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Q. My husband has fever for 10 days and abdominal pain while passsing stools. What is his problem?

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jun 09, 2020 and last reviewed on: Jun 20, 2020

Hello doctor,

My 59-year-old husband has had a fever for about 10 days, the first two days it varied between 37.8 and 38.8 maximum and small diarrhea without any other symptoms. We thought it was the COVID at the beginning but it cannot be because he had no other symptoms and me and my children have been in contact with him and we have no symptoms (knowing that I have health problems and have asthma) so we went to a doctor who prescribed diarrhea medication. Since the fever has dropped and it does not exceed 37.7 (so he continues to take Paracetamol) but for the past week he has been suffering from abdominal pain more precisely below the navel. So we went back to see the same doctor two days ago, who gave him an ultrasound that showed nothing abnormal. He diagnosed a colopathy but I have the impression that this diagnosis is wrong. He started this treatment that same day but until today there is no improvement. He still suffers from abdominal pain especially after going to the bathroom and fever although low (maximum 37.7 °) got as high as 38.8 tonight, no more diarrhea but little constipation. What do you recommend that I do? Could it be something serious knowing that the ultrasound showed nothing abnormal? Please help.

#

Hello,

Welcome to icliniq.com.

I feel very sorry to hear about your husband, and very rightly understand your concern and temptation for his unresolving symptoms. You are perfectly right that if treatment were given rightly he should have shown some improvement but unfortunately he did until now. So considering all the information you provided to me, there are few possibilities.

First of all, is typhoid fever which is a bacterial infection. The second is intestinal amebiasis which is a parasitic infection. Typhoid seems to be likely possibly given his almost 10 days of fever, and in second week, he started to develop abdominal pain which is suggestive of typhoid ulcers in small bowel. I would suggest him an antibiotic course for at least 10 days, and a maximum of 14 days which would cover both potential bugs. I also want that you get him some blood and stool tests before starting antibiotic course. The antibiotic course is relatively safe.

I also want that you closely examine his chest for the development of rose spots. They are very small pinkish marks which develop among patient over the chest in the second week of the illness. Do not worry they are harmless, it is just a manifestation. I really hope his symptoms will improve like a fever would start settle, and abdominal pain should resolve in the next 48 to 72 hours of the start of the antibiotic regimen.

I would also want to know the assessment/prescription of a previous doctor who said about colopathy. The colopathy is a very broad and vague term which means colon (large bowel) inflammation. It has a number of causes the one is painkillers (NSAIDs) and recently COVID 19 has shows some case reports with colopathy. But if your family and he himself does not have any contact history to COVID 19 positive or suspected case, then the possibility is very rare. Ultrasound is not a sensitive investigation for the disease which involves the bowel lumen such as in your husband's case. Ultrasound is more helpful in disease involving liver, spleen, or gall bladder. So it is not uncommon to have a normal ultrasound with conditions like typhoid fever or intestinal amebiasis.

So I am writing him antibiotics for 10 days now if the improvement is shown we would increase up to 14 days. I really hope with this course his symptoms will start settling in the next 48 to 72 hours. And lastly, get some blood and stool tests as I suggest her and discuss the reports once they are available.


The Probable causes:

Typhoid fever. Intestinal amebiasis. C. difficle infection. Colopathy.

Investigations to be done:

Complete blood count. Blood culture and sensitivity (before starting antibiotic course). IHA titer for E. Histolytica. Stool detail report and ova parasites. Stool for fecal calprotectin. Stool for C.difficle infection and stool for culture and Sensitivity (before starting antibiotic course). You can ask him to give sample today and start antibiotics just after giving the sample.

Treatment plan:

Capsule Cefixime 400 mg twice daily for 10 days, tablet Flagyl 400 mg thrice daily for seven days (this antibiotic can cause metallic taste in mouth and or decreased appetite) for that you can give him tablet Levosulpiride 25 mg thrice daily half hour before meals for nausea, appetite.

Preventive measures:

Take home cooked meals, take good amount of water, mineral water if possible (both infections are acquired after a contaminated food or water).

Regarding follow up:

See me after labs, and earlier if any further concern.

Hello doctor,

He did some blood tests. What is your diagnosis? Is it something bad?

#

Hello,

Welcome back to icliniq.com.

There are two reports. The one with complete count is perfectly normal. The other shows status of diabetes which is slightly abnormal. The normal level of HbA1c should be less than 6 and he has 6.5. But, do not worry as it is not alarming either.

Were you able to send him for other blood and stools tests which I have recommended above? Did he start antibiotics which I have suggested him? How is his fever and abdominal pain now?


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