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Persistent fever, Negative for WIDAL and urine. Diagnosis?

hello doctor i have 1 pt age 23 having continue fever since 20 days previously malaria falci was positive then after giving artesunate combinatio ps for mp become negative still fever persist and widal urine all negative before 2 days i did all investigation can u suggest me what is diagnosis and treatment fever comes in 12 hours or 24 or 36 hours
Asked On : Sat, 4 Aug 2012
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Diseases and Conditions
Internal Medicine Specialist 's  Response
Welcome to HCM,
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
Good Luck.
Dr.Akhilesh Dubey M.D.

Answered: Sat, 18 May 2013
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