OBSCURE ILLNESSES

In some of the illnesses clinical-picture is not clear-cut. Diagnosis and in-turn management is difficult. These illnesses are called OBSCURE ILLNESSES. They do exist but are not common. If you are coming across these illnesses frequently, it is likely your approach and analysis need more logical modification. The diagnosis of functional illness should be made positively after adequate and logical exclusion of the possibility of organic illness.

ONE SHOULD CONSIDER FOLLOWING POSSIBILITIES BEFORE LABELING AN ILLNESS OBSCURE.

PRODROMAL STAGE(EARLY STAGE/DISEASE NOT FULLY EVOLVED)

VARIATION IN PICTURE( BECAUSE OF AGE, ASSOCIATED CONDITIONS, TREATMENT TAKEN)

UNCOMMON PRESENTATION(e.g. ANICTERIC-HEPATITIS) / NORMAL FINDING/PRESENTATION CONSIDERED ILLNESS)

UNCOMMON ILLNESS

FUNCTIONAL ILLNESS

In the early stage different illnesses may have same manifestations. In the early stage bronchopneumonia, whooping cough, measles manifest similarly, after few days clinical picture becomes clear. Frequent observation/evaluation is helpful and required in obscure illnesses.

Clinical picture is altered/may be altered because of age, associated conditions and treatment taken

In infants meningitis may manifest without neck rigidity and whooping cough without whoop. In the malnourished children infections may present without fever. In partially treated malaria and typhoid patients fever persists but parasites are not seen/ widal titer does not rise.

Uncommon (atypical) presentation of common illnesses

Some of the common illnesses may mislead the physician because of uncommon presentation and falsely called obscure. Hepatitis usually present with jaundice but may present without it (anicteric hepatitis), tonsillitis usually present with fever and throat pain, but in some patients the only presentation may be pain in abdomen (because of associated mesenteric adenitis).

Normal finding / presentation considered illness

If regurgitation is considered vomiting or innocent murmur a pathological murmur, investigations reveal no abnormality and the illness is falsely called obscure

Uncommon illnesses

Uncommon illnesses are not common in primary care but may be encountered. These may not be diagnosed and may remain obscure for a long time. Do not forget uncommon illnesses but consider them after thorough exclusion of common illnesses.

Functional illnesses

These are not common in children but do exist. Consider this possibility after thorough exclusion of organic illnesses. In addition to exclusion of organic illnesses diagnose functional illnesses positively.

Consider this if problem is recurrent / no abnormal finding is detected / treatment is not effective /
there is gain to the patient