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What Causes Persistent Fever With Negative Widal Test?

Posted on Tue, 9 Dec 2014

Question: My dad had fever for 6 days. Now 12th day. Initial 3 days took 4 crocin per day with antibiotics then next 3 days less fever with less crocin. From 6th day started taxim o antibiotics. CBC came normal with low borderline wbc RBC and platelet 160000. No mpc dengue widal negative all these taken on the 6th day. Dr advice to take tamix 10 days. Uti culture normal. What fever is it. Do we need to plan diet like typhoid. Is it viral confused now feels tired. During fever and now no severe headache body ache rashes diarrhea now has excessive burping giving probiotic

Answered by Dr. Anshul Varshney (1 hour later)

Brief Answer:
I need a few more details.

Detailed Answer:
Welcome To HCM. I am Dr Anshul Varshney.
I understand your concern.
This is a fever of long duration. So, requires careful history.
I need to know:
1. How high was the fever initially?
2. How much is the fever now?
3. Has fever responded or continues to come?
4. Any history of diabetes?
5. Was he started on antibiotics before giving the Urine Culture sample?
6. Any pain abdomen?
7. Any jaundice?
8. Any cough or sputum production?
Revert with these details for a better help.
Stay Healthy.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anshul Varshney (23 minutes later)

Initial fever ranged 99 to 102 with crocin 4 times daily. Moxikind given next 3 days the fever lessened with 3 crocin per day antibiotics axithromax 7th day tsmix o started all given by Dr. Fever lasted 6 days only now nofever no ddiabetics.
No jaundice no abdomen pain now heavy burping taken pan d. Taking PPI last 1 year culture done on 7h day blood on 6th day. Antibiotics from day 1 itself

Answered by Dr. Anshul Varshney (35 minutes later)

Brief Answer:
Urine Infection or Viral is a possibility.

Detailed Answer:
Dear Friend.
Usually when you start on antibiotic and give Urine sample later, the culture reports gets negative.
So, he might have an Urinary Tract Infection (UTI). Viral infection is also a possibility as these days viral infection persists for long.
Low WBC counts favours Viral or Typhoid.
Typhoid Widal test comes positive after 1 week only.
Now since he is afebrile, I don't think any further investigation is advisable.
You can discuss with your doctor to stop all medicines now.
If fever comes back, a repeat Widal test, Ultrasound Abdomen, Blood Culture is warranted.
You can give him normal diet.
Just avoid fatty and spicy food because he is suffering from acidity causing burping.
He can continue on PPI that he is taking.
If you have any further query please ask me.
Stay Healthy.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anshul Varshney (30 minutes later)

Just now received his CBC RBC is slight lower Wbc came within range platelet is 248 thou per cc last week it was 160000. Clopilet was stopped a week back can he take it now assuming he might have had typhoid other than uti or viral

Answered by Dr. Anshul Varshney (7 minutes later)

Brief Answer:
He can resume.

Detailed Answer:
Welcome back.
See, slightly lower RBC is not a problem at all.
Don't worry.
Good news is that his WBC and platelet counts are normal.
Now, about Clopitab. In general he can resume that but concern is why is he on Clopitab and since when?
What cardiac condition he has?
What other medications he is taking. He Must be also on some medicine for Cholesterol like Atorvastatin, Rosuvastatin.
If you wish to discuss this part, provide me the details, otherwise he can start back on Clopitab after consultation with his primary care physician who has started it.
Stay Healthy.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar