QUESTION
My husband has been suffering from recurring fever every 3rd or 4th day for the past 7 months. All blood tests are normal, esr ,crp, cultures of urine and blood all normal, chest ct full body pet heart echo all normal. Tested positive for montoux and quantiferon gold, with no symptom other than fever, was put on ATT on 4th JULY 2011 fever persists with no other symptoms. Has been on ATT for more than 4 months with no respite and as per doctor TB is ruled out but 6 month course mandatory. Please help. Fever comes with mild chills and head ache at times.
ANSWER
Cyclical fever every few days is one of the characteristic signs of malaria, and the length of the cycles can help identify the type of malaria. Specifically a fever every three days is indicative of Plasmodium malariae infection, which also fits with the long, chronic persistence of the illness.
This parasite can be hard to diagnose as it is often present in low concentrations in the blood. If you haven’t had a blood film done already, ask your doctor to make a thin and thick blood film to look for the presence of Plasmodium malariae in your husband’s blood.
If the first films are negative, continue with daily films for a further 2 or 3 days. Another diagnostic option is a rapid diagnostic test, which can detect antibodies to the malaria parasites in the blood. P. malariae is easily treated with chloroquine.
Unfortunately, without further information and a more complete medical history it will be impossible to make a further diagnosis of your husband’s condition, but certainly checking for Plasmodium through a blood test would be a good first step.
thank you for your response however the febrile condition remains…… all the blood tests pet scan ct scan bone marrow.echo every thing is normal…. his esr is normal c reactive protien…..the fever comes every 4th day and stays for 2 days this has been going on for 9 months now with no change
I am sorry to hear that. Have they done tests for malaria? Unfortunately without a full history it is impossible to make further suggestions. Good luck and I hope his condition improves soon.
assuming symptoms are of malaria even if it is not showing in any test at least one should respond to treatment 2 courses of falcigo and 2 of lariago have been done
If tests are not showing any sign of malaria, then I doubt the patient has malaria! The symptoms can be very similar to a number of other diseases, such as dengue or even influenza. Treating patients with malaria medication when they do not have observable blood parasites, particularly in highly endemic areas, may lead to the emergence of drug resistance.
thank you for the response…… you are asking for complete medical history…… I have no other information about his medical history all blood reports and various scans are normal… is there a way that i can send you the scanned reports…….
Is it possible that malaria may not show up in any test even not respond to treatment.
The ONLY SYMPTOM IS FEVER EVERY 3RD 4TH OR 5TH DAY APPROXIMATLY 72 hrs .
Any other test which you can recommend
The most sensitive test for malaria is PCR of the patient’s blood, using Plasmodium-sensitive primers. This can give a positive diagnosis even when levels of parasitaemia are sub-clinical. Alternatively, you could try an antibody test, many of which come in rapid “self-testing” kit form. These rapid diagnostic tests (RDTs) are more sensitive than microscopy for diagnosis of low levels of parasitaemia and can be bought over the counter at pharmacies in many places.