PE31.1-14 | Tuberculosis and Febrile Infections — Assignment

CLINICAL SCENARIO

Students will write a structured clinical case analysis of a child presenting with fever lasting more than 10 days in an Indian paediatric setting. The assignment integrates TB work-up, differential diagnosis across infective causes (enteric fever, dengue, malaria, parasitic infections), and evidence-based management using NTEP and national guidelines. It develops clinical reasoning skills essential for managing fever in resource-limited and endemic settings.

Section 1: Clinical History and Epidemiological Context

Guidance: Document the history of present illness: fever onset, pattern (continuous, remittent, intermittent), associated symptoms (rash, cough, abdominal pain, rigors, night sweats, weight loss). Include travel history to malaria-endemic or TB-endemic areas, contact with known TB patients, vaccination status (NIS milestones), nutritional status, socioeconomic background, and household contacts. Identify epidemiological red flags.

Section 2: Physical Examination Findings

Guidance: Describe a systematic examination: anthropometry and nutritional status, temperature pattern (record at least 3 readings), skin findings (rash type, distribution, petechiae/purpura), lymphadenopathy (site, size, consistency — hilar vs cervical vs inguinal), hepatosplenomegaly, BCG scar presence and Mantoux result interpretation. Identify which findings point towards which diagnosis.

Section 3: Differential Diagnosis with Reasoning

Guidance: List at least 4 possible diagnoses in order of probability given your patient's presentation. For each: state the supporting features, the key distinguishing features from other diagnoses, and the specific investigation that would confirm or refute it. Include tuberculosis, enteric fever, dengue, malaria, and at least one parasitic cause where applicable.

Section 4: Diagnostic Work-up and Interpretation

Guidance: Justify every investigation you order. Include: CBC with differential (interpret lymphocytosis/eosinophilia/neutrophilia), ESR and CRP, blood culture, Widal test (discuss its limitations), NS1/IgM dengue serology (explain timing), peripheral blood smear for malaria (identify species by morphology), and TB-specific tests (Mantoux, gastric aspirate, CBNAAT — explain what each detects). State the result interpretation criteria for each.

Section 5: Final Diagnosis and Evidence-based Management

Guidance: State the final diagnosis with evidence. Describe management: drug(s), dose by weight, route, duration, and rationale. Reference NTEP guidelines for TB (weight-band FDC, 2HRZE/4HRE, IPT criteria), NVBDCP for malaria (ACT for falciparum vs chloroquine+primaquine for vivax, G6PD check), WHO dengue guidelines (no prophylactic platelets, no aspirin), and IAP guidelines for enteric fever (ceftriaxone dose, watch for week-3 perforation).

Section 6: Prevention and Public Health Perspective

Guidance: Discuss at least two preventive strategies relevant to your final diagnosis: e.g., NTEP IPT for TB contacts, NIS immunization schedule for vaccine-preventable fevers (MMR, DPT booster), vector control for dengue/malaria (larviciding, bed nets, IRS), food/water hygiene for typhoid, albendazole NDD for helminthic infestations. Mention the notification requirements for any notifiable disease identified.

PEER REVIEW

Review your peer's case analysis using the rubric above. For each criterion, assign a score and provide 2–3 specific sentences of constructive feedback explaining your rating. Identify one factual strength (a correctly applied guideline or interpretation) and one area for improvement. Avoid personal comments — focus entirely on the clinical content and guideline adherence.