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Updated 11 February 2013

Malaise

Malaise is a non-specific term, meaning a feeling of general discomfort or uneasiness. Malaise by itself is not diagnostic of any disorder.

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Description

Malaise is a non-specific term, meaning a feeling of general discomfort or uneasiness. Malaise by itself is not diagnostic of any disorder.

The early stage of an illness often has malaise as its only symptom: after a few hours, or even a few days, other more specific symptoms appear, which then allow the doctor to make a diagnosis.

Malaise is hardly ever an emergency. In some acute illnesses, the condition can progress very quickly, so that the phase of malaise is short-lived. The specific symptoms then, are those needing the urgent attention, not the malaise which preceded them.

Causes

As already stressed, many conditions have malaise in their early phase. Examples of important ones are:

Heart disease

  1. Infectious endocarditis
  2. Myocardial ischaemia
  3. Rhythm disturbances
  4. Heart failure

Infections

  1. Virus infections like ‘flu and glandular fever
  2. Bronchitis and pneumonia
  3. Hepatitis
  4. Tuberculosis
  5. Parasitic infestations

Endocrine/metabolic disorders

  1. Diabetes
  2. Thyroid disease
  3. Liver and pancreas disorders, gall-stones
  4. Liver and kidney failure
  5. Severe anaemia
  6. Auto-immune diseases

Malignancies

  1. Lymphomas
  2. Leukaemia
  3. Secondary deposits, for instance in the brain

Side effects of medications

  1. Antihypertensives
  2. Antihistamines
  3. Anticonvulsants
  4. Some psychiatric medications

Psychiatric

  1. Depression
  2. Dysthymia

Treatment

There is no treatment for malaise until the condition causing it has been diagnosed.

Diagnosis begins with clearly identifying any other possible symptoms, and is followed by a thorough examination, looking for any clues which may point to an underlying cause.

Only then can any blood tests or imaging be considered.

If general malaise persists with no clear symptoms emerging, it is reasonable to do a few basic screening tests such as:

  1. Full blood count and electrolytes,
  2. CRP, PCT,
  3. Kidney and liver functions, and
  4. Chest X-ray.

The results of these may point to other tests being necessary, for instance thyroid functions, or auto-antibody tests.

(Dr AG Hall)

 
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