from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import mm
from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import KeepTogether
from reportlab.graphics.shapes import Drawing, Rect, String, Line, Polygon, Arrow
from reportlab.graphics import renderPDF
from reportlab.platypus import Flowable
import textwrap

# ── colour palette ──────────────────────────────────────────────────────────
RED        = colors.HexColor("#C0392B")
ORANGE     = colors.HexColor("#E67E22")
TEAL       = colors.HexColor("#1A7A6E")
BLUE       = colors.HexColor("#2471A3")
PURPLE     = colors.HexColor("#7D3C98")
DARK_BLUE  = colors.HexColor("#1B2631")
LIGHT_BLUE = colors.HexColor("#D6EAF8")
LIGHT_RED  = colors.HexColor("#FADBD8")
LIGHT_TEAL = colors.HexColor("#D0ECE7")
LIGHT_ORANGE = colors.HexColor("#FDEBD0")
LIGHT_PURPLE = colors.HexColor("#E8DAEF")
LIGHT_GREY = colors.HexColor("#F2F3F4")
DARK_GREY  = colors.HexColor("#2C3E50")
WHITE      = colors.white
GOLD       = colors.HexColor("#D4AC0D")

PAGE_W, PAGE_H = A4  # 595 x 842 pts


# ── custom flowable: arrow-connected box ─────────────────────────────────────
class FlowBox(Flowable):
    """A single rounded box with an optional downward arrow below it."""
    def __init__(self, text, bg, fg=WHITE, width=None, height=40,
                 arrow=True, radius=6, font_size=9, bold=False):
        Flowable.__init__(self)
        self.text = text
        self.bg   = bg
        self.fg   = fg
        self.bw   = width or (PAGE_W - 80)
        self.bh   = height
        self.arrow = arrow
        self.radius = radius
        self.font_size = font_size
        self.bold  = bold
        self.width  = self.bw
        self.height = self.bh + (14 if arrow else 0)

    def draw(self):
        c = self.canv
        # box
        c.setFillColor(self.bg)
        c.setStrokeColor(colors.HexColor("#BDC3C7"))
        c.roundRect(0, 14 if self.arrow else 0,
                    self.bw, self.bh, self.radius, fill=1, stroke=1)
        # text
        c.setFillColor(self.fg)
        font = "Helvetica-Bold" if self.bold else "Helvetica"
        c.setFont(font, self.font_size)
        lines = self.text.split("\n")
        total_h = len(lines) * (self.font_size + 2)
        y_start = (14 if self.arrow else 0) + self.bh/2 + total_h/2 - self.font_size
        for line in lines:
            c.drawCentredString(self.bw/2, y_start, line)
            y_start -= (self.font_size + 2)
        # arrow
        if self.arrow:
            c.setStrokeColor(DARK_GREY)
            c.setFillColor(DARK_GREY)
            c.setLineWidth(1.5)
            cx = self.bw / 2
            c.line(cx, 13, cx, 2)
            # arrowhead
            c.setFillColor(DARK_GREY)
            p = c.beginPath()
            p.moveTo(cx, 0)
            p.lineTo(cx-4, 6)
            p.lineTo(cx+4, 6)
            p.close()
            c.drawPath(p, fill=1, stroke=0)


class DiamondBox(Flowable):
    """Decision diamond."""
    def __init__(self, text, bg=ORANGE, fg=WHITE, width=None, height=60, arrow=True):
        Flowable.__init__(self)
        self.text   = text
        self.bg     = bg
        self.fg     = fg
        self.bw     = width or (PAGE_W - 80)
        self.bh     = height
        self.arrow  = arrow
        self.width  = self.bw
        self.height = self.bh + (14 if arrow else 0)

    def draw(self):
        c   = self.canv
        bw, bh = self.bw, self.bh
        base_y = 14 if self.arrow else 0
        mx = bw / 2
        # diamond polygon
        c.setFillColor(self.bg)
        c.setStrokeColor(colors.HexColor("#BDC3C7"))
        c.setLineWidth(1)
        p = c.beginPath()
        p.moveTo(mx,       base_y + bh)       # top
        p.lineTo(bw,       base_y + bh/2)     # right
        p.lineTo(mx,       base_y)            # bottom
        p.lineTo(0,        base_y + bh/2)     # left
        p.close()
        c.drawPath(p, fill=1, stroke=1)
        # text
        c.setFillColor(self.fg)
        c.setFont("Helvetica-Bold", 9)
        lines = self.text.split("\n")
        y0 = base_y + bh/2 + (len(lines)-1)*6
        for line in lines:
            c.drawCentredString(mx, y0, line)
            y0 -= 13
        # arrow
        if self.arrow:
            c.setStrokeColor(DARK_GREY)
            c.setFillColor(DARK_GREY)
            c.setLineWidth(1.5)
            cx = bw / 2
            c.line(cx, 13, cx, 2)
            p2 = c.beginPath()
            p2.moveTo(cx, 0); p2.lineTo(cx-4, 6); p2.lineTo(cx+4, 6); p2.close()
            c.drawPath(p2, fill=1, stroke=0)


class TwoColumnBox(Flowable):
    """Two side-by-side coloured boxes (YES / NO branches)."""
    def __init__(self, left_text, right_text,
                 left_bg=RED, right_bg=TEAL,
                 left_fg=WHITE, right_fg=WHITE,
                 width=None, height=50, arrow=True):
        Flowable.__init__(self)
        self.lt = left_text;  self.rt = right_text
        self.lb = left_bg;    self.rb = right_bg
        self.lf = left_fg;    self.rf = right_fg
        self.bw = width or (PAGE_W - 80)
        self.bh = height
        self.arrow = arrow
        self.width  = self.bw
        self.height = self.bh + (14 if arrow else 0)

    def _draw_half(self, c, x, w, h, base_y, bg, fg, text, radius=6):
        c.setFillColor(bg)
        c.setStrokeColor(colors.HexColor("#BDC3C7"))
        c.roundRect(x, base_y, w, h, radius, fill=1, stroke=1)
        c.setFillColor(fg)
        c.setFont("Helvetica-Bold", 8)
        lines = text.split("\n")
        y0 = base_y + h/2 + (len(lines)-1)*5
        for line in lines:
            c.drawCentredString(x + w/2, y0, line)
            y0 -= 11

    def draw(self):
        c = self.canv
        base_y = 14 if self.arrow else 0
        half = (self.bw - 6) / 2
        self._draw_half(c, 0,          half, self.bh, base_y, self.lb, self.lf, self.lt)
        self._draw_half(c, half + 6,   half, self.bh, base_y, self.rb, self.rf, self.rt)
        if self.arrow:
            for cx in [half/2, half + 6 + half/2]:
                c.setStrokeColor(DARK_GREY); c.setFillColor(DARK_GREY)
                c.setLineWidth(1.5)
                c.line(cx, 13, cx, 2)
                p = c.beginPath()
                p.moveTo(cx,0); p.lineTo(cx-4,6); p.lineTo(cx+4,6); p.close()
                c.drawPath(p, fill=1, stroke=0)


class SectionHeader(Flowable):
    """Full-width coloured banner for section titles."""
    def __init__(self, number, title, bg=DARK_BLUE, fg=WHITE, width=None):
        Flowable.__init__(self)
        self.number = number
        self.title  = title
        self.bg     = bg
        self.fg     = fg
        self.bw     = width or (PAGE_W - 80)
        self.width  = self.bw
        self.height = 28

    def draw(self):
        c = self.canv
        c.setFillColor(self.bg)
        c.roundRect(0, 0, self.bw, 28, 5, fill=1, stroke=0)
        # number badge
        c.setFillColor(GOLD)
        c.circle(18, 14, 11, fill=1, stroke=0)
        c.setFillColor(DARK_BLUE)
        c.setFont("Helvetica-Bold", 11)
        c.drawCentredString(18, 10, str(self.number))
        # title
        c.setFillColor(self.fg)
        c.setFont("Helvetica-Bold", 11)
        c.drawString(38, 10, self.title)


def build_pdf(path):
    doc = SimpleDocTemplate(
        path, pagesize=A4,
        leftMargin=30, rightMargin=30,
        topMargin=28, bottomMargin=28
    )

    styles  = getSampleStyleSheet()
    BODY_W  = PAGE_W - 60   # usable width

    def style(name="Normal", size=8, color=DARK_GREY, align=TA_LEFT,
              bold=False, space_before=2, space_after=2):
        return ParagraphStyle(
            name, parent=styles["Normal"],
            fontSize=size, textColor=color,
            alignment=align, leading=size+3,
            fontName="Helvetica-Bold" if bold else "Helvetica",
            spaceBefore=space_before, spaceAfter=space_after
        )

    elems = []

    # ── TITLE BANNER ─────────────────────────────────────────────────────────
    title_tbl = Table(
        [[Paragraph(
            "<font color='white'><b>CLINICAL APPROACH TO FEVER IN OPD</b></font>",
            style(size=16, color=WHITE, align=TA_CENTER, bold=True)
          )],
         [Paragraph(
            "<font color='#D6EAF8'>A Systematic Flowchart | Based on Harrison's Principles of Internal Medicine 22E (2025)</font>",
            style(size=8, color=LIGHT_BLUE, align=TA_CENTER)
          )]],
        colWidths=[BODY_W]
    )
    title_tbl.setStyle(TableStyle([
        ("BACKGROUND",  (0,0), (-1,-1), DARK_BLUE),
        ("ROUNDEDCORNERS", [8]),
        ("TOPPADDING",  (0,0), (-1,-1), 12),
        ("BOTTOMPADDING",(0,0),(-1,-1), 10),
        ("LEFTPADDING", (0,0), (-1,-1), 12),
    ]))
    elems.append(title_tbl)
    elems.append(Spacer(1, 8))

    # definition strip
    def_tbl = Table(
        [[Paragraph(
            "Fever = Core body temperature <b>≥ 38.0°C (100.4°F)</b>  |  "
            "Normal oral temp: 36.1–37.2°C  |  "
            "Hyperpyrexia: >41.5°C (emergency)",
            style(size=8, color=DARK_GREY, align=TA_CENTER)
          )]],
        colWidths=[BODY_W]
    )
    def_tbl.setStyle(TableStyle([
        ("BACKGROUND",  (0,0), (-1,-1), LIGHT_BLUE),
        ("ROUNDEDCORNERS", [5]),
        ("TOPPADDING",  (0,0), (-1,-1), 6),
        ("BOTTOMPADDING",(0,0),(-1,-1), 6),
    ]))
    elems.append(def_tbl)
    elems.append(Spacer(1, 10))

    # ── STEP 1: TRIAGE ───────────────────────────────────────────────────────
    elems.append(SectionHeader(1, "IMMEDIATE TRIAGE  —  Is the patient stable?", bg=DARK_BLUE))
    elems.append(Spacer(1, 5))
    elems.append(DiamondBox("RED FLAGS present?", bg=ORANGE, height=52))
    elems.append(Spacer(1, 3))
    elems.append(TwoColumnBox(
        "YES → EMERGENCY\nAdmit / Refer\nSepsis protocol\nIV access + cultures\nEmpirical antibiotics",
        "NO → Stable Patient\nProceed to\ndetailed workup",
        left_bg=RED, right_bg=TEAL, height=52
    ))

    # red flags table
    elems.append(Spacer(1, 6))
    rf_data = [
        [Paragraph("<b>Red Flag</b>", style(8, WHITE, bold=True)),
         Paragraph("<b>Concern</b>", style(8, WHITE, bold=True))],
        ["HR >120, SBP <90 mmHg",          "Septic shock"],
        ["RR >30/min, SpO₂ <94%",           "Severe pneumonia / Sepsis"],
        ["Altered consciousness / confusion","Meningitis / Encephalopathy"],
        ["Petechiae / purpuric rash",        "Meningococcemia"],
        ["Neck stiffness + photophobia",     "Bacterial meningitis"],
        ["Fever + jaundice + RUQ pain",      "Ascending cholangitis"],
        ["Immunocompromised / neutropenic",  "Neutropenic fever (emergency)"],
        ["Fever + new cardiac murmur",       "Infective endocarditis"],
    ]
    rf_tbl = Table(rf_data, colWidths=[BODY_W*0.45, BODY_W*0.55])
    rf_tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,0),  RED),
        ("TEXTCOLOR",     (0,0), (-1,0),  WHITE),
        ("FONTNAME",      (0,0), (-1,0),  "Helvetica-Bold"),
        ("FONTSIZE",      (0,0), (-1,-1), 8),
        ("BACKGROUND",    (0,1), (-1,-1), LIGHT_RED),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [colors.HexColor("#FDEDEC"), LIGHT_RED]),
        ("GRID",          (0,0), (-1,-1), 0.4, colors.HexColor("#E8DAEF")),
        ("TOPPADDING",    (0,0), (-1,-1), 3),
        ("BOTTOMPADDING", (0,0), (-1,-1), 3),
        ("LEFTPADDING",   (0,0), (-1,-1), 5),
    ]))
    elems.append(rf_tbl)
    elems.append(Spacer(1, 10))

    # ── STEP 2: HISTORY ──────────────────────────────────────────────────────
    elems.append(SectionHeader(2, "DETAILED HISTORY", bg=BLUE))
    elems.append(Spacer(1, 5))

    hist_data = [
        [Paragraph("<b>Domain</b>", style(8, WHITE, bold=True)),
         Paragraph("<b>Key Questions</b>", style(8, WHITE, bold=True))],
        ["Fever pattern",   "Onset, duration, degree, diurnal variation, rigors, response to antipyretics"],
        ["Respiratory",     "Cough, sputum colour, dyspnoea, pleuritic chest pain"],
        ["GI",              "Nausea, vomiting, diarrhoea, abdominal pain, jaundice, change in stool colour"],
        ["Urinary",         "Dysuria, frequency, urgency, loin pain, haematuria"],
        ["CNS",             "Headache, neck stiffness, photophobia, confusion, seizures"],
        ["Skin",            "Rash (type, distribution, progression), ulcers, swellings"],
        ["MSK",             "Joint swelling/pain, myalgia, bone pain"],
        ["Constitutional",  "Night sweats, weight loss (>10%), anorexia, fatigue"],
        ["Travel history",  "Malaria zone, typhoid-endemic area, dengue belt, recent international travel"],
        ["Exposures",       "Animal contact, tick/mosquito bites, raw food, sick contacts, sexual history"],
        ["Medications",     "Any new drug in last 4 weeks (drug fever), immunosuppressants, steroids"],
        ["PMH / Immune",    "HIV, diabetes, malignancy, prosthetic valves, prior TB/malaria, transplant"],
        ["Vaccination",     "Typhoid, Hep A/B, meningococcal, influenza status"],
    ]
    hist_tbl = Table(hist_data, colWidths=[BODY_W*0.22, BODY_W*0.78])
    hist_tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,0),  BLUE),
        ("TEXTCOLOR",     (0,0), (-1,0),  WHITE),
        ("FONTNAME",      (0,0), (-1,0),  "Helvetica-Bold"),
        ("FONTSIZE",      (0,0), (-1,-1), 7.5),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [LIGHT_BLUE, colors.HexColor("#EBF5FB")]),
        ("GRID",          (0,0), (-1,-1), 0.4, colors.HexColor("#AED6F1")),
        ("TOPPADDING",    (0,0), (-1,-1), 3),
        ("BOTTOMPADDING", (0,0), (-1,-1), 3),
        ("LEFTPADDING",   (0,0), (-1,-1), 5),
        ("FONTNAME",      (0,1), (0,-1),  "Helvetica-Bold"),
        ("TEXTCOLOR",     (0,1), (0,-1),  BLUE),
    ]))
    elems.append(hist_tbl)
    elems.append(Spacer(1, 10))

    # ── STEP 3: FEVER PATTERNS ───────────────────────────────────────────────
    elems.append(SectionHeader(3, "FEVER PATTERNS  (Temperature Curve)", bg=PURPLE))
    elems.append(Spacer(1, 5))

    fp_data = [
        [Paragraph("<b>Pattern</b>", style(8, WHITE, bold=True)),
         Paragraph("<b>Description</b>", style(8, WHITE, bold=True)),
         Paragraph("<b>Classic Association</b>", style(8, WHITE, bold=True))],
        ["Continuous / Sustained", "Persistent; variation <1°C; never normal",    "Typhoid, lobar pneumonia, UTI"],
        ["Remittent",              "Fluctuates >1°C; never reaches normal",        "Most bacterial infections"],
        ["Intermittent",           "Spikes then returns to normal daily",           "Malaria (P. vivax 48h), abscesses"],
        ["Tertian",                "Fever every 3rd day",                           "P. vivax / P. ovale malaria"],
        ["Quartan",                "Fever every 4th day",                           "P. malariae malaria"],
        ["Hectic / Septic",        "Wide swings + drenching sweats",               "Pyogenic abscesses, endocarditis"],
        ["Pel–Ebstein",            "Weeks of fever alternating with afebrile weeks","Hodgkin's lymphoma"],
        ["Relapsing",              "Recurrent febrile episodes with remission",    "Brucellosis, Borrelia, malaria"],
    ]
    fp_tbl = Table(fp_data, colWidths=[BODY_W*0.22, BODY_W*0.40, BODY_W*0.38])
    fp_tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,0),  PURPLE),
        ("TEXTCOLOR",     (0,0), (-1,0),  WHITE),
        ("FONTNAME",      (0,0), (-1,0),  "Helvetica-Bold"),
        ("FONTSIZE",      (0,0), (-1,-1), 7.5),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [LIGHT_PURPLE, colors.HexColor("#F5EEF8")]),
        ("GRID",          (0,0), (-1,-1), 0.4, colors.HexColor("#D7BDE2")),
        ("TOPPADDING",    (0,0), (-1,-1), 3),
        ("BOTTOMPADDING", (0,0), (-1,-1), 3),
        ("LEFTPADDING",   (0,0), (-1,-1), 5),
        ("FONTNAME",      (0,1), (0,-1),  "Helvetica-Bold"),
        ("TEXTCOLOR",     (0,1), (0,-1),  PURPLE),
    ]))
    elems.append(fp_tbl)
    elems.append(Spacer(1, 10))

    # ── STEP 4: PHYSICAL EXAMINATION ─────────────────────────────────────────
    elems.append(SectionHeader(4, "PHYSICAL EXAMINATION", bg=TEAL))
    elems.append(Spacer(1, 5))

    pe_data = [
        [Paragraph("<b>System</b>", style(8, WHITE, bold=True)),
         Paragraph("<b>Key Findings</b>", style(8, WHITE, bold=True)),
         Paragraph("<b>Significance</b>", style(8, WHITE, bold=True))],
        ["Vitals",           "Temp, HR, BP, RR, SpO₂; pulse–temp dissociation",     "Typhoid if HR low despite high fever"],
        ["General",          "Toxic vs. well appearance, pallor, icterus, cyanosis", "Severity assessment"],
        ["Skin",             "Rash type & distribution, petechiae, eschar, jaundice","Meningococcemia, typhus, viral exanthem"],
        ["Eyes",             "Icterus, conjunctival suffusion, Roth spots",           "Hepatitis, leptospirosis, endocarditis"],
        ["ENT",              "Tonsillar exudate, pharyngeal erythema, sinus tender.", "Strep, EBV, sinusitis"],
        ["Neck",             "Kernig's/Brudzinski's, lymphadenopathy, thyroid",       "Meningitis, lymphoma, thyroiditis"],
        ["Chest / CVS",      "Crepitations, bronchial breathing, new murmur, rub",   "Pneumonia, endocarditis, pericarditis"],
        ["Abdomen",          "Hepatomegaly, splenomegaly, tenderness, rigidity",      "Malaria, typhoid, hepatitis, abscess"],
        ["Joints",           "Swelling, warmth, tenderness",                          "Septic arthritis, rheumatic fever"],
        ["GU",               "CVA tenderness, urethral discharge",                    "Pyelonephritis, STI"],
        ["Neuro",            "Focal deficits, consciousness (GCS), fundoscopy",       "Encephalitis, meningitis"],
    ]
    pe_tbl = Table(pe_data, colWidths=[BODY_W*0.16, BODY_W*0.43, BODY_W*0.41])
    pe_tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,0),  TEAL),
        ("TEXTCOLOR",     (0,0), (-1,0),  WHITE),
        ("FONTNAME",      (0,0), (-1,0),  "Helvetica-Bold"),
        ("FONTSIZE",      (0,0), (-1,-1), 7.5),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [LIGHT_TEAL, colors.HexColor("#E8F8F5")]),
        ("GRID",          (0,0), (-1,-1), 0.4, colors.HexColor("#A9DFBF")),
        ("TOPPADDING",    (0,0), (-1,-1), 3),
        ("BOTTOMPADDING", (0,0), (-1,-1), 3),
        ("LEFTPADDING",   (0,0), (-1,-1), 5),
        ("FONTNAME",      (0,1), (0,-1),  "Helvetica-Bold"),
        ("TEXTCOLOR",     (0,1), (0,-1),  TEAL),
    ]))
    elems.append(pe_tbl)
    elems.append(Spacer(1, 10))

    # ── STEP 5: CLASSIFY FEVER ───────────────────────────────────────────────
    elems.append(SectionHeader(5, "CLASSIFY THE FEVER BY DURATION", bg=colors.HexColor("#1F618D")))
    elems.append(Spacer(1, 5))

    dur_data = [
        [Paragraph("<b>Category</b>", style(8, WHITE, bold=True)),
         Paragraph("<b>Duration</b>", style(8, WHITE, bold=True)),
         Paragraph("<b>Common Causes</b>", style(8, WHITE, bold=True)),
         Paragraph("<b>Workup Focus</b>", style(8, WHITE, bold=True))],
        [Paragraph("<b>Acute Fever</b>", style(8, TEAL, bold=True)),
         "< 1 week",
         "Viral URTI, malaria, dengue, UTI, bacterial pneumonia, gastroenteritis",
         "CBC, malaria smear, dengue NS1, urine R/E, CXR"],
        [Paragraph("<b>Subacute Fever</b>", style(8, ORANGE, bold=True)),
         "1 – 3 weeks",
         "Typhoid, brucellosis, infective endocarditis, TB, malignancy",
         "Blood cultures ×2, Widal/Typhidot, Echo, CT, ESR/CRP"],
        [Paragraph("<b>FUO</b>", style(8, RED, bold=True)),
         "> 3 weeks\n(undiagnosed)",
         "Infectious (TB, endocarditis), NIID (SLE, vasculitis), Malignancy (lymphoma), Drug fever",
         "PET-CT, bone marrow biopsy, temporal artery biopsy, ANA/ANCA"],
    ]
    dur_tbl = Table(dur_data, colWidths=[BODY_W*0.17, BODY_W*0.13, BODY_W*0.42, BODY_W*0.28])
    dur_tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,0),  colors.HexColor("#1F618D")),
        ("TEXTCOLOR",     (0,0), (-1,0),  WHITE),
        ("FONTNAME",      (0,0), (-1,0),  "Helvetica-Bold"),
        ("FONTSIZE",      (0,0), (-1,-1), 7.5),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [LIGHT_TEAL, LIGHT_ORANGE, LIGHT_RED]),
        ("GRID",          (0,0), (-1,-1), 0.4, colors.HexColor("#AED6F1")),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 5),
        ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
    ]))
    elems.append(dur_tbl)
    elems.append(Spacer(1, 10))

    # ── STEP 6: INVESTIGATIONS ───────────────────────────────────────────────
    elems.append(SectionHeader(6, "INVESTIGATIONS", bg=colors.HexColor("#117A65")))
    elems.append(Spacer(1, 5))

    # Tier 1
    elems.append(Paragraph("TIER 1 — First-Line (All Patients)", style(8, TEAL, bold=True)))
    elems.append(Spacer(1, 3))
    t1_data = [
        [Paragraph("<b>Test</b>", style(8, WHITE, bold=True)),
         Paragraph("<b>Rationale / Interpretation</b>", style(8, WHITE, bold=True))],
        ["CBC with differential",    "Leukocytosis (bacterial), leukopenia (viral/typhoid), eosinophilia (parasites), atypical lymphocytes (EBV)"],
        ["ESR / CRP",                "Nonspecific inflammation marker; very elevated in bacterial infections & autoimmune disease"],
        ["Blood culture ×2",         "Pre-antibiotic; gold standard for bacteremia, typhoid, endocarditis"],
        ["Urine R/E + culture",       "Rule out UTI / pyelonephritis in all patients with unexplained fever"],
        ["Peripheral blood smear",    "Mandatory if any travel history; identifies malaria species & parasitaemia"],
        ["Chest X-ray",              "Pneumonia, TB (primary/reactivation), lymphoma, pleural effusion, cardiomegaly"],
        ["LFT / RFT",                "Hepatitis, leptospirosis (jaundice), renal involvement in sepsis"],
        ["Blood glucose",             "Assess immune compromise in uncontrolled diabetes"],
        ["Serum electrolytes",        "Dehydration, SIADH in CNS infections"],
        ["Widal / Typhidot IgM",      "(Endemic areas) Enteric fever — note: interpret with clinical context"],
        ["Dengue NS1 antigen",        "(Days 1–5) Dengue fever; add IgM/IgG from day 5 onwards"],
    ]
    t1_tbl = Table(t1_data, colWidths=[BODY_W*0.28, BODY_W*0.72])
    t1_tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,0),  colors.HexColor("#117A65")),
        ("TEXTCOLOR",     (0,0), (-1,0),  WHITE),
        ("FONTNAME",      (0,0), (-1,0),  "Helvetica-Bold"),
        ("FONTSIZE",      (0,0), (-1,-1), 7.5),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [LIGHT_TEAL, colors.HexColor("#E8F8F5")]),
        ("GRID",          (0,0), (-1,-1), 0.4, colors.HexColor("#A2D9CE")),
        ("TOPPADDING",    (0,0), (-1,-1), 3),
        ("BOTTOMPADDING", (0,0), (-1,-1), 3),
        ("LEFTPADDING",   (0,0), (-1,-1), 5),
        ("FONTNAME",      (0,1), (0,-1),  "Helvetica-Bold"),
        ("TEXTCOLOR",     (0,1), (0,-1),  colors.HexColor("#117A65")),
    ]))
    elems.append(t1_tbl)
    elems.append(Spacer(1, 7))

    # Tier 2
    elems.append(Paragraph("TIER 2 — Targeted Tests (Based on Clinical Clues)", style(8, ORANGE, bold=True)))
    elems.append(Spacer(1, 3))
    t2_data = [
        [Paragraph("<b>Suspected Diagnosis</b>", style(8, WHITE, bold=True)),
         Paragraph("<b>Additional Tests</b>", style(8, WHITE, bold=True))],
        ["Tuberculosis",           "Mantoux test, sputum AFB ×3, ADA, HRCT chest, GeneXpert MTB/RIF"],
        ["Malaria",                "Thick & thin films, malaria RDT, PCR for speciation"],
        ["HIV",                    "HIV ELISA, p24 antigen, CD4 count, viral load"],
        ["Dengue (severe)",        "Serial CBC for thrombocytopenia, LFT, dengue IgM/IgG"],
        ["Leptospirosis",          "MAT (microscopic agglutination test), IgM ELISA, urine culture"],
        ["EBV / CMV",              "Monospot test, EBV IgM VCA, CMV IgM, atypical lymphocytes"],
        ["Infective Endocarditis", "TTE / TEE echocardiography, serial blood cultures ×3"],
        ["Meningitis",             "LP: CSF cell count, protein, glucose, culture, Gram stain, PCR"],
        ["Autoimmune / NIID",      "ANA, anti-dsDNA, ANCA, complement (C3/C4), RF, anti-CCP"],
        ["Malignancy",             "LDH, uric acid, SPEP, CT-PET, bone marrow biopsy"],
        ["Brucellosis",            "Brucella serology (SAT / ELISA), blood culture (Castañeda method)"],
    ]
    t2_tbl = Table(t2_data, colWidths=[BODY_W*0.28, BODY_W*0.72])
    t2_tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,0),  ORANGE),
        ("TEXTCOLOR",     (0,0), (-1,0),  WHITE),
        ("FONTNAME",      (0,0), (-1,0),  "Helvetica-Bold"),
        ("FONTSIZE",      (0,0), (-1,-1), 7.5),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [LIGHT_ORANGE, colors.HexColor("#FDFEFE")]),
        ("GRID",          (0,0), (-1,-1), 0.4, colors.HexColor("#FAD7A0")),
        ("TOPPADDING",    (0,0), (-1,-1), 3),
        ("BOTTOMPADDING", (0,0), (-1,-1), 3),
        ("LEFTPADDING",   (0,0), (-1,-1), 5),
        ("FONTNAME",      (0,1), (0,-1),  "Helvetica-Bold"),
        ("TEXTCOLOR",     (0,1), (0,-1),  ORANGE),
    ]))
    elems.append(t2_tbl)
    elems.append(Spacer(1, 10))

    # ── STEP 7: DIFFERENTIAL DIAGNOSIS ───────────────────────────────────────
    elems.append(SectionHeader(7, "DIFFERENTIAL DIAGNOSIS  —  4 Main Categories", bg=colors.HexColor("#6C3483")))
    elems.append(Spacer(1, 5))

    dd_data = [
        [Paragraph("<b>Infectious (50–60% in tropics)</b>", style(8, WHITE, bold=True)),
         Paragraph("<b>NIID (20–30% in West)</b>", style(8, WHITE, bold=True)),
         Paragraph("<b>Malignancy (10–20%)</b>", style(8, WHITE, bold=True)),
         Paragraph("<b>Miscellaneous</b>", style(8, WHITE, bold=True))],
        [Paragraph("Bacterial: Typhoid, TB, brucellosis, endocarditis, pyelonephritis, abscess, pneumonia\n\n"
                   "Viral: Dengue, EBV, CMV, Hep A/E, HIV\n\n"
                   "Parasitic: Malaria, visceral leishmaniasis\n\n"
                   "Fungal: Histoplasma, Candida (immunocomp.)", style(7.5, DARK_GREY)),
         Paragraph("SLE\nAdult Still's disease\nVasculitis (GCA, PAN)\nIBD (Crohn's)\nSarcoidosis\nRheumatoid arthritis\nPMR (elderly)\nAutoinflammatory syndromes", style(7.5, DARK_GREY)),
         Paragraph("Hodgkin's lymphoma\n(Pel–Ebstein fever)\nNon-Hodgkin's lymphoma\nLeukemia (AML/ALL)\nRenal cell carcinoma\nHepatic malignancy\nPrimary liver tumour", style(7.5, DARK_GREY)),
         Paragraph("Drug fever\n(stop suspect drug;\nfever resolves in 72h)\n\nFactitious fever\n\nHeat stroke\n\nThyroid storm\n\nAdrenal insufficiency", style(7.5, DARK_GREY))],
    ]
    dd_tbl = Table(dd_data, colWidths=[BODY_W*0.30, BODY_W*0.22, BODY_W*0.23, BODY_W*0.25])
    dd_tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (0,0),  RED),
        ("BACKGROUND",    (1,0), (1,0),  BLUE),
        ("BACKGROUND",    (2,0), (2,0),  PURPLE),
        ("BACKGROUND",    (3,0), (3,0),  TEAL),
        ("TEXTCOLOR",     (0,0), (-1,0), WHITE),
        ("FONTNAME",      (0,0), (-1,0), "Helvetica-Bold"),
        ("FONTSIZE",      (0,0), (-1,-1), 7.5),
        ("BACKGROUND",    (0,1), (0,1),  LIGHT_RED),
        ("BACKGROUND",    (1,1), (1,1),  LIGHT_BLUE),
        ("BACKGROUND",    (2,1), (2,1),  LIGHT_PURPLE),
        ("BACKGROUND",    (3,1), (3,1),  LIGHT_TEAL),
        ("GRID",          (0,0), (-1,-1), 0.4, colors.HexColor("#D5D8DC")),
        ("TOPPADDING",    (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING",   (0,0), (-1,-1), 5),
        ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ]))
    elems.append(dd_tbl)
    elems.append(Spacer(1, 10))

    # ── STEP 8: FUO WORKUP ───────────────────────────────────────────────────
    elems.append(SectionHeader(8, "FUO WORKUP  (Fever > 3 weeks, undiagnosed)", bg=RED))
    elems.append(Spacer(1, 5))

    fuo_data = [
        [Paragraph("<b>Stage</b>", style(8, WHITE, bold=True)),
         Paragraph("<b>Action</b>", style(8, WHITE, bold=True))],
        [Paragraph("<b>Stage 1</b>\nRepeat basics", style(8, RED, bold=True)),
         "Repeat detailed history + thorough physical exam; ensure no obvious diagnosis missed; CBC, CRP, LFT, RFT, UA, blood cultures"],
        [Paragraph("<b>Stage 2</b>\nAdvanced imaging", style(8, RED, bold=True)),
         "CT chest/abdomen/pelvis; PET-CT (most sensitive for occult infection & malignancy); Echocardiography (TEE); specific serologies: ANA, ANCA, cryoglobulins, Q fever IFA"],
        [Paragraph("<b>Stage 3</b>\nInvasive procedures", style(8, RED, bold=True)),
         "Bone marrow biopsy (pancytopenia, haematological malignancy, TB, leishmaniasis); temporal artery biopsy (elderly, high ESR → GCA); liver biopsy (granulomatous hepatitis); lymph node biopsy"],
        [Paragraph("<b>Stage 4</b>\nWatchful waiting", style(8, RED, bold=True)),
         "If patient is stable and no diagnosis established: avoid empirical antibiotics/steroids; monitor closely; reassess after 2–4 weeks; reconsider entire differential"],
    ]
    fuo_tbl = Table(fuo_data, colWidths=[BODY_W*0.20, BODY_W*0.80])
    fuo_tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,0),  RED),
        ("TEXTCOLOR",     (0,0), (-1,0),  WHITE),
        ("FONTNAME",      (0,0), (-1,0),  "Helvetica-Bold"),
        ("FONTSIZE",      (0,0), (-1,-1), 7.5),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [colors.HexColor("#FDEDEC"), LIGHT_RED]),
        ("GRID",          (0,0), (-1,-1), 0.4, colors.HexColor("#F1948A")),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 5),
        ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ]))
    elems.append(fuo_tbl)
    elems.append(Spacer(1, 10))

    # ── STEP 9: TREATMENT DECISION ───────────────────────────────────────────
    elems.append(SectionHeader(9, "TREATMENT DECISION", bg=colors.HexColor("#1E8449")))
    elems.append(Spacer(1, 5))

    tx_data = [
        [Paragraph("<b>Condition</b>", style(8, WHITE, bold=True)),
         Paragraph("<b>Treatment</b>", style(8, WHITE, bold=True))],
        ["Sepsis / Bacteremia",      "IV broad-spectrum antibiotics within 1 hour; blood cultures first; source control"],
        ["Typhoid fever",            "Ceftriaxone 2g IV OD (7–14 days) OR azithromycin 1g OD (5 days); ciprofloxacin if sensitive"],
        ["Malaria (P. falciparum)",  "ACT (artemether–lumefantrine or artesunate); severe → IV artesunate"],
        ["Malaria (P. vivax)",       "Chloroquine + primaquine (after G6PD test)"],
        ["Pneumonia (CAP)",          "Amoxicillin-clavulanate ± azithromycin; severe → IV ceftriaxone + azithromycin"],
        ["TB",                       "RHEZ for 2 months → RH for 4 months (DOTS regimen); DOTS compliance mandatory"],
        ["Dengue",                   "Supportive: IV fluids, paracetamol (NO NSAIDs/aspirin); monitor platelets"],
        ["Viral URTI",               "Supportive; paracetamol, hydration, rest; antibiotics NOT indicated"],
        ["Autoimmune (SLE, etc.)",   "NSAIDs for mild; hydroxychloroquine + steroids; DMARDs for refractory disease"],
        ["Malignancy",               "Refer oncology; treat any concurrent infection; symptom palliation"],
        ["Drug fever",               "Stop offending drug; fever typically resolves within 48–72 hours"],
    ]
    tx_tbl = Table(tx_data, colWidths=[BODY_W*0.27, BODY_W*0.73])
    tx_tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,0),  colors.HexColor("#1E8449")),
        ("TEXTCOLOR",     (0,0), (-1,0),  WHITE),
        ("FONTNAME",      (0,0), (-1,0),  "Helvetica-Bold"),
        ("FONTSIZE",      (0,0), (-1,-1), 7.5),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [LIGHT_TEAL, colors.HexColor("#F9FBE7")]),
        ("GRID",          (0,0), (-1,-1), 0.4, colors.HexColor("#82E0AA")),
        ("TOPPADDING",    (0,0), (-1,-1), 3),
        ("BOTTOMPADDING", (0,0), (-1,-1), 3),
        ("LEFTPADDING",   (0,0), (-1,-1), 5),
        ("FONTNAME",      (0,1), (0,-1),  "Helvetica-Bold"),
        ("TEXTCOLOR",     (0,1), (0,-1),  colors.HexColor("#1E8449")),
    ]))
    elems.append(tx_tbl)
    elems.append(Spacer(1, 8))

    # antipyretics strip
    ap_tbl = Table(
        [[Paragraph(
            "  <b>ANTIPYRETICS:</b>  Paracetamol 500–1000 mg PO q6h (adults) | 15 mg/kg q6h (children)  |  "
            "Ibuprofen (avoid in dengue, dehydration, renal impairment)  |  "
            "<b>Avoid aspirin in children</b> (Reye's syndrome risk)  |  "
            "Always ensure adequate oral / IV hydration",
            style(7.5, DARK_GREY, align=TA_LEFT)
          )]],
        colWidths=[BODY_W]
    )
    ap_tbl.setStyle(TableStyle([
        ("BACKGROUND",  (0,0), (-1,-1), colors.HexColor("#FEF9E7")),
        ("LEFTBORDER",  (0,0), (0,-1),  4, GOLD),
        ("TOPPADDING",  (0,0), (-1,-1), 5),
        ("BOTTOMPADDING",(0,0),(-1,-1), 5),
        ("LEFTPADDING", (0,0), (-1,-1), 8),
        ("BOX",         (0,0), (-1,-1), 0.5, GOLD),
    ]))
    elems.append(ap_tbl)
    elems.append(Spacer(1, 8))

    # ── WHEN TO ADMIT ─────────────────────────────────────────────────────────
    elems.append(SectionHeader(10, "WHEN TO ADMIT / REFER URGENTLY", bg=RED))
    elems.append(Spacer(1, 5))

    admit_items = [
        "Fever >40°C unresponsive to antipyretics",
        "Any haemodynamic instability (HR >120, SBP <90 mmHg)",
        "Fever + meningism OR altered consciousness",
        "Fever + purpuric / petechial rash",
        "Immunocompromised host (HIV, transplant, chemotherapy, neutropenia)",
        "Unable to maintain oral intake / severe dehydration",
        "Fever of Unknown Origin requiring further inpatient workup",
        "Suspected endocarditis, severe malaria, complicated typhoid",
    ]
    admit_data = [[Paragraph(f"✦  {item}", style(8, DARK_GREY))] for item in admit_items]
    admit_tbl = Table(admit_data, colWidths=[BODY_W])
    admit_tbl.setStyle(TableStyle([
        ("ROWBACKGROUNDS", (0,0), (-1,-1), [LIGHT_RED, colors.HexColor("#FDFEFE")]),
        ("GRID",           (0,0), (-1,-1), 0.3, colors.HexColor("#F1948A")),
        ("TOPPADDING",     (0,0), (-1,-1), 3),
        ("BOTTOMPADDING",  (0,0), (-1,-1), 3),
        ("LEFTPADDING",    (0,0), (-1,-1), 8),
    ]))
    elems.append(admit_tbl)
    elems.append(Spacer(1, 10))

    # ── CLINICAL PEARL ────────────────────────────────────────────────────────
    pearl_tbl = Table(
        [[Paragraph(
            "  ★  <b>CLINICAL PEARL (Harrison's 22E):</b>  The single most valuable step in any fever workup is a "
            "<b>detailed history and physical examination</b>. Most FUOs represent atypical presentations of "
            "common diseases, not rare diagnoses. Infections account for >50% of FUO in the tropics (TB predominates); "
            "Non-Infectious Inflammatory Diseases predominate in the West. "
            "<b>Avoid empirical antibiotics in stable, undiagnosed patients</b> — they obscure the diagnostic picture and promote resistance.",
            style(7.5, DARK_GREY, align=TA_JUSTIFY)
          )]],
        colWidths=[BODY_W]
    )
    pearl_tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), colors.HexColor("#FEF5E7")),
        ("BOX",           (0,0), (-1,-1), 1.5, GOLD),
        ("TOPPADDING",    (0,0), (-1,-1), 8),
        ("BOTTOMPADDING", (0,0), (-1,-1), 8),
        ("LEFTPADDING",   (0,0), (-1,-1), 10),
        ("RIGHTPADDING",  (0,0), (-1,-1), 10),
    ]))
    elems.append(pearl_tbl)
    elems.append(Spacer(1, 6))

    # ── FOOTER ────────────────────────────────────────────────────────────────
    footer_tbl = Table(
        [[Paragraph(
            "Source: Harrison's Principles of Internal Medicine 22E (2025, McGraw-Hill) — "
            "Ch. 21 Fever & Rash | Ch. 22 Fever of Unknown Origin | Ch. 79 Infections in Cancer  |  "
            "Generated by Orris Clinical AI  |  For educational use only",
            style(6.5, colors.HexColor("#808B96"), align=TA_CENTER)
          )]],
        colWidths=[BODY_W]
    )
    footer_tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), LIGHT_GREY),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
    ]))
    elems.append(footer_tbl)

    doc.build(elems)
    print(f"PDF saved: {path}")


if __name__ == "__main__":
    out = "/home/daytona/workspace/fever-flowchart/Fever_Workup_Flowchart.pdf"
    build_pdf(out)

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/fever-flowchart/generate_fever_pdf.py'

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/fever-flowchart/generate_fever_pdf.py'