Suspected Enteric Fever in a Man of 65

Abstract:

This case emphasizes the importance of patient hospitalization in a homeopathic hospital in acute diseases or acute exacerbation of chronic diseases. Objective signs which can be witnessed during hospitalization are the guide to the simillimum. The need for antipyretic and antibiotics is replaced by the homeopathic simillimum.  Remedy action can be assessed and relevant action can be taken at each step of treatment.

Key words:

Nosodes, Acute febrile illness, Pyrogen, Relative Bradycardia, Suspected Enteric fever

Introduction:

Febrile illness of various etiologies have been a great challenge to treat homeopathically in an era of complexities of febrile illnesses, mutations of pathogens and resistance to antibiotics. When a well selected remedy is providing symptomatic relief without complete resolution of infection, there is a need of close monitoring and observation. Hospitalization of the febrile patient helps to identify the objective signs which guides to subsequent prescriptions.

When the first prescription has given relief to the patient and the physician feels there is blockage of action, then prescribe a Nosode. This could be a nosode, an anti miasmatic, or a chronic remedy – Kent, J. T . (second prescription).

Relative bradycardia in a febrile patient (temperature pulse dissociation) without any use of beta blockers is a very important observation seen in this case. Many fevers like typhoid, brucellosis, leptospirosis, are known for producing temperature pulse dissociation.

This particular sign was an entry point to select the simillimum. Enteric fever usually has relative bradycardia and leucopenia which is seen in this case. But Rapid Typhi IgM and Widal test was negative. If fever persists, blood culture is the gold standard investigation which will definitely diagnose any occult enteric infection.

The nosode pyrogen should be considered, When the pulse and temperature are out of rhythm especially from septic origin, pathology has developed. We can employ nosodes as truly homeopathic remedies. When thus employed, the general rules of homeopathic posology apply.

Case History

A man of 65 presented with complaint of fever, bodyache3+, weakness, bitter taste in mouth since 4 days. Patient was taking antipyretics with transient relief. No history of travel.

Sensation of current in whole body, after sneezing lasting 5-7 minutes. Fever with chilliness3+ and weakness2+. Perspiration scanty. Sweats only if antipyretics are taken.  Fever continuous < evening and night- documented by relatives -103.6. Headache in temple, bilateral right >left. Keeps shifting. No passage of stool for the last 3 days. Burning micturition < fever during.
Burning before micturition. No vomiting.

Physical generals
Thirst- thirstless3+            Perspiration- scanty3+                         Chilliness due to fever3+

Appearance – Weak, prostrated, toxic 3+

Figure 1. Patient appearance suggested toxicity and drowsiness.

Investigations

 Diagnosis– Acute Febrile Illness?? Enteric Fever (Rapid Typhi Test Negative),

Enteric fever is suspected in view of fever with bradycardia and leucopenia with chronic benign enlargement of prostate.

Classification of disease:  acute individual dynamic disease with fully developed symptoms.

On examination:
Temperature: 103.2, Pulse- 70 bpm, regular, bounding
Cracks in tongue midline with yellow coating.
B.P -100/60mmhg
Toxic look – Mild dehydration.

Acute fever totality: Boeninghausen’s concept of Totality

Totality

• Thirstlessness -fever during
• Chill air draft of slightest
• Extremities pain -fever during
• Extremities pain < motion agg
• Fever perspiration absent
• Taste bitter- fever during agg

Repertorisation:

SELECTION OF REMEDY/POTENCY/REPETITION
Acute Prescription – Nux vomica

Susceptibility: high
▪ High symptom similarity
▪ General sensitivity of the body is high.
▪ Characteristic symptoms
▪ Characteristic symptoms at mental and physical level
▪ Immunity and vitality of the patient is good.
▪ Acute disease
▪ No h/o Suppression

First Prescription on 6/10/21
Rx Nux vomica1M

Repetition of dose:

• In acute cases, the action of the remedy is known to exhaust early and therefore, frequent repetition is indicated. The frequency is cut down gradually so that the dose tapers gradually in cases of sustained improvement.
• Premature cessation of the remedy is known to promote a relapse
• Aphorism 248, Organon of medicine 6^th, that, in acute cases, repetition of dose every 2-6 hours and in very urgent cases, every hour or oftener is admissible.

Follow up criteria
Fever
Burning during micturition
Body pain
Appetite
Thirst

Follow up

Figure 2: Day 1: Temperature graph with Pulse rate (Represented in Box)

Figure 3: Day 2: Temperature graph with Pulse rate (Represented in Box)

Figure 4: Day 3: Temperature graph.

Figure 5: Day 4: Temperature graph

Patient was improving but the fever wasn’t settling down in spite of frequent repetition.

We reviewed  the  case. The objective sign of discordant temperature and pulse was a leading indication for the remedy Pyrogen as per the reference from Phatak Materia Medica, Boericke Materia Medica and Clarkes Materia Medica..

10/10/21	Body ache during chills Pulse out of proportion-Discordant to temperature
	Temp 100.8F Discordant relation of fever and pulse Remedy- PYROGEN	Pyrogen 200 4 pills every 2 hourly -Started from 8.30 am

Figure 6: Day 5: Temperature graph 

Figure 7: Day 6: Temperature graph with Pulse rate (Represented in Box)

Figure 8: Day 7: Temperature graph with Pulse rate (Represented in Box)

Patient was discharged on day 7 on Pyrogen 200 qds for 1 week . Patient was instructed to monitor temperature and pulse rate.

Patient was observed for 3.5 months. He was asymptomatic and afebrile.

Lessons and conclusions from the case:

1. Value of hospitalisation while receiving homeopathic treatment.
2. Role of objective symptoms in homeopathic prescribing.
3. Concept of disease diagnosis, investigations and regular monitoring
4. Importance of temperature graph Presentation.
5. Materia medica knowledge and drug differentiation
6. Importance of team work
7. Evidence based homeopathy

Acknowledgement

We are thankful to Dr. Mohanbhai Patel, Chairman, the Homeopathic Education Society (Smt .Chandaben Mohanbhai Patel Homeopathic Medical College),Dr Asmita Parikh, The General Secretary, The Homeopathic Education Society , Smt Chandaben Mohanbhai Patel Homeopathic Medical College  and Dr Parizad Damania – Principal,Smt Chandaben Mohanbhai Patel Homeopathic Medical college for the encouragement, support and hospital infrastructure.

References:

1.Clarke JH. Dictionary of Practical Materia Medica vol-1, B Jain Publishers Pvt Ltd, Reprint edition 1992, pg : 931.

2. William Boericke, Boericke’s New Manual of Homeopathic Materia Medica with Repertory, B Jain Publisher (P) Ltd, Third Revised and Augmented Based on 9th Edition, 42nd Impression 2018, pg :540.
3. Dr. Phatak SR. Materia Medica of Homoeopathic Medicines, 2nd Edition 22nd impression: B. Jain publication Ltd., 2018, Pg:630.
4. Lectures on Homeopathic material medica, ed: 1st Indian edition, James Tyler Kent (A.M., M.D), B Jain publication co Ltd, pg : 871.
5. Keynotes and Characteristics with Comparisons, Ed: 2nd, H.C. Allen, M.D, IBPP, New Delhi, Pg : 326
6. Repertory of the Homoeopathic Materia Medica, Indian Edition, Reprinted from Sixth American Edition, J.T. Kent, Indian Books and Periodicals Publishers, New Delhi, 896,1044,1045,1262,1275,1289.
7. Fredrick Schroyens, Radar 9.0, Synthesis Repertory,
8. Dr. Samuel Hahnemann, 6th edition of Organon of Medicine, translated by William Boericke Aph. 248, Page no. 273
9. Dr M. L. Dhawale, Part 1, Principles and Practice of Homoeopathy, 3^rd Edition, 2004, Dr M. L. Dhawale Memorial Trust, Mumbai, Page No 284, Pg 281