Monsoon Illness in North India

Every July the clinics of Gurgaon fill with fever. Patients arrive with headaches, body aches, sometimes a faint rash; the families arrive with anxiety — and with good reason, because the city has learned in recent years to respect what the monsoon brings with it.

The four to rule in, and out

In practical terms, four diagnoses account for the great majority of monsoon febrile illness in our region: dengue, malaria, typhoid, and — increasingly — influenza. Chikungunya, scrub typhus, and leptospirosis appear less often but should never be forgotten. A careful history and a small, thoughtfully chosen set of tests sort most of this within a day.

What patients can usefully do at home

• Hydration, and more hydration. Oral rehydration solution is not only for diarrhoea; it is a friend of any febrile patient whose appetite has flagged.
• Paracetamol, not NSAIDs. Ibuprofen and aspirin can worsen bleeding tendency in dengue and strain the kidneys in any febrile illness where dehydration is a risk.
• Watch the warning signs. Severe abdominal pain, persistent vomiting, bleeding from any site, unusual drowsiness, cold extremities. These are not symptoms to manage at home; they are symptoms to bring to a physician, today.

What the physician should resist

Empirical antibiotics in the first forty-eight hours of an undifferentiated viral-looking fever rarely help and sometimes confuse. So does the urge to repeat investigations within a short window. The correct answer is often to observe, to support, and to reassess with fresh eyes.

The monsoon is a predictable teacher. Every year it reminds us that good medicine is patient, and that panic — on either side of the consulting table — is almost never a diagnosis.