Does a patient with a 3-day history of fever, cough, sore throat, and rash, who has recently traveled and has not improved with medication, and has a normal platelet count, require hospital admission?

From the Guidelines

This patient likely requires hospital admission for further evaluation and management due to the combination of fever, cough, sore throat, and rash for 3 days, recent travel history, and lack of response to previous medication, which suggests a potentially serious infection. The patient's symptoms and travel history raise concerns for various infectious diseases, including malaria, dengue, and other region-specific pathogens 1. Although the normal platelet count is reassuring, it does not rule out significant illness.

The patient should be admitted for a diagnostic workup, including:

• Blood cultures
• Complete blood count
• Comprehensive metabolic panel
• Chest imaging
• Specific tests based on travel history, such as malaria smears, dengue, or other region-specific pathogens

Empiric treatment might include broad-spectrum antibiotics like ceftriaxone 1-2g IV daily plus azithromycin 500mg daily, with adjustments based on clinical findings and test results 1. Hospital admission allows for close monitoring of vital signs, respiratory status, and rash progression, as well as isolation if an infectious disease of public health concern is suspected. The combination of persistent symptoms, travel history, and treatment failure raises concerns for infections that could rapidly deteriorate without proper inpatient care and surveillance.

Given the most recent and highest quality study available 1, which highlights the importance of prompt diagnosis and treatment of severe malaria, it is crucial to consider this diagnosis in the differential diagnosis, especially given the patient's recent travel history. However, without more specific information on the patient's travel history and symptoms, it is difficult to provide a more targeted approach to management. Therefore, a comprehensive diagnostic workup and empiric treatment with broad-spectrum antibiotics, along with close monitoring, are recommended.

From the Research

Indication for Admission

The patient's symptoms, including a 3-day history of fever, cough, sore throat, and rash, along with recent travel and lack of improvement with medication, suggest a potential need for hospital admission.

• The patient's normal platelet count of 146 is within the normal range, which may not necessarily indicate a need for admission based on this factor alone.
• However, the combination of symptoms and travel history could suggest an infectious disease, potentially requiring hospitalization for further evaluation and treatment.

Consideration of Infectious Diseases

• Studies have shown that patients with influenza-like illnesses, such as the one described, may benefit from antiviral treatment and, in some cases, antibiotics 2.
• The patient's lack of improvement with medication and the presence of a rash could indicate a more severe infection, such as COVID-19, which may require hospitalization for oxygen supplementation and other supportive care 3.
• Oseltamivir treatment has been shown to reduce the incidence of lower respiratory tract complications and hospitalizations in patients with influenza-like illnesses 4.

Decision for Hospital Admission

• Given the patient's symptoms and lack of improvement with medication, hospital admission may be necessary for further evaluation and treatment.
• The decision for admission should be based on the patient's overall clinical presentation, including the severity of symptoms, travel history, and response to initial treatment.
• Hospital admission would allow for closer monitoring, further diagnostic testing, and the administration of supportive care, such as oxygen supplementation and antiviral medications, as needed.