Persistent Low-Grade Fever: Symptoms, Concerns, and Next Steps

Persistent low-grade fever

Hello Doctor, I have been experiencing recurrent low-grade fevers since last Friday afternoon, and it has now been a week with no improvement.
I visited a clinic where the doctor prescribed Tamiflu, but it has not been effective.
My symptoms include persistent low-grade fever (over 37°C), a scratchy throat, no swollen or painful lymph nodes, drowsiness, mild nausea, mild diarrhea, but normal appetite.
I also have generalized itching, and I can see a few small red spots under the skin of my palms that disappear quickly.
Could you please advise what tests I should undergo in the infectious disease department? Additionally, what should I be cautious about? Thank you, Doctor.

Mr. Lin, 20~29 year old female. Ask Date: 2024/01/26

Dr. Li Jian reply Internal Medicine

It is recommended that you go to the infectious disease department for further blood tests.
Thank you for your inquiry.

Reply Date: 2024/01/26

More Info

Persistent low-grade fever can be a concerning symptom, especially when it lasts for more than a week, as you have described. Your symptoms of a persistent low-grade fever (around 37 degrees Celsius), throat discomfort, mild nausea, slight diarrhea, and transient skin rashes warrant a thorough evaluation to determine the underlying cause.

Understanding Your Symptoms
1. Low-Grade Fever: A persistent low-grade fever can indicate an ongoing infection or inflammatory process. Common causes include viral infections, bacterial infections, or even autoimmune conditions. Given that you have already taken antiviral medication (克流感, which is likely oseltamivir), it suggests that your doctor suspected a viral infection, such as influenza, but the lack of improvement indicates that it may not be the primary cause.

2. Throat Discomfort: This could be due to a viral infection, such as a common cold or pharyngitis, but it could also be a sign of something more serious, especially if accompanied by fever.

3. Lymph Nodes: The absence of swollen lymph nodes is somewhat reassuring, as it may suggest that there is no significant systemic infection or malignancy at play.

4. Fatigue and Nausea: These symptoms can be associated with many conditions, including infections, gastrointestinal issues, or even stress and anxiety.

5. Skin Rashes: The transient nature of the rashes could indicate an allergic reaction or a viral exanthem. The fact that they disappear quickly is notable but should still be evaluated.

Next Steps
Given the persistence of your symptoms, it is advisable to follow up with a healthcare provider, preferably an infectious disease specialist. Here are some recommended steps and tests that may be considered:
1. Comprehensive Blood Tests: A complete blood count (CBC) can help assess for signs of infection (elevated white blood cells) or anemia. Additionally, liver and kidney function tests can provide insights into your overall health.

2. Inflammatory Markers: Tests such as C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) can help determine if there is an inflammatory process occurring in your body.

3. Throat Culture or Rapid Strep Test: If your throat discomfort persists, a throat swab can help identify bacterial infections like streptococcal pharyngitis.

4. Urinalysis: This can help rule out urinary tract infections, which can sometimes present with low-grade fever and malaise.

5. Imaging Studies: If there is a suspicion of an abscess or other localized infection, imaging studies such as an ultrasound or CT scan may be warranted.

6. Skin Examination: A dermatologist may need to evaluate the skin rashes, especially if they recur or worsen.

Monitoring and Self-Care
While you await further evaluation, here are some self-care measures you can take:
- Hydration: Ensure you are drinking plenty of fluids to stay hydrated, especially if you are experiencing mild diarrhea.

- Rest: Prioritize rest to help your body recover.

- Symptom Diary: Keep a record of your symptoms, including their frequency, duration, and any potential triggers, which can be helpful for your healthcare provider.

- Avoid Self-Medication: Unless advised by a healthcare professional, avoid taking additional medications that could mask symptoms or complicate your diagnosis.

When to Seek Immediate Care
If you experience any of the following, seek immediate medical attention:
- High fever (above 39 degrees Celsius or 102 degrees Fahrenheit)
- Severe headache or neck stiffness
- Difficulty breathing or chest pain
- Persistent vomiting or diarrhea
- Any new or worsening symptoms
In conclusion, while persistent low-grade fever can often be benign, your symptoms warrant further investigation to rule out any serious underlying conditions. Consulting with an infectious disease specialist will help guide you through the necessary evaluations and treatment options. Remember, early diagnosis and intervention are key to effective management.

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