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What Causes High Fever And Joint Pain In An Elderly Person?
Question: Hello Doctor,My Father age 63 ,weighing 67 kg had high fever with pain in joints 15 days back,during the first day of fever I gave him paracetamol 650mg TDS,& next day his tounge got fumbled while talking on phone, I measured temp,it was 103, I took him to a physician, doctors asked for Malria test then for chickanguniya & dengue too,but all the test reports came negative,doctor admitted him and put on IV paracetamol & DNS & also initiated anti malarial & combination of cefexime & azithromycin for 3 days.
Doctor I want to learn from you wether the treatment given by the doctor was appropriate or not and secondly what was the reason of tounge fumbling.
Now after 13 days my father had fever again,I again visited the same doctor & this time he went for urine test & typhoid test,later came negative but in urine pus cell range came 5-6,then he initiated for faropenem sodium 300 bd for 3 days.
I want to learn from you,Is pus cell range 5-6 Hpf is a signal of UTI & is this higher antibiotic was the only choice ?
Doctor I want to learn from you wether the treatment given by the doctor was appropriate or not and secondly what was the reason of tounge fumbling.
Now after 13 days my father had fever again,I again visited the same doctor & this time he went for urine test & typhoid test,later came negative but in urine pus cell range came 5-6,then he initiated for faropenem sodium 300 bd for 3 days.
I want to learn from you,Is pus cell range 5-6 Hpf is a signal of UTI & is this higher antibiotic was the only choice ?
Brief Answer:
Fever unspecified ?UTI
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
Most of the common causes of fever like Malaria,Dengue or Typhoid fever during the monsoon may have non-specific symptoms without much of findings initially.It is often difficult to pinpoint the underlying cause of fever and hence the battery of investigation to exclude common cause of monsoon illnesses. Many a times a doctor has to to resort to empirical antibiotics and even empirical antimalarial too as often Blood for MP comes negative in spite of patient having malaria ,particularly Falciparum malaria.
Transient episode of tongue fumbling is likely to be due to transient Ischemic attack (TIA) at his age .Is he diabetic also?.Did he have any episode of tongue fumbling in the past?Kindly elaborate on this.
Urine on microscopy pus cells up to 5/hpf is a normal finding.He has already received a course of antibiotic-which means UTI is partially treated.Ideally urine should also be subjected to culture and sensitivity test before starting the second course of empirical antibiotic.I agree the higher antibiotic is not the only choice.
However Faropenem is the only orally active beta-lactam antibiotic belonging to the penem group. Rest of the penem/higher antibiotics of this group are parenteral preparation or injectable only.This is probably the reason for starting Faropenem .
Regards
Dr. T.K. Biswas M.D. XXXXXXX
Fever unspecified ?UTI
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
Most of the common causes of fever like Malaria,Dengue or Typhoid fever during the monsoon may have non-specific symptoms without much of findings initially.It is often difficult to pinpoint the underlying cause of fever and hence the battery of investigation to exclude common cause of monsoon illnesses. Many a times a doctor has to to resort to empirical antibiotics and even empirical antimalarial too as often Blood for MP comes negative in spite of patient having malaria ,particularly Falciparum malaria.
Transient episode of tongue fumbling is likely to be due to transient Ischemic attack (TIA) at his age .Is he diabetic also?.Did he have any episode of tongue fumbling in the past?Kindly elaborate on this.
Urine on microscopy pus cells up to 5/hpf is a normal finding.He has already received a course of antibiotic-which means UTI is partially treated.Ideally urine should also be subjected to culture and sensitivity test before starting the second course of empirical antibiotic.I agree the higher antibiotic is not the only choice.
However Faropenem is the only orally active beta-lactam antibiotic belonging to the penem group. Rest of the penem/higher antibiotics of this group are parenteral preparation or injectable only.This is probably the reason for starting Faropenem .
Regards
Dr. T.K. Biswas M.D. XXXXXXX
Above answer was peer-reviewed by :
Dr. Yogesh D
Thanks doctor
No he is not diabetic neither he had an episode of tounge fumbling in past
Doctor i would like to learn from you what should be the first aid & what you suggest a doctor should do if such case of fumbling of tounge comes to him,because last time doctor said this was because of high fever only.
What are the thing that i should take care in future?
No he is not diabetic neither he had an episode of tounge fumbling in past
Doctor i would like to learn from you what should be the first aid & what you suggest a doctor should do if such case of fumbling of tounge comes to him,because last time doctor said this was because of high fever only.
What are the thing that i should take care in future?
Brief Answer:
Abnormal involuntary movement of tongue
Detailed Answer:
The treating physician remains the best judge as he is also examining the patient.
If the tongue fumbling or twisting (episode not very clear to me) occurs only at spike of fever,it will be prudent to give paracetamol (500 mg) orally to prevent high rise of temperature.
Regards
Dr. T.K. Biswas M.D. XXXXXXX
Abnormal involuntary movement of tongue
Detailed Answer:
The treating physician remains the best judge as he is also examining the patient.
If the tongue fumbling or twisting (episode not very clear to me) occurs only at spike of fever,it will be prudent to give paracetamol (500 mg) orally to prevent high rise of temperature.
Regards
Dr. T.K. Biswas M.D. XXXXXXX
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Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
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