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What Causes Persistent Fever?
Question: Hello Doctor, My Wife, age 28 years is suffering from fever from last 14 days( w.e.f 12.05.14). During first four days she was on medication with MONOCEF and Zintec (morning and evening)+ Paracetamol(sos).
The fever didn't improved during first four days and it was as high as 103.6 , generally fever repeated with pain in legs and headache at each 6 to 7 hours after taking paracetamol. During next four days monocef was replaced with medicine CEFTUM and during same period blood report showed a urine and blood infection. The report was as follow
1. Hemoglobin - 9.90
2. Total Leukocyte count - 3.60
3. DLC- eosinophils - 0.00.
4. ALC - Eosinophils -0.00
5.URINE -R/E- Microscopy- RBC - 20-30 RBC/HPF.
6. ESR - 43.
7. Widal test - Negative.
The fever occurence decreased to two times a day in morning and evening after taking the combination of ceftum, zintec and crocin but still fever was maintained and also lack of hunger noticed therefore after consulting to doctor the medicine was changed with TAXIMO- O, LEVOSEAL R ( morning and evening and Crocin(SOS). At the same time doctor told to go for second blood check and typhoid was discovered in blood sample( Report attached), doctor said to continue the taximo and Levoseal combination dose for next 5 days, but after taking medicine for next 4 days, fever still continued and occurence of fever increased 3 to 4 times a day with nearly 101.8 .
After consulting doctor for third time one extra medicine was added name oflomac 300 along with taximo-o and levoseal. but after taking the above combination still the fever persist with 101.6 fever 3 to 4 times a day.
The only improvement is that legs in pain and headache has gone though some time headache occurs. Hunger has been improved.
Please let me know why the fever is not leaving even after 14 days of medication and is this fever something more along with typhoid. What to do next to reduce the fever.
The fever didn't improved during first four days and it was as high as 103.6 , generally fever repeated with pain in legs and headache at each 6 to 7 hours after taking paracetamol. During next four days monocef was replaced with medicine CEFTUM and during same period blood report showed a urine and blood infection. The report was as follow
1. Hemoglobin - 9.90
2. Total Leukocyte count - 3.60
3. DLC- eosinophils - 0.00.
4. ALC - Eosinophils -0.00
5.URINE -R/E- Microscopy- RBC - 20-30 RBC/HPF.
6. ESR - 43.
7. Widal test - Negative.
The fever occurence decreased to two times a day in morning and evening after taking the combination of ceftum, zintec and crocin but still fever was maintained and also lack of hunger noticed therefore after consulting to doctor the medicine was changed with TAXIMO- O, LEVOSEAL R ( morning and evening and Crocin(SOS). At the same time doctor told to go for second blood check and typhoid was discovered in blood sample( Report attached), doctor said to continue the taximo and Levoseal combination dose for next 5 days, but after taking medicine for next 4 days, fever still continued and occurence of fever increased 3 to 4 times a day with nearly 101.8 .
After consulting doctor for third time one extra medicine was added name oflomac 300 along with taximo-o and levoseal. but after taking the above combination still the fever persist with 101.6 fever 3 to 4 times a day.
The only improvement is that legs in pain and headache has gone though some time headache occurs. Hunger has been improved.
Please let me know why the fever is not leaving even after 14 days of medication and is this fever something more along with typhoid. What to do next to reduce the fever.
Brief Answer:
It is important to exclude Malaria.
Detailed Answer:
Hello XXXXXXX
Thanks for writing to HCM
I have gone through your wife's reports and history in detail.
She is suffering from typhoid fever,it is confirmed by positive widal test.
She has received maximum medications for typhoid fever.
Persistent fever inspite of maximum medications indicates that she might be suffering from other concomitant infection also.
She is also suffering from anemia ,so it is important to rule out causes like malaria.
She need few other investigations like repeat blood culture and Malaria test.
She also need random blood sugar,Liver function test,Stool routine and microscopic examination,chest X-ray (PA view) & Ultrasound of abdomen.Further investigations can be done if needed.
It is important to see for neck rigidity,enlarged lymph nodes etc.
She is also suffering from hematuria(blood in urine),it may be due to recent urinary tract infection.
She need proper clinical examination so that further investigations can be planned.
Proper treatment depend upon findings.
She can be given antimalarial drugs empirically.
Get well soon.
Hope I have answered your question.
Further queries are most welcome.
Take Care
Dr.Indu XXXXXXX
It is important to exclude Malaria.
Detailed Answer:
Hello XXXXXXX
Thanks for writing to HCM
I have gone through your wife's reports and history in detail.
She is suffering from typhoid fever,it is confirmed by positive widal test.
She has received maximum medications for typhoid fever.
Persistent fever inspite of maximum medications indicates that she might be suffering from other concomitant infection also.
She is also suffering from anemia ,so it is important to rule out causes like malaria.
She need few other investigations like repeat blood culture and Malaria test.
She also need random blood sugar,Liver function test,Stool routine and microscopic examination,chest X-ray (PA view) & Ultrasound of abdomen.Further investigations can be done if needed.
It is important to see for neck rigidity,enlarged lymph nodes etc.
She is also suffering from hematuria(blood in urine),it may be due to recent urinary tract infection.
She need proper clinical examination so that further investigations can be planned.
Proper treatment depend upon findings.
She can be given antimalarial drugs empirically.
Get well soon.
Hope I have answered your question.
Further queries are most welcome.
Take Care
Dr.Indu XXXXXXX
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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