42 YEAR MALE WITH FEVER AND HEADACHE SINCE 20 DAYS
A 39 year old male ,farmer by occupation comes to casualty with complaint of fever ,headache and pain abdomen ,loss of appetite since 20 days. Chief complaint Patient complains of fever since 20 days, headache since 20 days, pain abdomen since 20 days Loss of appetite since 15 days History of presenting illness Patient was apparently asymptomatic 20 days back then developed fever of insidious onset ,gradually progressive which increases during the night and relieves on taking medication,not associated with any rash.The day before the onset of fever patient was spraying pesticide in his field ,he supposedly wanted to finish two days of work in a single day and said that he was exposed to the fumes of the sprayer for a longer period of time since usual. Pain abdomen is non radiating and not associated with nausea /vomiting ,not associated with diarrhoea Headache is non radiating and mostly in the front and sides of the head . Loss of appetite since 15 days Patient noticed a scab on