A report on fever clinic at Nehru

Homoeopathic Medical College and Hospital

Dr. Mohit Mathur (Reader); Dr. Anu Kapoor (Reader (NFSG))

INTRODUCTION:
A fever clinic was set up in Nehru Homoeopathic Medical College & Hospital (NHMC & H), New
Delhi under the guidance of Dr. Surender Verma Principal/HOD (NHMC&H) during the period August
to October 2015 in view of sharp rise in fever cases in Delhi & NCR region which witnessed the
worse outbreak of dengue fever in past five years. Fifty beds for dengue fever cases were
functionalised in Nehru Homoeopathic Medical College & Hospital for care of dengue fever
patients. Two senior residents and four junior resident doctors were hired on contract for 89 days
by Pt. Madan Mohan Malviya Hospital and deputed in NHMC & H for treatment of fever cases and
transfer of critical patients to a higher centre. Fever clinics were advised to refer patients to NHMC
& H for admissions.

Facts about Dengue fever1:

Dengue is a mosquito-borne viral disease. Dengue virus is transmitted by female mosquitoes
mainly of the species Aedes aegypti and, to a lesser extent, A. albopictus. The disease is
widespread throughout the tropics, with local variations in risk influenced by rainfall, temperature
and unplanned rapid urbanization. Demographic and societal changes such as population growth,
urbanization and modern development contributed to the geographical spread of dengue virus 2.
Severe dengue (also known as Dengue Haemorrhagic Fever) was first recognized in the 1950s
during dengue epidemics in the Philippines and Thailand. Today, severe dengue affects most Asian

and Latin American countries and has become a leading cause of hospitalization and death among
children in these regions.
There are 4 distinct, but closely related, serotypes of the virus that cause dengue (DEN-1, DEN-2,
DEN-3 and DEN-4). Recovery from infection by one provides lifelong immunity against that
particular serotype. However, cross-immunity to the other serotypes after recovery is only partial
and temporary. Subsequent infections by other serotypes increase the risk of developing severe
dengue.
Clinical features: After an incubation period of 2 to 7 days, the typical patient experiences the
sudden onset of fever, headache, retro-orbital pain, and back pain along with the severe myalgia
that gave rise to the colloquial designation break-bone fever. There is often a macular rash on
the first day as well as adenopathy, palatal vesicles, and scleral injection. The illness may last a
week, with additional symptoms usually including anorexia, nausea or vomiting, marked
cutaneous hypersensitivity, and near the time of defervescence a maculopapular rash beginning
on the trunk and spreading to the extremities and the face. Epistaxis and scattered petechiae are
often noted in uncomplicated dengue, and pre-existing gastrointestinal lesions may bleed during
the acute illness. Laboratory findings include leukopenia, thrombocytopenia, and, in many cases,
serum aminotransferase elevations. The diagnosis is made by IgM ELISA or paired serology during
recovery or by antigen-detection ELISA or RT-PCR during the acute phase 3.
Severe dengue is a potentially deadly complication due to plasma leaking, fluid accumulation,
respiratory distress, severe bleeding, or organ impairment. Warning signs occur 37 days after the
first symptoms in conjunction with a decrease in temperature (below 38C/100F) and include:
severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums, fatigue, restlessness

and blood in vomit. The next 2448 hours of the critical stage can be lethal; proper medical care is
needed to avoid complications and risk of death.

Treatment
There is no specific treatment for dengue fever.
For severe dengue, medical care by physicians and nurses experienced with the effects and
progression of the disease can save lives decreasing mortality rates from more than 20% to less
than 1%. Maintenance of the patient's body fluid volume is critical to severe dengue care.
Immunization
There is no vaccine to protect against dengue. However, major progress has been made in
developing a vaccine against dengue/severe dengue. Three tetravalent live-attenuated vaccines
are under development in phase II and phase III clinical trials, and 3 other vaccine candidates
(based on subunit, DNA and purified inactivated virus platforms) are at earlier stages of clinical
development.

Data derived from the fever clinic in NHMC & H

OPD data: Total fever/dengue patients seen in OPD of fever clinic since 15 th august 2015- 1448
patients.

IPD data: Total fever cases admitted in IPD of NHMC & H from 22 nd September 2015 to 23rd
October 2015- 35 patients (27 males and 8 females). Patient were given homoeopathic treatment
on the basis of their symptom totality along with the conventional treatment.
Average age of IPD patients was 26 years. Average duration of febrile illness in IPD patients was
4.6 days. Out of 35 cases admitted, three patients were tested positive for malaria (Plasmodium
vivax), three patients tested positive for typhoid, and fourteen (14) patients were tested positive
for dengue fever antigen (NS1).The average duration of stay in IPD was 2.3 days. (table 1.1)
Out of 35 patients, in 31 patients the platelet count was performed a minimum of two times to a
maximum of five times. In 20 patients the platelet count was performed 3 to 5 times. The average
platelet count in these 20 patients was 171986/mm 3 with a range from 7000/mm3 to 360000/ mm3.
(table 1.2)
Besides fever the most frequently encountered symptoms were generalised bodyache, followed by
headache, chill and retro-orbital pain (chart 1). Under homoeopathic treatment Byronic alba was
found to be indicated in majority of patients followed by Ferrum Phosphoricum and Eupatorium
Perfoliatum (chart 2).

OUTCOME:
Out of total 35 patients admitted in the IPD of NHMC & H, 4 patients were referred to Pundit
Madam Mohan Malviya Hospital as their fever could be brought under control and 2 of them
showed signs of dengue haemorrhagic fever. The remaining 31 patients responded well to
combine homoeopathic and allopathic treatment and were afebrile with no body ache at the time
of discharge.

DISCUSSION:
An overwhelming majority of patients (88%) improved clinically with evidence of improvement in
laboratory investigations during the IPD treatment. This indicates a strong possibility of
effectiveness of homoeopathic treatment in fever patients, including dengue fever. However
considering the small number of cases and the fact that patients received conventional medicines
along with homoeopathic treatment, further studies are needed to validate the evidence of
effectiveness of homoeopathic treatment.

ACKNOWLEDGEMENT
We express our gratitude to Dr. Surender Verma, principal/HOD for his supervision and guidance
throughout the study.

References:
1. www.who.into/topics/infectious_diseases/factsheets/en
2. Gubler DJ. Epidemic dengue/dengue haemorrhagic fever as a public health, social and
economic problem in the 21st century. Trends in microbiology 2002; 10(2): 100-103.
3. Peter CJ. Harrisons principles of internal medicine (16 th edition) McGraw-Hill 2005;
ch180. Pg. 1164.

NAME

ajay

2
3

sapna
manisha

AGE(yea
rs)

SE
X

DURATIO
N OF
ILLNESS(
days)

MP

NS1

widal

DURATION OF
STAY (days)

18
24

F
F

2
6

2
2

MANAGEMENT
OUTCOME

HOMOEOPATHIC

FEVER

BODYAC
HE

ferrum phosporicum
200

afebrile

absent

afebrile
afebrile

absent
absent

bryonia alba 200

bryonia alba 200;
natrum muriaticum

200
4

rakesh
kumar

21

5
p.
viva
x

bryonia alba 200

afebrile

absent

bryonia alba 200

afebrile

absent

bryonia alba 200

rhus toxicodendron;
belladonna; arsenicum
album; bryonia alba

afebrile

absent

afebrile

absent

afebrile

absent

bryonia alba 200

eupatorium
perfoliatum 30
eupatorium
perfoliatum 30
eupatorium
perfoliatum 30; 200

arsenic album 200

bryonia alba 200

aconite30; arsenicum
album 30; ferrum
phosphoricum 200

afebrile

absent

afebrile

absent

afebrile

absent

sulphur 200;
ferrum phosphoricum
30

afebrile

absent

bryonia alba 200

afebrile

absent

bryonia alba 200

afebrile

absent

afebrile

absent

afebrile

absent

ram
bhawan
shamaila
akhtar

harish

30

pankaj

19

19

25

11

akshay
manoj
kumar
anshu
chaudhary

25

12

rohit

19

13

kanhiya

19

10

14

seema

43

15

arvind

28

16

ramraj

23

10

20

25

17

munni devi

47

18

sujit kumar

18

19

vipan

30

20

anwar

65

positive
positi
ve

4
positi
ve
positi
ve
positi
ve
positi
ve
positi
ve
positi
ve
positi
ve
p.
viva
x

2
2

1
3

ferrum phosphoricum
30
ferrum phosphoricum
30

afebrile
afebrile
afebrile
clinical
conditio
n not
relieved

absent
absent

21

neha

29

10

nux vomica 30

afebrile

absent

22

18

bryonia alba 200

afebrile

absent

23

azad
chandershe
kar

25

bryonia alba 200

afebrile

absent

24

dinesh

40

10

bryonia alba 30

afebrile

absent

25

anil kumar

30

positi
ve

eupatorium perfolatum
30

26

ravi

30

positi
ve

crotalus horridus 30

27

rahul singh

24

positi
ve

28

22

29

ram sahu
kuldeep
singh

arsenicum album 30
eupatorium perfolatum
30

28

30

nisha

22

31
32
33

lalit
bablu
surender
rama

22

positi
ve

positi
ve

20

23

34

priyanka

20

35

sunny

18

positive

p.
viva
x
positive
1/160

headache
& eyeache

afebrile

absent

bryonia alba 200

102 F

absent

bryonia alba 200

afebrile

absent

bryonia alba 200

afebrile

absent

rhus toxicodendron
200

afebrile

absent

afebrile

absent

afebrile

absent

afebrile

absent

1
positi
ve

afebrile
pt.
progrssi
ng to
DHF so
referred
pt.
progrssi
ng to
DHF so
referred

5
4

bryonia alba 30
ferrum phosphoricum
30
ferrum phosphoricum
30

NAME

AGE

PLATELET COUNT
(/cu mm)

ajay
sapna
manisha
rakesh
kumar
ram
bhawan
shamaila
akhtar
harish
pankaj
akshay
manoj
kumar
anshu
chaudhary
rohit
kanhiya
seema
arvind
ramraj
munni devi

5
years
18
years
24
years
21
years
20
years
25
years
30
years
19
years
19
years
25
years
25
years
19
years
19
years
43
years
28
years
23
years
47
years

80000
190000
180000
160000
145000
145000
150000
135000
190000
190000

1600
00
2450
00
3200
00
1610
00
8800
0
1180
00
1600
00
1030
00
1450
00
2500
00

17000
0
15000
0
19000
0
16500
0

72000
86000
17000
0
24000
0

230000
43000
290000
310000
160000
160000
360000

8000
0
3000
00
3200
00
1900
00
1600
00
1800
00

11000
0
31000
0
19000
0
20000
0
19500
0

20000
0

17500
0

12000
0
13000
0

16000
0

27000
0

sujit kumar
vipan
anwar
neha
azad
chandershe
kar
dinesh
anil kumar
ravi
rahul singh
ram sahu
kuldeep
singh
nisha
lalit
bablu
surender
rama
priyanka

18
years
30
years
65
years
29
years
18
years
25
years
40
years
30
years
30
years
29
years
22
years
28
years
22
years
22
years
20
years
23
years
20

180000
180000
160000
340000

8000
0
2000
00
8800
0
1900
00

21000
0

20000
0

1000
00
2900
00

10000
0
18000
0

78000
20000
0

7000
1000
00
1900
00

65000
12000
0
25000
0

15000
0

230000
85000
150000
165000
52000
30000
120000
130000
60000
180000
350000
74000
180000

2500
00
1500
00
1800
00
3300
00
1550
00

36000
0

16000
0

sunny

18

38000

2800
00

Chart 1

frequency of occuRREncE OF SYMPTOMS

symptoms

papular rash 2
petechiae 2
generalised bodyache
backache
5
myalgia
3
arthralgia
7
pain in abdomen
9
vomiting
10
nausea
10
anorexia
3
photophobia 1
retro-orbital pain
headache
perspiration
3
chill
fever
0

10

28

14
26
16
35
15

no. of patients

20

25

30

35

40

Chart 2

HOMOEOPATHIC MEDICINES PRESCRIBED IN FEVER CASES

aconite

natrum mur

belladonna

sulphur

nux vomica

ars alb

crotalus horridus

rhus tox

eupatorium perf

ferrum phos

bryonia

14
0

10

12

14

16