Fever of unknown origin consists of persistent fever of more than 101-degree F for a period of three weeks without any identifiable causative factor. It is important to undertake thorough history, examination and investigations to diagnose underlying pathology. Such patients can be treated empirically until diagnosis is clear.
Options for empirical treatments (till clear diagnosis is reached):
- For gastrointestinal infections – Cefadroxil + Ofloxacin + Metronidazole
- For non-gastrointestinal infections – Cefadroxil + Doxycycline + Metronidazole
- For pregnant patients – Cefixime + Metronidazole (avoid in first trimester)
- For suspected Salmonella or parasitic infection – Azithromycin + Doxycycline
Symptomatic treatments:
- Tab. Limcee (Vitamin C 500 mg) – one tablet once a day for vitamin deficiency
- Tab. Caripill (Carica papaya leaf extract 1100 mg) – one tablet thrice a day for 5 days for thrombocytopenia
- Cap. Pantakind-DSR (Pantoprazole 40 mg, Domperidone 30 mg) – one capsule once a day for vomiting. For pregnant patients – Cap. Propilan (Lansoprazole 15 mg) one tablet once a day.
- Cap. Roko (Loperamide 2 mg) – two capsule after 1st loose stool, then one tablet after each loose stool (Maximum dose – 16 mg per day).
- Tab. Nutrolin B Plus (Folic acid 750 mcg, Lactobacillus 40 million spores, Niacinamide 25 mg, Pyridoxine 1 mg) – one tablet twice a day for 7 days.
- Tab. Zincovit (Multivitamin; Zinc; grape extract) – one tablet per day for 7 days.
- Electral oral rehydration solution (ORS) – 2 sachets in 2 litres of water per day till fever last (for dehydration).
- Tab. Dolo 650 (Paracetamol 650 mg) – one tablet every 6 hours till fever last.
- Tab. Septilin (herbal remedy) – two tablets every 12 hours till fever last (for infection).
Suggested pathologies based on presentations:
- Meningeal signs, seizures – meningitis, meningoencephalitis, malaria
- Abdominal pain or peritoneal signs – appendicitis; peritonitis, typhoid fever
- Diarrhea, vomiting – gastroenteritis, typhoid fever
- Jaundice/enlarged liver – hepatitis
- Persistent cough – pneumonia, measles, tuberculosis
- Ear pain, red tympanic membrane – otitis media
- Sore throat, enlarged lymph nodes – pharyngitis, diphtheria
- Dysuria, urinary frequency, back pain – urinary tract infection
- Red, warm, painful skin – Erysipelas, cellulitis, abscess
- Limp, difficulty walking – osteomyelitis, septic arthritis
- Rash – measles, dengue, haemorrhagic fever, chikungunya
- Bleeding (petechiae, epistaxis, etc.) – dengue, haemorrhagic fever
- Joint pains – Rheumatic fever, chikungunya, dengue
General advice:
- Ensure adequate dehydration
- Monitor patient’s fluid intake and output accurately
- Individual advice based on underlying condition
Investigations:
- Complete blood count
- Fever profile
- Any other investigation based on clinical suspicion.
Referral:
Hospitalize patient immediately if patient presents with signs of sepsis, haemodynamic shock, symptoms suggestive of meningitis, seizures, severe abdominal pains, severe dehydration, or new onset heart murmur.