Persistent Fever for Three Weeks: What Specialist Should You See?

Continuous fever for three weeks?

Hello, my symptoms have included a continuous fever for three weeks (from March 21 to today, April 9), fatigue, generalized weakness, muscle aches, and loss of appetite (I didn't eat for two days during the high fever and didn't feel hungry).
For the first two weeks, I had high fevers reaching up to 40 degrees Celsius, and the fever could only be reduced to around 38.5 degrees with antipyretics, which were ineffective.
I had to rely on IV fluids to manage suspected influenza and saw a doctor.
Although the rapid test showed no influenza reaction, the doctor prescribed Oseltamivir, and after completing the entire course, my symptoms did not improve (I have no sore throat or runny nose).
Blood and urine tests showed no significant abnormalities, but there was evidence of a bacterial infection.
Today, my highest fever reached 38.3 degrees, with recurrent fevers, but it hasn't gone up to 39 degrees.
Which specialty should I consult for a detailed examination? Currently, the biggest impact is severe disruption to my studies, malnutrition, and poor activity levels.

Lin, 10~19 year old female. Ask Date: 2018/04/09

Dr. Chen Bozhang reply Family Medicine

Dear Ms.
Lin,
You mentioned in your letter that you have been experiencing continuous fever, fatigue, generalized weakness, and poor appetite for three weeks.
You have sought medical attention and taken antiviral medication for suspected influenza, but your symptoms have not improved.
The most likely cause of your persistent high fever is still an infectious disease, followed by certain rheumatologic and hematologic disorders.
I recommend that you seek assistance from an infectious disease specialist at a hospital.
If necessary, hospitalization for further evaluation may be required to determine the underlying cause.
If the physician conducts a thorough examination and still cannot find an answer, it is advisable to consult other specialties.
Sincerely,
Dr.
Chen Po-Chang
Department of Family Medicine, Keelung Hospital, Ministry of Health and Welfare

Reply Date: 2018/04/09

More Info

Given your persistent fever and accompanying symptoms, it is crucial to approach this situation with a comprehensive understanding of potential underlying causes. Persistent fever lasting three weeks, especially with high temperatures reaching 40°C (104°F), warrants thorough investigation. The symptoms you describe—fatigue, muscle aches, loss of appetite, and ineffective response to antipyretics (fever-reducing medications)—suggest that this is not a typical viral infection like influenza, especially since your rapid tests for flu were negative.

Recommended Steps for Medical Evaluation
1. Primary Care Physician (PCP): Start by consulting your primary care physician. They can perform a detailed history and physical examination, which is essential in identifying any patterns or clues related to your symptoms. They may also order initial laboratory tests, including complete blood counts (CBC), comprehensive metabolic panels, and inflammatory markers like C-reactive protein (CRP) to assess for infection or inflammation.

2. Infectious Disease Specialist: If your PCP suspects a more complex infectious process or if initial tests do not yield conclusive results, they may refer you to an infectious disease specialist. This specialist can provide a more in-depth evaluation of potential infections that may not be immediately apparent, including atypical infections, chronic infections, or even rare diseases.

3. Rheumatology Consultation: Given the systemic nature of your symptoms, if there is a suspicion of autoimmune conditions (which can present with prolonged fever and systemic symptoms), a referral to a rheumatologist may be warranted. Conditions like systemic lupus erythematosus or other connective tissue diseases can sometimes present with prolonged fever and nonspecific symptoms.

4. Hematology/Oncology: If there are any indications of hematological issues (like abnormal blood counts) or if malignancy is suspected, a hematologist or oncologist may need to be involved. They can evaluate for conditions such as lymphoma, which can present with prolonged fever and systemic symptoms.

5. Imaging Studies: Depending on your physician's assessment, imaging studies such as chest X-rays, ultrasounds, or CT scans may be necessary to identify any underlying infections or abnormalities in organs that could explain your symptoms.

Importance of Follow-Up
Given that your symptoms have persisted and are significantly impacting your daily life, including your academic performance and nutrition, it is essential to maintain close communication with your healthcare providers. Documenting your symptoms, including any changes in fever patterns, associated symptoms, and responses to medications, can provide valuable information for your healthcare team.

Conclusion
In summary, your persistent fever and associated symptoms require a multi-faceted approach to diagnosis and management. Starting with your primary care physician is the best first step, followed by potential referrals to specialists based on the findings. Early intervention and thorough investigation are key to identifying the underlying cause of your symptoms and ensuring appropriate treatment. Do not hesitate to seek medical attention, especially if your symptoms worsen or new symptoms develop. Your health and well-being are paramount, and timely medical care can make a significant difference in your recovery.

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