therapeutic flow chart) Normal DeviantComplications coursecoursecourse IdentificationIdentificationOrientation Orientationof characteristicsto parents Wait and watchInfrequent repetition Infrequent to frequent repetition

29. IMPORTANT CONCEPTS  Knowledge of illness  Knowledge of complication  Identification of right remedy  Assessment of susceptibility  Suppression  Minimum repetition  Follow up assessment