Clinical Case

This patient has been sent to the ED following an initial presentation to their GP with the following letter;

“Dear Doctor,

Thank you for seeing this normally fit and well 35 year old gentleman whom I have not seen before. He complains of sweats, rigors, headache, sore throat and generalised myalgia. This started abruptly last night.

On examination, he is febrile (39.0°C), sweaty and tachycardic (105 beats per minute). I am concerned because he is mildly photophobic, although I am not convinced he has neck stiffness. There is no rash.

I am concerned that he may have meningitis and would value your opinion”

Last night your patient became somewhat myalgic, shivery and tired. He had an early night but awoke this morning with a generalised headache, sore throat and aching all over. He feels hot and sweaty yet at other times cannot keep warm. He reports some rigors and drenching sweats.

One or two people in their office have been off with a similar illness recently.

Your patient has no relevant past medical nor surgical history and is taking no regular medications.

Your patient informs you that they had a safari holiday 3 months ago in Tanzania and did not take malaria pills despite being recommended to do so by the tropical health centre prior to departure.