What can be the reason for prolonged fever?

Question

Hi doctor,

My brother is suffering from fever for more than 45 days. All the tests and scans are done. Bone marrow and hepatitis report came as negative. AB culture and TB culture report are yet to come. There was a bacteria, Weil-Felix rickettsia came as positive. His WBC count is 22000 cells per microliter. He had medication for two weeks (Doxy tablet), but there was no improvement in fever. On assumption doctor has given AKT-4, which is making him tired day by day. He had stopped all the tablets now and the fever was below 100 degree in the last five days, but again now he is having fever. Please help.

Answer 1

Hi,

Welcome to icliniq.com. There is no doubt that he is suffering from severe infection. It could be due to rickettsia or tuberculosis. Doxycyline is the first line drug to treat rickettsial infection and fever should have subsided within 48 to 72 hours after starting therapy. But, it did not show any improvement in your brother. May be it was not rickettsial infection (bacterial infection). Weil-Felix reaction test used to diagnose rickettsial disease, but has high false positivity rate. For rapid confirmation of tuberculosis, gamma interferon assay can be carried out where results are available in 24 hours. AKT-4 is (Rifampicin, Isoniazid, Pyrazinamide and Ethambutol) given in tuberculosis, which are high potency antibiotics and very effective in treating tuberculosis. These drugs can lead to hypoglycemia causing weakness but should be continued for at least six months to eradicate tuberculosis once the tuberculosis is confirmed. So, please continue with your medication.