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Cause for fever with chills, rigors, and negative MATOUX TEST.

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hello s/m, my father who is 45 yrs old is suffering from fever with chills and rigors since last 8 months, his health worsened since 2 jan 2014 with temp max of 103^f. he complains of retro orbital pain. he denies any respiratory symptoms, dysuria, urgency,change in bowel habits, joint pain, rash or gastrointestial symptoms. work in last month showed negative MP, normal CBC differential, sterile blood and urine, normal CXR, negative mantoux test. ESR WAS NORMAL, ultrasound showed HSM, pyelo signs good...
he had multiple antibiotics like gentamycin, amikacin, tazobact, nitrofurantoin.
he is diabetic on medication
he is also hypertensive on medication

he is 5.11 ft and weight around 102 kgs.

he is currently on medicine such as Azee, combither forte, and calpol.

his health is not recovering. he is still suffering from fever, we have to take medicine every time he gets fever, I would be pleased if you can suggest me what should I do further!

Category: Internal Medicine Specialist

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Category: HIV- AIDS Specialist
 18 Doctors Online

Hello. Thank you for your query at I understand your concern. Your father seems to have Fever of Unknown Origin(FUO). FUO refers to a prolonged febrile illness without an established etiology(cause) despite intensive evaluation and diagnostic testing. He needs a few additional tests to confirm a diagnosis of FUO. The most common cause of FUO is infection (hidden and latent). Other rare causes include connective tissue disorders and malignancy You have not mentioned any routine blood chemistries such as kidney and liver function tests, including liver enzymes and bilirubin. And Hepatitis serology tests should be done if liver tests were abnormal. I would advise you first that you get the following tests done: 1. Liver function test(LFT). 2. Kidney function test. 3. Hepatitis serology if LFT were found to be abnormal. 4. Serum lactate dehydrogenase level 5. Creatine phosphokinase test 6. HIV combo test If there is any abnormality in above tests, then these following tests should also be done: -Serum protein electrophoresis -CT scan of abdomen -CT scan of chest Please get the first set of tests done and please upload all their reports when available, including old ones. Thank you.

Patient replied :

sir these are my reports. m still sufferring from fever regularly. my medicine are not working in my body..

Hello. Thank you for writing to us again.
Since the dates are not clearly mentioned in the reports you sent, i am assuming the first image ( the one with the liver function test reports is the latest one ). Couple of things that need to be noted are you have Hepatosplenomegaly and right now yur latest reports show that your liver enzymes are deranged. The good thing is infectious hepatitis have been ruled out, even though rarely Non A Non B hepatitis can cause live damage in the same way like other hepatitis viruses.
These reports are not very conclusive. Hence as advised before, i request you to get the following done asap and upload the reports :
1) CT SCAN whole abdomen
2) CT SCAN Thorax
3) HIV combo test
4) Lactate Dehydrogenase test
5) Creatine Phosphokinase test.
6) Bone Marrow Study for LD bodies ( to rule out kala-azar)
He has already received enough antibiotics and he should have recovered by now. Hence it is very important you get the CT and the other tests mentioned above done soon. Based on the reports we can take a decision.
Since his liver values are impaired, i will recommed you start taking Tab. Liv 52 DS 2-0-1, 2 tablets in empty stomach in the morning,and one tablet before sleeping. This treatment has to be continued for a month.
Also do you have any loss of appetite in recent times? Do you feel fatigued through out the day? Do you have any feeling of nausea constantly?
You can reply to the above questions but most importantly please get the tests done. Once the reports are ready, we will assist you further.

Patient replied :

no sir, I dont have any loss in my appetite, perhaps I feel fatigued throughout the day, and I feel nausious sometimes. sir i'm thinking of admitting my self in the hospital. so kindly suggest me best hospital so that I can go on with my further treatment there. ps best hospital in india. I dont have any problem coming there. thankyou

Hello. Thank you for writing to us again.
Yes i strongly feel you need to get all the above mentioned tests done, and it will be better if you can stay in a hospital during that period, so that they can even monitor you. Kindly make a note of all the tests that i suggested, and also the doctor will run the same set of tests when they admit you.
There are good hospitals all over India. It is entirely your choice where you want to get in and which city you will be more comfortable in. I will suggest a few,
1) AIl India Institute of Medical Sciences, New Delhi
2) Apollo, Chennai
3) Sri Ramachanda Medical College and Hospital, Chennai.
These are some of the hospitals that are good, and you can expect them to take very good care of you. However, if you have any preference you can go ahead. As i said before, there are lots of good hospitals all over India. I just suggested a few.

Patient replied :

thankyou sir, but can you please give your suggestion about CMC vellore. my friends are suggesting me to go for it.

Hello Sir. Thank you for writing to us again.
I am sorry i missed CMC, Vellore in my initial list. Yes it is a very reputed hospital with very good doctors. They will definitely be able to help you and diagnose your condition.
Once you get all the tests done, please upload your reports.
Take care,

Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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