Undiagnosed cause of fever

[Ritg]

Hello experts,

My mother (aged 54yrs) is suffering from fever (around 102 degrees) for the past 8days. She also complains of severe restlesness, headache, pain in her joints, legs, hands, pain at the back of her eyes. She's been having 3 paracetamols per day. Whenever the fever goes beyond 100F, she takes a paracetamol. Upon consulting a doctor she said he could not identify the cause based on her symptoms and recommended a blood test.

The blood report, shows Negative for, malaria, dengue, typhoid. The CBC report is as below:

CBC (INCLUDES DIFF/PLT)
Test Within
Range Out of
Range Biological Ref Range Units
HEMOGLOBIN   13.0   11.7 - 15.5   g/dL  
HEMATOCRIT   40.1   35.0 - 45.0   %  
WHITE BLOOD CELL COUNT   5.5   3.8 - 10.8   Thousand/uL  
NEUTROPHILS   49.7   40.0 - 75.0   %  
LYMPHOCYTES   37.1   16.0 - 46.0   %  
MONOCYTES     12.8   H
0.0 - 12.0   %  
EOSINOPHILS   0.1   0.0 - 7.0   %  
BASOPHILS   0.3   0.0 - 2.0   %  
NUCLEATED RBC   0.0      /100 WBC  
PLATELET COUNT   225   140 - 400   Thousand/uL  
ABSOLUTE NEUTROPHILS   2734   1500 - 7800   cells/uL  
ABSOLUTE LYMPHOCYTES   2041   850 - 3900   cells/uL  
ABSOLUTE MONOCYTES   704   200 - 950   cells/uL  
ABSOLUTE EOSINOPHILS     6   L
15 - 550   cells/uL  
ABSOLUTE BASOPHILS   17   0 - 200   cells/uL  
RED BLOOD CELL COUNT   4.49   3.80 - 5.10   Million/uL  
MCV   89.1   80.0 - 100.0   fL  
MCH   28.9   27.0 - 33.0   pg  
MCHC   32.5   32.0 - 36.0   g/dL  
RDW   14.5   11.0 - 15.0   %  
MPV   8.8   7.5 - 11.5   fL  
  
Per the above report, the Monocyte count is slightly high, whereas Absolute eosinophils count is low. and rest seems within range.

Could you please advise what could be the reason for her prolonged fever and other associated symptoms. Her fever comes down when she has a paracetamol, but as soon as the effect of the paracetamol wears off, she is again down with fever and all associated restlessness. We are really clueless of what to do.  We have not been able to diagnose the problem, to get the right treatment done.

Please help.

Thanks,
Ritg

[jemma116]

As your mother has had urine and blood tests that show nothing, perhaps she should be checked out for an inflammatory disease like rheumatoid arthritis and also for parasites.

She may have picked up a parasite from contaminated food or water.

The maximum dosage of Paracetamol is usually no more than 8 in a 24 hour period and two tablets can be taken in one dose.  So 2 tablets 4 times a day can be taken within a 24 hour period.

Make sure that your mother is drinking plenty of water and juices.  Always wash your hands after using the toilet and always wash fresh fruit and vegetables before eating.  If your water may be contaminated, boil it before drinking.

Wishing her a speedy recovery.

[Ritg]

Hi,

Firstly, thanks a lot for your comments.

@Caryopteris : We stay in India (New Delhi).
@Jen12977 : Yes the doctor did ask for a urine test (but NOT urine culture) to be conducted, which we did get done. But nothing came of the urine test. Report of urine test is below. If you suspect UTI, do you suggest a urine culture for the same.Or does urine test give any indication.

URINALYSIS, COMPLETE
Test Within
Range Out of
Range Biological Ref Range Units
COLOR   PALE YELLOW   LIGHT YELLOW - DARK YELLOW    
APPEARANCE   CLEAR   CLEAR    
SPECIFIC GRAVITY   1.011   1.001 - 1.035    
PH   6.0   5.0 - 8.0    
GLUCOSE   NEGATIVE   NEGATIVE    
BILIRUBIN   NEGATIVE   NEGATIVE    
KETONES   NEGATIVE   NEGATIVE    
OCCULT BLOOD   NEGATIVE   NEGATIVE    
PROTEIN   NEGATIVE   NEGATIVE    
NITRITE   NEGATIVE   NEGATIVE    
LEUKOCYTE ESTERASE   NEGATIVE   NEGATIVE    
WBC   0-5   NONE SEEN - 5   /HPF  
RBC   NONE SEEN   NONE SEEN - 3   /HPF  
SQUAMOUS EPITHELIAL CELLS     6-10   H
NONE SEEN - 5   /HPF  
TRANSITIONAL EPITHELIAL CELLS   NONE SEEN   NONE SEEN - 5   /HPF  
RENAL EPITHELIAL CELLS   NONE SEEN   NONE SEEN - 3   /HPF  
BACTERIA   NONE SEEN   NONE SEEN   /HPF  
CALCIUM OXALATE CRYSTALS   NONE SEEN   NONE SEEN - FEW   /HPF  
TRIPLE PHOSPHATE CRYSTALS   NONE SEEN   NONE SEEN - FEW   /HPF  
URIC ACID CRYSTALS   NONE SEEN   NONE SEEN - FEW   /HPF  
AMORPHOUS SEDIMENT   NONE SEEN   NONE SEEN - FEW   /HPF  
CRYSTALS   NONE SEEN   NONE SEEN   /HPF  
HYALINE CAST   NONE SEEN   NONE SEEN   /LPF  
GRANULAR CAST   NONE SEEN   NONE SEEN   /LPF  
CASTS   NONE SEEN   NONE SEEN   /LPF  
YEAST   NONE SEEN   NONE SEEN   /HPF  
  
**Panel Comments**
URINALYSIS, COMPLETE
  METHOD : AUTOMATED REFLECTANCE SPECTROPHOTOMETRY/MICROSCOPICSAMPLE TYPE : URINE
  This urine was examined microscopically for the presence of WBC, RBC, Bacteria, Casts, and otherformed elements. Only those elements seen werereported. Specific gravity done by refractive index method.

[Jen12977]

Did the doctor do a urinalysis on your mother? She could have a UTI which will cause all of those symptoms. She needs to stay hydrated. I would definitely ask the doctor to check her urine ASAP. Please keep me posted on her condition.

[Caryopteris]

You didnt say where she lives, but it seems like in certain areas, tick-borne diseases like Lyme are often the culprit.