Fever(case I)

Normal body temperature ranges 36.5~37.5℃.Fever(also known as pyrexia or temperature colloquially)occurs when the body temperature is 37.5℃ or above.Fever may be present in many different conditions,commonly in infections,connective tissue disorders,cancer or drug-reaction of certain drugs are the common clinical reasons of fever.

Clinical assessment should include a review of the patients'past medical and drug history,and physical examination.Investigations may include routine blood tests,culture and sensitivity analysis of the blood,urine,sputum,and chest X-ray,where appropriate.Patients with neutropenia may not show the usual symptoms/signs of infection,they should be assessed more closely.

D: Good morning. How may I help you?

P: I have a temperature from time to time, doctor.

D: When did it begin?

P: It started 3 days ago.

D: Did you take your temperature?

P. Yes Most of the time it was around 38%C. But last night it was as high as 39.2C. I took some paracetamol and drank lots of water. After that, the temperature came back down.

D: How often do you feel feverish?

P: Not very often. Sometimes I feel feverish in the morning when I woke up, and sometimes in the afternoon.

D: Have you taken any other medication?

P: I have been taking the antibiotic, amoxil and Chinese medicine against viruses, but they do not work.

D: Do you have any other symptoms or problems apart from fever?

P: I have sore throat for a week, and a little bit of dry cough. Each time temperature goes above 38, my head aches but not too severely.

D: How is your appetite?

P: Oky.

D: Any problems with your water works or bowels?

D: Do you feel weak or lethargic?

P: Not exactly. But these days I nod off easily. I sleep more and feel tired during the day which is not normal for me.

D: May I examine you, please?

P: Yes. of course doctor.

D: Thank you. Please take off your shirt and socks, and lie down on the bed. There is a blanket here for you to cover yourself. Let me know when you are ready. Close the curtain and wait. After the examination.

D: You have an inflamed throat and swelling of the tonsils, which I suppose is making you feverish. In addition, I find rash (tiny red spots, tiny petechiae) spreading on your legs. And you looked pale, that's why I asked if you felt tired.

P: Is there something seriously wrong with me, doctor?

D: I dont know yet. We should do a blood test in the first instance to find out more. Please take this blood form to the phlebotomist to have your blood taken one hour later. after the blood test.

D: I am sorry that your blood test is abnormal. I am afraid it's not very good. Both your red blood cell and latelet counts are low. Your white cell count is high with immature blood cells. You may have leukemia, we need to do more tests to be sure whether this is the case or not. I recommend that you be admitted to hospital for us to do the tests and start the right treatment for you, as soon as possible.