Persistent Fever Without Other Symptoms: When to Seek Medical Help?

Q: Persistent Fever Without Other Symptoms: When to Seek Medical Help?

Hello： Your issue should be addressed at a major hospital for blood tests and X-ray examinations. <br>Persistent fever combined with respiratory symptoms may indicate pneumonia; however, since you also have gastrointestinal symptoms, it could be a viral infection such as enterovi

Persistent or intermittent fever without other symptoms for an extended period?

Hello Dr.
Tsai,
1.
On May 24th, I experienced an unexplained high fever (38°C - 38.6°C).
Aside from a headache, I had no other discomfort or symptoms such as soreness, pain, or cough, and my energy and appetite remained normal.
After taking antipyretic and analgesic medication from the pharmacy, my temperature initially dropped to 37.5°C but then rose again to 38°C - 38.5°C.
2.
I then visited an ENT specialist, who initially diagnosed me with a cold.
After taking medication for two days (for headache and fever), my temperature returned to normal.
3.
However, on the fourth day after feeling better, I had another fever of 38°C - 38.5°C.
I went to another pediatric clinic, where the doctor noted that my throat was red and swollen (indicating post-nasal drip) and, due to the recurring fever, diagnosed me with an adenovirus infection.
After taking the prescribed medication, I experienced diarrhea (watery stools) on the same day.
During the medication period, my temperature ranged from 37.3°C to 37.8°C.
After finishing the medication, I continued to have diarrhea and a significant loss of appetite, along with bloating and pain around my navel and left lower abdomen, prompting me to return for a follow-up.
4.
I had four follow-up visits at the same clinic, focusing on gastrointestinal issues and throat redness with a sensation of a foreign body (a slippery feeling like mucus or phlegm).
By the fourth visit, after finishing the medication, my appetite improved, and my gastrointestinal pain was much better, but my temperature still fluctuated between 37.3°C and 37.8°C, and the sensation in my throat persisted.
5.
I then began to experience throat pain and still felt something slippery stuck in my throat that I couldn't cough out or swallow, so I returned to the original ENT clinic.
After examination, my throat was red and swollen again.
The doctor prescribed medication and suggested that I go to the hospital for blood tests due to the persistent fever.
Duration of symptoms: The first high fever was noted on May 24th, and for nearly three weeks, my temperature has been between 37.3°C and 37.8°C as of today, June 24th.
During this period, I underwent treatment for gastrointestinal issues and diarrhea for about two weeks.
I would like to ask:
1.
What could be the cause of this persistent fever? Should I go to a major hospital for specific examinations?
2.
Which department should I consult for treatment? Or can I directly undergo specific examinations?
3.
Although my gastrointestinal condition has improved, I have been feeling unwell again in the past few days (June 26).
Should I consider undergoing an endoscopy or colonoscopy? (I had an endoscopy in March this year, which showed only mild inflammation.)
I apologize for the multitude of symptoms and appreciate your assistance.

Xiao Jie, 20~29 year old female. Ask Date: 2007/06/27

Dr. Cai Jueren reply Family Medicine

Hello: Your issue should be addressed at a major hospital for blood tests and X-ray examinations.
Persistent fever combined with respiratory symptoms may indicate pneumonia; however, since you also have gastrointestinal symptoms, it could be a viral infection such as enterovirus.
Given that the symptoms have persisted for so many days, I recommend that you seek medical attention at a hospital as soon as possible.
Thank you for your inquiry.
Dr.
Tsai Jue-Ren, Hualien Hospital.

Reply Date: 2007/06/27

More Info

Persistent fever without other symptoms can be a concerning issue, and it's important to approach it thoughtfully. Based on your description, you have experienced a series of fevers, gastrointestinal symptoms, and throat discomfort over the past month. Here’s a comprehensive response to your questions, along with some medical insights.

Understanding Persistent Fever
1. What Could Be Causing the Fever?
Persistent fever can arise from various causes, including infections (viral or bacterial), autoimmune disorders, or even malignancies. In your case, the initial high fever followed by gastrointestinal symptoms suggests a possible viral infection, such as adenovirus, which can cause both respiratory and gastrointestinal symptoms. The recurrent nature of your fever, especially after initial improvement, raises the possibility of a lingering infection or a secondary issue that needs to be addressed.

2. When to Seek Medical Help?
Given that your fever has persisted for several weeks and has been accompanied by gastrointestinal symptoms, it is advisable to seek further medical evaluation. If you experience any of the following, you should seek immediate medical attention:
- Fever exceeding 39°C (102.2°F) that does not respond to antipyretics.

- Severe abdominal pain or changes in bowel habits (e.g., persistent diarrhea).

- Signs of dehydration (e.g., decreased urination, dizziness).

- Any new or worsening symptoms.

Recommended Steps for Evaluation
1. Which Specialist to See?
Given your symptoms, starting with a visit to an internal medicine specialist or a general practitioner would be appropriate. They can perform a thorough evaluation and determine if you need to be referred to a specialist, such as an infectious disease expert or a gastroenterologist.

2. What Tests Might Be Necessary?
Your doctor may recommend a series of tests, including:
- Blood Tests: Complete blood count (CBC), inflammatory markers (like CRP or ESR), and blood cultures to check for infections.

- Imaging Studies: Depending on your symptoms, an abdominal ultrasound or CT scan may be warranted to rule out any underlying issues in the gastrointestinal tract.

- Endoscopy: If your gastrointestinal symptoms persist, a repeat endoscopy may be considered to assess for any new developments since your last examination.

3. Managing Gastrointestinal Symptoms:
Since you mentioned a history of gastrointestinal discomfort, it’s crucial to manage these symptoms effectively. Staying hydrated, eating a bland diet, and avoiding irritants (like caffeine and spicy foods) can help. If your symptoms worsen, further evaluation by a gastroenterologist might be necessary.

Conclusion
In summary, persistent fever, especially when accompanied by other symptoms, warrants a thorough medical evaluation. It’s essential to communicate all your symptoms clearly to your healthcare provider, as this will aid in diagnosing the underlying cause. Given the duration of your symptoms and the complexity of your case, it’s advisable to seek medical attention promptly. Early intervention can lead to better outcomes and help alleviate your concerns. Remember, your health is paramount, and addressing these symptoms with a professional is the best course of action.

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