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What Is The Cause And Treatment For Fever In An Alzheimer's Patient?
Question: my wife aged 79 is an Alzheimer patient, hospitalized for fainting spells when made to sit up or otherwise stressed. She is now showing spikes of fever 102F ; antibiotics have been changed often over a 10- day period. Urine, blood, spinal fluid show no growth when cultured. Attending physicians seem puzzled. What's left for them to try?
Brief Answer:
Following investigation advised
Detailed Answer:
Hi
Welcome to Healthcare-Magic
Greetings of the day,
Its a medical dilemma you are facing. Fever can be the most simple and sometimes the most difficult clinical situation to manage, especially if it turns out to be Pyrexia of unknown Origin(PUO or FOU).
Apart from examining the body fluids like blood, urine and csf its also important to look for body cavities and also rule out them as the source. Apart from infectious causes there are other causes for Fever.
Its important to have a detailed examination by the physician. I would also like to suggest the following possibility which needs to be considered and ruled out.
1. 2D Echocardiogram: To rule out the possibility of Infective Endocarditis, especially in view of fainting spells
2. Ultrasound of abdomen; to look for liver abscess and sub phrenic abscess.
3. Drug history: Even some of the drugs can cause drug induced fever.
4. Auto -immune disorder: SLE and other issues needs to be considered.
5. Chest X Ray: To rule out infective focci in lung
Do get back to me the progress and investigation done so far, will be glad to assist you.
Take Care
Best Regards
Dr T Shobha Deepak
MBBS,MD
Following investigation advised
Detailed Answer:
Hi
Welcome to Healthcare-Magic
Greetings of the day,
Its a medical dilemma you are facing. Fever can be the most simple and sometimes the most difficult clinical situation to manage, especially if it turns out to be Pyrexia of unknown Origin(PUO or FOU).
Apart from examining the body fluids like blood, urine and csf its also important to look for body cavities and also rule out them as the source. Apart from infectious causes there are other causes for Fever.
Its important to have a detailed examination by the physician. I would also like to suggest the following possibility which needs to be considered and ruled out.
1. 2D Echocardiogram: To rule out the possibility of Infective Endocarditis, especially in view of fainting spells
2. Ultrasound of abdomen; to look for liver abscess and sub phrenic abscess.
3. Drug history: Even some of the drugs can cause drug induced fever.
4. Auto -immune disorder: SLE and other issues needs to be considered.
5. Chest X Ray: To rule out infective focci in lung
Do get back to me the progress and investigation done so far, will be glad to assist you.
Take Care
Best Regards
Dr T Shobha Deepak
MBBS,MD
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Most of the suggested procedures have been done, e.g., echocardiogram, 24-hr Holter monitor, ECG, CT scan (brain),ultrasound (abdominal), with no strongly indicative findings. It has been suggested that an additional specialist - a neurologist - be engaged to make an input, at considerable expense. I'm reluctant, especially since the spikes of fever seem to have nearly suppressed. What do you think?
Brief Answer:
Unlikely for Neurological problem to present with
Detailed Answer:
Hi
Greetings
I feel Neurologist may not be of much help. Unlikely for Neurological problem to present with spikes.
CT scan brain done would have ruled out Brain abscess or Sagittal sinus thrombosis.
It's also important to consider and rule out disease with A typical presentation like Tuberculosis or Brucellosis.
Kindly keep me updated
Take care
Best Regards
Dr T Shobha Deepak
Unlikely for Neurological problem to present with
Detailed Answer:
Hi
Greetings
I feel Neurologist may not be of much help. Unlikely for Neurological problem to present with spikes.
CT scan brain done would have ruled out Brain abscess or Sagittal sinus thrombosis.
It's also important to consider and rule out disease with A typical presentation like Tuberculosis or Brucellosis.
Kindly keep me updated
Take care
Best Regards
Dr T Shobha Deepak
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
To be fair, attending physician justifies Neurologist's intervention partly because fine tremor of hands/fingers seen occasionally, even without stress. Suspicion of Parkinson's disease mentioned, although some typical features e.g., rigor of facial muscles, shuffling walk - not observed.
Brief Answer:
Further assessment required
Detailed Answer:
Hi
Neurologist assessment may be required for assessment of tremors. But presence of Parkinsonism does not explain fever. So evaluation of fever requires further assessment including detailed physical examination everyday and investigation.
Do keep me updated about the development.
One of the cause which needs to be considered based on her age especially if she has associated facial pain/headache is Temporal arteritis. I would also suggest a Opthalmologic assessment for fundus examination which as a part of routine assessment may throw some light on cause of fever.
Take CAre
Best Regards
Dr T Shobha
Further assessment required
Detailed Answer:
Hi
Neurologist assessment may be required for assessment of tremors. But presence of Parkinsonism does not explain fever. So evaluation of fever requires further assessment including detailed physical examination everyday and investigation.
Do keep me updated about the development.
One of the cause which needs to be considered based on her age especially if she has associated facial pain/headache is Temporal arteritis. I would also suggest a Opthalmologic assessment for fundus examination which as a part of routine assessment may throw some light on cause of fever.
Take CAre
Best Regards
Dr T Shobha
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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