A fever that keeps coming back needs a search.
Most fevers are viral and settle within a week. A fever that goes on for more than a week or two, or keeps returning, usually has a cause that can be found and treated. Finding it takes a patient, step-by-step search, not a guess.
In plain words.
Doctors worry more when a fever has lasted longer than one to two weeks, keeps coming back after short breaks, or first tests have not found the cause.
In India the commonest hidden causes are infections: TB (in the lungs, glands, belly or elsewhere), typhoid, malaria, scrub typhus, a urine or kidney infection, a pocket of pus in the liver or elsewhere, and an infection of a heart valve. HIV is another cause worth ruling out.
Fever can also come from conditions that are not infections: arthritis and other immune conditions, an overactive or inflamed thyroid, a clot in the leg, a reaction to a medicine, and some blood or other cancers. These are less common, but the search looks for them too.
Do not start antibiotics or steroids on your own. They can hide the fever for a while, make the key tests come back falsely normal, and steroids can let TB spread. Paracetamol for comfort is fine.
A written fever chart, with the temperature measured on a thermometer at the same times each day, is one of the most useful things you can bring. It shows the doctor the pattern.
The search for a hidden cause
The chart shows the pattern: fever most days for three weeks, with short normal spells that do not last. Rest and paracetamol have not settled it.
A careful story and examination, then tests in steps: blood and urine first, then a chest X-ray and an ultrasound of the belly, then more focused tests where the clues point.
Once the cause is found, it is treated properly, and the fever settles over days to weeks. Treating the cause, not just the fever, is what makes it stay away.
Go to hospital now if
- Fever with confusion, unusual drowsiness, a fit, or a stiff neck with a bad headache: call 112.
- A rash of small purple or red spots that do not fade when a glass is pressed on them: call 112.
- Fever with fast breathing, breathlessness at rest, or blue lips: call 112.
- Fever with fainting, cold and clammy or blotchy skin, or passing very little urine: go to hospital now.
- Fever while on cancer treatment (chemotherapy), or after the spleen has been removed: go to hospital now, even if you feel fairly well.
- Fever with bleeding from the gums or nose, black stools, or yellow eyes with drowsiness: go to hospital now.
- A baby under three months with a temperature of 38 °C or more: go to hospital now.
Call 112 or go to the nearest emergency department. Ambulance: 108 (102 in some states).
See a doctor within a day or two if
- A fever has lasted more than a week
- The fever keeps coming back after it seemed to settle
- You are losing weight, sweating at night, or coughing for more than two weeks
- You have a heart valve problem, or have had dental or other procedures in the last few weeks
- You have a new lump, joint swelling or rash
- You have diabetes, are on steroids or other medicines that lower the body’s defences, or have HIV
Tests that help.
Not everyone needs every test. He decides which ones are worth doing for you.
| Test | What it tells |
|---|---|
| Complete blood count (CBC), ESR and CRP | Show infection, inflammation and problems with blood cells. |
| Malaria test, and blood cultures | Blood cultures find germs in the blood and must be taken before any antibiotic. |
| Urine test and urine culture | Look for a hidden urine or kidney infection. |
| Liver and kidney function | Point to the liver, kidneys or a bile infection. |
| Chest X-ray, and an ultrasound of the belly | Look for TB, a pocket of pus, enlarged glands or a larger spleen. |
| Focused tests, where the clues point | For example tests for TB, HIV (with your consent), scrub typhus, thyroid or immune conditions, an echo of the heart, or a CT scan. |
Have it ready.
Tick them off as you gather them. The ticks stay on this phone only.
Online, or in person?
Taking one antibiotic after another, or steroids, to “bring the fever down” is the commonest reason a cause stays hidden. It can also hide TB until it is advanced. Have the tests taken first.
A video call can
Needs a visit in person
- Blood and urine tests, at a laboratory or by home collection
- An examination for glands, the spleen, the heart and the joints
- X-rays, scans, an echo, and sometimes a biopsy
- Any sign in the red box: that is an emergency
Talk it through with Dr. Arya.
Bring your reports and medicines to a video consultation. He goes through them with you, in plain words, and says clearly if you need to be seen in person.
Book a video consultationDr. Prabhat Arya · MBBS, MD (Internal Medicine) · Delhi Medical Council Reg. No. DMC-83759