Could my father's fever and abdominal pain indicate dengue?

Question

Hello doctor,

My father had sudden fever ranging from 100 to 102.6 degrees Farenheit yesterday, but he has no clear symptoms. As he had loose stool yesterday, he was advised Oflox O by the doctor, two tablets daily for five days. And also Dolo 650, which we started giving him yesterday. Today the fever has been around 99.5 F the whole day, and he has no stomach problem except slight abdominal pain, but he has been complaining of weakness. What could be the reason for this fever? And if the fever subsides, should we be worried about dengue? Please see the attached reports, and tell me why his blood counts are low?

He is diabetic, hypertensive, and had a CABG two years back. He also suffered a right-sided hemiparesis, ten years back. He is taking Mixtard Insulin 30/70 (42 units in the morning and 12 units at night), Glycomet GP, Linagliptin 5 mg, Fibator 10 mg, Metolar 25, Dynapres 0.4, Arreno, Ecosprin, Thyronorm 25 mg, and capsule Uprise once a month.

Answer 1

Hi,

Welcome to icliniq.com.

I have gone through your father's CBC report (attachment removed to protect patient identity). As per the report, his neutrophils count is slightly high and platelet count is low.
Platelet count can be decreased in malaria, dengue, blood infection, etc., like conditions, in which excess platelet destruction occurs. In certain viral infection also platelet count is reduced because of decreased production of platelets.
As your father was having abdominal pain and loose stool, it seems to be a gastroenteritis. I suggest you try doing the following.

a. Antibiotic course can be completed.

b. Maintain hydration by consuming lots of water.

c. Fruits like papaya should be consumed more.

d. Symptomatic management has to be done for gastroenteritis.

e. In dengue, rashes, fever with chills, and generalized body pain or retro-orbital pain is present. So, if your dad is not improving, then investigate for dengue IgM ELISA testing.

Continue your all other medicines. Regularly check his blood pressure, blood sugar, and yearly investigate with EKG (electrocardiography) and a treadmill test. And avoid a sedentary lifestyle.

Answer 2

Hi,

Welcome back to icliniq.com.

It is good that your father did not get a fever in the last 24 hours. So, it seems to be improving.
But, if he is taking Paracetamol, then also there will be no fever.
In your CBC report, low lymphocytes count can be from a viral infection. It might also be from low immunity because of an infection. So, lymphocyte count can be low secondary to an infection.
The neutrophils are not much raised, so no need to worry. Repeat CBC (complete blood count) after five days, if he has no fever.
But, if the symptoms worsen, then dengue test should be done. ESR (erythrocyte sedimentation rate), IgM typhoid tri-dot testing, and ultrasonography should also be done.
Meanwhile, continue symptomatic management.

Answer 3

Hi,

Welcome back to icliniq.com.

I have seen all the attached CBC (complete blood count) reports here (attachment removed to protect patient identity).

There is no need to worry about the reports. All the findings are normal.
A platelet clump is seen, but your father's platelet count and lymphocyte count are within the limit, which was abnormal when having the fever.
Platelet clump develops because of some platelet destruction. It might be formed as your father was having an infection around a week before.
Also, platelet clumps may present because of excess EDTA tube shaking, not mixing blood properly, faulty collection techniques, etc. I do not think you have to worry about that.
Please note that hypertension, high blood sugar, high cholesterol, etc., are the predisposing factors for stroke. Hence, it is important to continue all prescribed medication.
Your father is also taking Aspirin, and that will prevent further stroke like a thrombotic event. Metoprolol is prescribed as a cardioprotective drug.
If blood sugar comes under control, then he can be shifted to oral hypoglycemic drugs only.