Fever

Skeletal tuberculosis is one of the common forms of extra pulmonary tuberculosis of which 50% of the cases are of spinal tuberculosis and the rest are tubercular arthritis or tendinitis or osteomyelitis (3-5). We report a case of “caries sicca” type of osteoarticular tuberculosis of the shoulder joint, who presented to us primarily for pyrexia. She was investigated at outpatient department as well at the time of previous indoor admissions. She presented to us as her fever persisted despite her admissions twice in multi-speciality hospital. Apart from fever, her relatives noticed right frozen shoulder for which Magnetic Resonance Imaging (MRI) was done which showed changes of arthropathy and synovial effusion. Arthrocentesis was positive for Mycobacterium tuberculosis by Cartridge Based Nucleic Acid Amplification Test. The patient was started on anti-tubercular drugs and physical rehabilitation, upon which she improved. Diagnosis can be missed in such a patient presenting as pyrexia of unknown origin without obvious swelling or sinus at the joint. Extra pulmonary tuberculosis can be one of the common causes of patient presenting with pyrexia of unknown origin; tuberculosis of the shoulder joint is even rarer.

Malaria infection is responsible for high mortality rates in sub – Saharan Africa and this is partly caused by poor infrastructure especially for diagnosis in rural areas thereby making complying with the World Health Organization policy on proper malaria tests before treatment difficult. A cross – sectional study was conducted to evaluate the validity of presumptive diagnosis in malaria infections by comparing with microscopy and CareStart™ malaria HRP2/pLDH Pf Test kit (RDT). 1000 consenting study subjects in the Outpatient Department of Braithwaite Memorial Specialist Hospital (BMSH), Rivers State, Nigeria were sampled for malaria parasites from January 2014 to June 2016. Blood samples were gotten through venous procedure and analyzed for the presence of Plasmodium using Giemsa – microscopy and RDT kits while presumptive diagnosis (presence of fever) was determined by a Physician. All results were statistically analyzed and Giemsa – microscopy was used as the “Gold standard” for malaria diagnosis. Malaria prevalence rates of 32%, 32% and 15% were recorded for presumptive diagnosis, microscopy and RDT respectively (P<0.05). Fever had sensitivity, specificity and diagnostic accuracy values of 99%, 100% and 99.7% respectively while RDT had sensitivity, specificity and diagnostic accuracy values of 46%, 100% and 83% respectively when compared to Giemsa – microscopy. This study showed that RDT was not as sensitive as fever and microscopy in the detection of malaria but it can be used when microscopy is not available due to its high specificity and diagnostic accuracy. Although more research is needed in the validity of presumptive diagnosis as a reliable diagnostic technique, suspected cases of malaria infection based on presumptive diagnosis (presence of fever) by highly experienced physicians can be considered for malaria treatment especially in emergency situations and in malaria – endemic rural areas lacking well – equipped malaria diagnostic centres for laboratory diagnosis but all suspected malaria cases should be confirmed with proper laboratory diagnosis (if possible) to avoid malaria mis – diagnosis and parasite drug resistance by wrong administration of antimalarial.