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					                Rajiv Gandhi University of Helth Sciences
                          Bangalore, Karnataka.

                          SYNOPSIS OF DISSERTATION


1.   Name of Candidate           Dr. G.NAZEER AHMED
     and Address                 P.G in General Medicine
                                 Department of Medicine
                                 KIMS Hospital
                                 Bangalore


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
     Subject

4    Date of Admission to        13th June 2008
     Course


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.
                                                                                        1
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
unaffordability.

 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
management.
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

     Complete haemogram,
     Peripheral blood picture
     Platelet count,
     urine rountine,
     Liver function test,
     Blood urea,
     Serum creatinine,
     Chest x-ray,
     Ultrasound,
     ECG,
     Dengue antibodies,
     QBC for MP,
     HBsAg ,
     Leptospira antibodies,
     Widal test,
     Blood culture,
     HIV antibodies,
     Bone Marrow.(if needed)



7.4 Has ethical clearance been obtained from your institution in case of 7.3?

      Yes



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
         Rev.1998;113;480-96.

      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
                                            M.D,
                                            Professor of Medicine,
                                             Department of Medicine,
                                             KIMS, Bangalore.


       11.2   Signature




11.5   Head of the Department         Dr. M.V POORNACHANDRA
                                      Professor & Head of
                                      Department of Medicine
                                      KIMS, Bangalore.
       11.6   Signature


________________________________________________________________________




12.    12.1   Remarks of Chairman and Principal




       12.2   Signature.

				
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