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Having recurrent low grade fever. Taking zifi 200. Blood test showed high ESR. Looking for cure

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Internal Medicine Specialist
Practicing since : 2001
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Hi,
My wife has recurrent low grad fever for last 3 months.
Following is the history of her illness and tretment done so far:

1. 26th March: Severe Abdominal Pain: Ultrasound and other tests done. Ultrasound also detected kidney stone and suspected appendicitis.

2. 27th March: During operation appenidx was found normal and instead rupture of Ovarian Cyst was seen, hence the cyst was operated with assistance from a Gynechologist.

3. 29th : Discharged from Hospital. Was on medication till next 7 days. Also took 10 Gentamicin injection due to urin infection reported in urin culture report.

4. 4th April: Doctors review suggested normal recovery. Antibotics stopped

5. 9th April: Some problem of stomach ache, loose motion, and fever (upto 102 degress reported). Ultrasound and CBC done done but were normal(other than the Kidney stone reported), Antibiotics: OfloxTz given.
Pain subsided and fever gone

6. 17th April: Re-review showed normal recovery.

7. Low grade Fever (< 99.5 degrees) persisted since then. Also, patient reported discomfort in the operation wound. Seemed like it didn't heal completly.

8. Upon reference from other doctor started taking Zifi-200 for 10 days. Fever subsided after stopping medicine intake for 4-5 days. Fever agains re-surfaced with temp ranging betwen 98-99.4 degrees.

9. On 27th May, CBC, Throid, Liver Profile, Lipid and Kidney profile, Urin routine. Everthing normal except for Urin pus cells=20-25

10. 2nd June: On doctors advice, Urin culture was done, less dense E-coli culture were seen but, doctor anticipated UTI and advised 14 amicacin injections.

11. 9th XXXXXXX : Injections were over. Fever not seen till the injections were given

12. 17th June: Fever (< 99.4) was again seen randomly ranging between 98.0-99.4 degrees.

13 Since 17th June: Fever is continously ranging between 98-99.4. While in morning its <98.6 but, > 98.6 any other time

14. July 1st Fever gone. Tmepretur is now ranging between 97.5-98.6

15. July 15th Fever reoccured and is ranging between 98-98.6 (in morning) to 98.7-99.3(in evening)

The tempreture chart in each occurence is something like

Morning Afternon Evening Night
98.0-98.6 98.4-99.1 98.7-99.3 98.7-99.3
There are no other symptoms. So far, I havent seen tempreture going above 99.4
Blood test shows high ESR (38), however other things are normal.
Ultrasound says normal except for a small kidney stone
There are no visible lumps or tumours visible in lymph node areas.
No weight loss till now (only .5 kg)
I have got her examined by two general physicians as well.
I am really scared of something serous happening.
Posted Thu, 9 Aug 2012 in General Health
 
 
Answered by Dr. Ram Choudhary 17 minutes later
XXXXXX,

Welcome to healthcare magic!
Thanks for putting up the case so beautifully.
The fever you are mentioning is having a temperature range that is most of the times in normal range.
A body temperature of 98.6 degrees is the standard but it's true in mornings only.
At other time when we are physically active or by the evening in otherwise also body temperature normally reaches 99.2degrees.
She must be having Anemia and loss of appetite. Due to that she is feeling tired and a normal temperature on higher side seems like fever to you.
I think she should move around, do light work and take balanced diets now rather than the antibiotics cocktail therapy.

I hope this advise would be helpful for you.

Still if you have any queries or doubts, please write me back,
I would be happy to solve them.

Wish you a great health!
Above answer was peer-reviewed by
 
Follow-up: Having recurrent low grade fever. Taking zifi 200. Blood test showed high ESR. Looking for cure 46 minutes later
Thanks a lot for the reply doctor.
This is also explained by other Physicially who saw her.

But, my concern is that she is doing the same work under same conditions all the time, but for 9-10 days the tempreture is less than 98.6 (or very few times > 98.6 but <99.0). Also, on those days, the morning tempreture is also normal like 97.5-97.9

Now a days again the morning tempreture is always > 98.0, but limited to 98.6. Earlier, she always had subnormal tempreture ranging between 97-98.6 (rarely would go upto 99), but, now she has almost 99.0-99.3 tempreture through out the day (with intermittent dips upto 98.7) before going to bed. When she goes to the bed in an airconditioned room the tempreture goes down upto 98.5 after 10-15 mins.
In the same conditions my tempreture is always normal.
For instance when she had 99.1 degree temp and at the same time in same conditions, I had 97.9. Can this be explained by difference in body metabolism. We both weren't doing anything at that time. I can confirm that in past she always had lesser body tempreture than mine.

So, I am wondering :
1. What has went wrong that elevated her normal tempreture.
2. Could that be related to some malignant behavior in the body.
3. Could that be auto immune disease due to high dose of antibiotics during her hospital stay and then after due to UTI.
4. She also has cervical spondilitis, which is disturbing her in daily life. Could that be a cause. However, I have read that this doesn't have any relation with the fever occurrence
5. She also has pain in her legs for last 1-2 year. Doctors say that it is due to varicose vein.

Best Regards
 
 
Answered by Dr. Ram Choudhary 5 hours later
Hi,

Welcome back to healthcare magic Physicians!
Convalescent body temperature is a bit more variable than normal one due to the inflammatory cascade that is now in declining phase.
As such women have slightly higher temperature in post ovulatory phase.
Malignancy is well known cause of fever, but taking a lead about malignancy by presence of fever would be too pessimistic same is true of autoimmune story.
Cervical spondylitis and varicose vein are not a cause of fever unless other factors like thrombophlebitis etc. is associated.
I think you should keep a regular follow up to your physician and mean while adjust to older routine life.
I think the advise would be helpful for you.

If you still have queries if any, please feel free to communicate back.

And if satisfied with my solution then please accept the answer and take a moment to post your view in the Review Section about my Clinical skills!

Wish you a great XXXXXXX
Above answer was peer-reviewed by
 
Follow-up: Having recurrent low grade fever. Taking zifi 200. Blood test showed high ESR. Looking for cure 12 hours later
Hi Doctor,
Thanks for the reply.
I also thought the same that Convalescent body temperature is a bit more variable than normal one due to the inflammatory cascade but, I am worried as its continuing for more than 3-4 months now.
Shouldn't that have subsided in 1-2 months.

What does inflammatory cascade mean. Does it imply, inflammatory conditions spreading over different parts or something else?
Does it elevate the ESR value as happened in this case?
What could be the duration or life cycle of this inflammation?
What kind of inflammation it could be?
What part of the body usually suffer from inflammation?
Any other test that can confirm these facts?

Sorry for all these kinds of queries but, I just want to clear out any kind of doubts sooner than later. I hope you understand

Best Regards
 
 
Answered by Dr. Ram Choudhary 3 hours later
Hi,

Welcome back to healthcare magic Physicians!

The inflammatory cascade is an intricate play of cytohormone called cytokines which are released in response to any generalised threat to body like infection and trauma etc. and is not limited to a system of body but affects whole body.
It's duration is variable depending on the type of primary condition that starts it and the back ground health of the individual.
A Fever, raised heart rate, raised respiratory rate and a raised or very low TLC can help detecting it.
ESR IS UNIFORMLY HIGH IN THESE CASES.

I think the advise would be helpful for you.

If you still have queries if any, please feel free to communicate back.

And if satisfied with my solution then please accept the answer and take a moment to post your view in the Review Section about my Clinical skills!

Wish you a great XXXXXXX
Above answer was peer-reviewed by
 
Follow-up: Having recurrent low grade fever. Taking zifi 200. Blood test showed high ESR. Looking for cure 2 hours later
Just few more questions:
1. I am still worried as its continuing for more than 3-4 months now.
Had there been some inflammation then shouldn't that have subsided XXXXXXX in 1-2 months if it is something not severe.? Usually, we have arthritis inflammation etc but, it goes away after some time or by medication. In my case, it isn't seem to happening.
2. Could this be due to multiple occurences?
3. Can there be `not so severe` inflammations lasting for several months post laproscopy?

Best regards
 
 
Answered by Dr. Ram Choudhary 9 hours later
Hi,
Welcome back to healthcare Magic!
Yes, I agree that 3-4months is a long time for the inflammation to pursue a patient but the severity is so less that it does not seem really of any major consequences. The multiple recurrences thing is a result rather than the cause.
There can be such cases when infection pocket form in abdomen and remain buried in there creating a ill health.
An ultrasound abdomen can be repeated to detect any such collection if the trouble persists longer.
If you need any further advise or clarification let me know.
If satisfied with my reply and clinical acumen then please accept the answer and spend a moment to put up a Review for me on the website's colum.
Above answer was peer-reviewed by
 
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