Brief Answer:
Reason of fever in brain damage

Detailed Answer:
Hi, thanks for asking from HCM.


I can understand your concern. Your son had severe traumatic brain injury. He has been managed from that aspect, but still bed ridden. There are so many reasons of chronic fever in a bed ridden brain injury patient, I am going to mention all possibilities. You can discuss it with your doctor

: Bed sore - It can occur on back/head/heel. It is also known as pressure sore and occurs due to pressure on prominent points.
You can look for it. Pus from it or even discharge from it may be the cause of fever.
It can be managed by regular dressing, change posture every 2 hourly, use air/water mattress.

: I V cannula site - If he is having IV (intravenous) cannula, kindly feel vein for hardening. It is "thrombophelibitis". Even old cannula can cause fever.
If you find old cannula or thrombophelibitis, kindly ask to remove cannula and apply "heparin gel" over it. Usual treatment is "anti-inflammatory medicine like Diclofenac sodium.

: Autonomic disturbance - It is a complicated name for you. In severe brain damage, temperature regulatory centre of body may get damaged and it can lead to rise in thermostat. It can cause persistent high temperature without any reason. There are some other features also like sudden profuse sweating, sudden stiffness in body, rise in pulse/BP.
Treatment is icepack application, regular bowel and bladder care, avoiding painful stimulus.

: Look for fungal or viral infection. In case of prolonged antibiotic therapy, these infection can occur due to impaired immune system. It can be confirmed with the help of "microbiologist". Ask doctor to send culture for fungus.

Hope it will help you. Still in doubt, please let me know. As all other investigations have been done and negative, I have mentioned only uncommon causes.

thanks. Take care

---

Brief Answer:
Other reasons of fever and management

Detailed Answer:
Hi, thanks for asking from HCM.


It is good that he is not having bed sore and has regained most of his functions. If there is no visible reason of fever then it should be managed as "Nosocomial (hospital acquired) Fever of unknown origin(FUO)". It is labeled as FUO when after 3 days of hospital admission patient acquires fever and all cultures come negative.

Most of the time cause is
: Infection - ICU acquired which is subacute due to regular use of antibiotics. It can be diagnosed by sending blood/urine/tracheal aspirate or sputum for culture sensitivity after stopping antibiotics completely for at least 3 days.
Ask doctor to get complete blood count, differential leucocyte count, liver and kidney function, ultrasound of abdomen, chest X ray, muscle enzyme, ESR test.
If it suggests some kind of infection and examine that area in detail and also let me know.

: Inflammation or reaction - It is non-infectious cause. It means body's response is causing fever. It can be checked by examining injury site/operative site/any drain or catheter site/vein or artery site. Look for any redness/swelling/pain or shiny skin.

If you find something, bring it to your doctor notice. Examine that area and remove any pus or foreign body present there. Treat it with anti-inflammatory like Diclofenac-Paracetamol combination after prescription.

: Drug or allergy - Ask your doctor to again go through his drugs and look for that drug which can cause fever. Also examine him for any allergy which he might have developed at hospital.
It can be simply treated by discontinuing that drug and avoiding allergen. Kindly send me details of his ongoing medication.

: If everything comes negative and he remains fine or improves, observe for few days. If he is not improving, look for rare causes of fever (Hospital acquired)
Example are
; Viral
; Fungal - I have mentioned it previously also. Kindly ask your doctor to investigate for it.
; Lymph node enlargement - Tuberculosis or Brucellosis, Typhoid or Paratyphoid fever.

Regarding affect of high grade fever on body, it is damaging specially in traumatic brain injury. You must control it as much as possible by
: Continuing Paracetamol
: Cold saline soaked pad application
: Keep in AC room
: Give him at least 3.5 to 4 litre of fluids
: Maintain his nutrition by giving him frequent meal containing high protein diet.
: Avoid frequent visit of new visitors to him

Hope it will help him. I am looking forward to some diagnosis after it. Please let me know about further progress.

Thanks, take care

---

Brief Answer:
Drug which can cause fever

Detailed Answer:
Hi, thanks for asking from HCM.


Out of all these mentioned drugs, only Allegra (Fexofenadine) use can cause fever and it is not common. But still you can ask your doctor to stop this drug if no allergy or any other indication. Look for the response. Rest all drugs almost do not cause fever.

Kindly ask your doctor regarding fungal infection also. It can be diagnosed by fungal culture, XXXXXXX staining of body fluids which are suspected to be infected.

Hope it will help you. Thanks. Take care.
If still you want to discuss something, please let me know.

---