Persistent Fever for a Week: Possible Causes and Next Steps

Fever has been frequent over the past week?

Hello doctor, since last Wednesday, I have been experiencing fever every evening, ranging between 38-39 degrees Celsius.
During the afternoons, I do not have this symptom, and I do not have a runny nose or cough.
Right before the fever starts, I feel warmth above my chest, especially noticeable around my ears and neck.
I saw a doctor this week, and they diagnosed it as a flu-like illness.
In the first few days, I had headaches, but after taking medication, the headaches have resolved.
However, the fever has persisted for nearly a week, which is very concerning.
I would like to ask what kind of condition this might be and which specialty I should consult.

Lucas, 20~29 year old female. Ask Date: 2022/01/25

Dr. Liao Yaopan reply Family Medicine

Hello, the most common cause of fever is still due to infections.
If the cause is not determined and the fever persists, further investigation is recommended.
It is advisable to consult an infectious disease specialist for evaluation.
Please note that online consultations are not equivalent to in-person medical visits and cannot provide diagnoses or treatment recommendations.
Changhua Hospital cares about your health.

Reply Date: 2022/01/25

More Info

Persistent fever can be a perplexing and concerning symptom, especially when it lasts for an extended period, such as a week. Based on your description, it seems that you are experiencing a pattern of fever that occurs primarily in the evenings, with temperatures ranging between 38-39 degrees Celsius. This type of fever, particularly when it is accompanied by localized warmth in areas such as the neck and ears, can indicate several potential underlying causes.

Firstly, it is important to consider that fever is a natural response of the body to infection or inflammation. The most common causes of persistent fever include infections (viral, bacterial, or fungal), autoimmune diseases, and malignancies. Given that you have already seen a doctor who suggested a possible influenza-like illness, it is plausible that you may be dealing with a viral infection. However, the absence of respiratory symptoms such as cough or nasal discharge makes it less likely to be a typical case of influenza.

In your situation, the following possibilities should be considered:
1. Viral Infections: Besides influenza, other viral infections can cause prolonged fever without significant respiratory symptoms. These can include infections such as Epstein-Barr virus (which causes mononucleosis), cytomegalovirus, or even less common viruses.

2. Bacterial Infections: Certain bacterial infections can present with fever and localized warmth without overt symptoms. Conditions such as urinary tract infections, endocarditis, or even abscesses can sometimes present this way.

3. Autoimmune Disorders: Conditions like systemic lupus erythematosus or rheumatoid arthritis can lead to persistent fevers as part of their symptomatology. These diseases often have other accompanying symptoms, such as joint pain or rashes.

4. Malignancies: Although less common, certain cancers can present with persistent fevers, particularly lymphomas or leukemias.

Given that your fever has persisted for a week, it is advisable to follow up with a healthcare provider, preferably an infectious disease specialist or a general practitioner who can conduct a thorough evaluation. They may recommend further diagnostic tests, including blood tests (such as complete blood count, inflammatory markers like CRP or ESR, and specific serologies), imaging studies, or even a urine analysis to rule out infections that may not present with obvious symptoms.

In terms of immediate next steps, you should monitor your symptoms closely. If you experience any new symptoms such as difficulty breathing, chest pain, severe headache, or any signs of dehydration, you should seek medical attention promptly. Additionally, if the fever persists beyond a week or worsens, it is crucial to return to your healthcare provider for further evaluation.

In conclusion, while persistent fever can be caused by a variety of conditions, it is essential to approach this symptom systematically. A thorough medical evaluation, including appropriate laboratory tests, will help identify the underlying cause and guide effective treatment. Remember to keep a record of your symptoms, including the pattern of your fever, any associated symptoms, and any medications you have taken, as this information will be valuable for your healthcare provider in making a diagnosis.

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