Rajiv Gandhi University of Helth Sciences
SYNOPSIS OF DISSERTATION
1. Name of Candidate Dr. G.NAZEER AHMED
and Address P.G in General Medicine
Department of Medicine
2 Name of the KEMPEGOWDA INSTITUTE OF MEDICAL SCIENCES
Institution AND RESEARCH CENTERE, BANGALORE – 560 070
3 Course of the Study & M.D. IN GENERAL MEDICINE
4 Date of Admission to 13th June 2008
5 Title of the Topic Clinical study of fever with thrombocytopenia
with special reference to infective etiology
6. Brief Resume of intended work
6.1 Need for the study:
In recent days fever with thrombocytopenia is common clinical presentation in the medical wards.
Established infective causes like Dengue is well known for fever with thrombocytopenia . There
are not many studies elucidating other infections for thrombocytopenia. Only few studies are
available for Enteric fever and Malaria.
This study has been undertaken to know the modes of clinical presentations and possible causes
of fever with thrombocytopenia where in cause of infection could be established like
dengue,enteric fever,malaria,leptospria,hepatitis B, and HIV infection.There may be other
infective causes wherein the etiology cannot be pointed out because of lack of facilities or
This study might help us to correlate the clinical features and laboratory findings to come to
conclusion regarding the possible infective causes for thrombocytopenia and thus diagnosis and
6.2 Review of literature
P.S Nair conducted study of fever with thrombocytopenia and concluded that septicemia
was the commonest cause.2
A study conducted by Md Ayule et al showed that the commonest presentation was fever
(100%) followed by headache (48%) myalgia (66%) and vomiting.3
Septicemia resulting from gram negative and gram positive organisms is the commonest
cause of thrombocytopenia.1, 4
Causes of fever and thrombocytopenia includes viral, bacterial and protozoal.1, 4
Dengue infection in humans causes a spectrum of illness ranging from inapparent to
severe and fatal Dengue haemorrhagic disease.5
In HIV+ patients, the 1-year prevalence of thrombocytopenia was 8.7% in persons with
one or more AIDS-defining opportunistic illnesses(clinical AIDS), 3.1% in patients with
a CD4 count <200 cells/mm3 but not clinical AIDS(immunologic AIDS), and 1.7% in
persons without clinical or immunologic AIDS.6
The observations of SCOTT et al suggested that while patients with malaria may be
predisposed to the development of thrombocytopenia, a reduced platelet count in some
patients may also be due in part to pseudo-thrombocytopenia.7
6.3 Aims and Objectives :
1. To elucidate possible infective etiology for fever with thrombocytopenia.
2. To correlate clinical features, laboratory studies and infective etiology
7. Materials and Methods :
7.1 Source of data:
All the adult patients with fever with Thrombocytopenia admitted to KIMS hospital and
Research center from December 2008 to September 2010.
7.2 Method of collection of data:
The data for this study will be collected by patient evaluation which will be done by
detailed history taking, Clinical examination,and relevant investigations using a
proforma specially designed for this study.
Sample size :100 cases
Study design :Prospective clinical study
Sample design : Purposive sampling
Study duration :December 2008 to September 2010.
Inclusion criteria :
All the adult patients with fever and thrombocytopenia of infective etiology.
Exclusion criteria :
Patients with fever with thrombocytopenia other than infective etiology like
ITP,drug induced thrombocytopenia, HELLP Syndrome, myeloproliferative
diseases,DIC of noninfective etiology(Abruptio placenta , Snake bite) are excluded
from the study.
7.3 Does the study require any investigations or interventions to be conducted on
patients or other humans or animals ? If so, please describe briefly.
No animal studies required. All investigation to be done are routine investigation
The study requires the following investigations
Peripheral blood picture
Liver function test,
QBC for MP,
Bone Marrow.(if needed)
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
8. List of references
1. Firkin, Chesterman,Penangton Rush, Haemorrhagic disorders.capillary and
platelet defects.In:Degruchi’s Clinical Haematology in Medical Practice,5
Ed:Oxford Blackwell Science,1989:360.
2. Nair P S, Jain P,Khanduri U, Kumar.V, A study of fever associated
thrombocytopenia, J of Asso of Physicians of India.2006;51:1173
3. Md Ayule et al, Characteristics of Dengue fever in a large public hospital,Jeddah,
Saudi Arabia,J of Ayub Med Coll Abott,2006;18(2).
4. Risdall RJ, Bruning RD, Hermandez JL, Gordan DH, Bacterial associated
haemophagocytic syndrome.Cancer.1984 Dec 15;54(12).
5. Gubler DJ,Dengue and Dengue Haemorrhagic fever, Clin Mic Biol
6. Sullivan, Patrick S.; Hanson, Debra L.; Chu, Susan Y.; Jones, Jeffrey L.;
Ciesielski, Carol A, Surveillance for Thrombocytopenia in Persons Infected With
HIV: Results From the Multistate Adult and Adolescent Spectrum of Disease
Project,J Acqu Immu Def Synd and Human Retrovirology,1997;14(4):374-9
7. SCOTT et al, Thrombocytopenia in patients with malaria: automated analysis of
optical platelet counts and platelet clumps with the Cell Dyn CD4000
analyser,Clinical and Lab Haematology,2002;24(5):295-302
9. Signature of the Candidate
10. Remarks of the Guide
The prevalence of fever with thrombocytopenia is increasing in its occurrence.
Awareness of its infective cause is needed for timely diagnosis and management. Hence
the study is undertaken.
11. Name & Designation of
11.1 Guide Dr. SHIVALINGAIAH
Professor of Medicine,
Department of Medicine,
11.5 Head of the Department Dr. M.V POORNACHANDRA
Professor & Head of
Department of Medicine
12. 12.1 Remarks of Chairman and Principal