Q: My 39 years old aunt is having fever for the last 20 days. She has been prescribed quinine as in for malaria and was given antibiotics injections for typhoid but her condition has not improved even then. Another doctor confirmed it as viral fever and told us that wrong medicines were given to her. Then he changed the medicines. Although there was relief earlier but now she is unable to talk to anyone and losing consciousness. Please advise.

A:There are a number of possible medical causes, which could have contributed to her present condition. The description provided is very non-specific however viral, bacterial, parasitic and even fungal pathogens can result in symptoms and signs close to the one you have described. Although non-infectious causes such as stroke (cerebrovascular accidents), metabolic encephalopathy (due to diabetes, liver or kidney failure), toxins or malignancy may lead to similar clinical presentation, the relatively young age, presence of fever, prior history of tuberculosis, and consideration of a number of infective syndromes in the differential diagnosis and treatment considerations (malaria, typhoid, viral illness) are indicative of an infective aetiology. I would suggest immediate transfer of the patient to hospital equipped with the facility to investigate and manage complicated cases. It is very likely that she will need a number of investigations such as blood tests, brain scanning (CT or MRI), and other appropriate specialised tests as felt necessary by the senior doctors before the actual diagnosis could be ascertained. The key to recovery would be urgent transfer to a proper health care set up, immediate supportive management, early diagnosis and specific treatment. My best wishes for you and your relative.