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This patient is having fever for more than 20 days,even if he was malaria positive, first it should be treated for malaria and repeat blood test to make sure parasite is clear,if not patient is having PUO ( Pyrexia Of Unknown Origin).A very good and detail history is very important to point to possible cause.
He should be investigated thoroughly including Complete Blood count
, blood culture
, urine routine, stool routine, an X ray chest, Abdominal ultrasonography
, if clinically indicated investigations related to connective tissue
disorder and bone marrow to find out the cause of fever if cause is detected then it can be treated.
2 D echocardiography
to look for vegetations on heart valve.
Sometimes infection is tricky.I hope the cause is detected and treated.
Please take care
Dr.Akhilesh Dubey M.D.