Unveiling the Dangers of Ignoring Fever: A Parent's Guide to Timely Medical Care

DISCLAIMER

The characters in this story are purely imaginary and of the author's imagination. Any resemblance to any character, either living or dead, is purely coincidental. Nothing in the content should be used as a substitute for professional medical advice. I can only guide you and create awareness because no doctor can give proper diagnosis and treatment unless and until they see the patient. It would be best if you always visited your general physician for diagnosis and treatment for your specific medical needs.

Fever - Guide to timely medical care

Fever is an inclusive term. So, what is a fever? As we all know, in simple terms, an increase in our body temperature!  What do we do to get well off that fever? We usually don’t go to the doctor. We go to the pharmacy to buy medicines to reduce the fever and settle for temporary well-being. We only consider going to the doctor when the incident occurs more than three or four times.

In my general practice, I have seen only a few patients coming with complaints of fever for the past duration within 24 hours. What they don’t have is "Awareness".

We always take “fever” lightly. We think it will go away if we take medications to reduce the fever and get cured. We will bring a temporary reduction in turmoil, that’s for sure; sometimes, it may not even re-occur. Note that “Sometimes” you won't get relief from the fever even after taking over-the-counter fever-reducing medicines readily available in the pharmacy. I am not saying you must go to a doctor immediately if you suspect a fever. But “the cause of fever” Is what you must care about.

So, I will tell a small story about “What may happen if you ignore your fever without treating the cause of it!”

So, let’s start with a family of three. A 6-year-old son named John and their parents are Victor and Emily, respectively. Victor and Emily got married. At 22, they had their son the year following their marriage.

When John was about five, he felt slightly warm over his forehead; his parents suspected fever and gave him fever-reducing medications. John started feeling well and began playing and running around the house; his parents were happy and left as it was. The next day, he developed a headache and was again feeling warm. So they gave him the same medication, and the fever was reduced. They did the same again and again for three days. Day by day, the time duration between the fever-reducing medicines and the time he developed a fever increased.

4th DAY:

On the 4th day, he developed shivering, which was followed by sweating, and he was too weak to play. Also, he created a dry cough, which is nothing but “cough without expectoration”, i.e. cough without spitting sputum and some mild abdominal pain. So his parents noticed something was wrong with him and took him to a doctor. The doctor checked him and asked about the symptoms, the duration of the fever, and whether he had abdominal pain, difficulty passing urine, loose stools, or dysentery (Blood in seats). He was prescribed fever-reducing medication along with antibiotics and asked if they would want to do some blood investigations to diagnose the type of fever. The parents said they replied “no” as he had a fever only for four days.

Antibiotics are the drugs that fight against the organisms responsible for causing the infection, which means only the bacteria and not against the virus, fungi and parasites. So, the doctor prescribed the medicines for three days and asked them to come to his clinic the next day to check the progress of the illness. But they ignored the next two days and did not take him to the doctor.

6th DAY:

In the following two days, John was feeling somewhat better, but he was still too weak to play, and he had mild stomach pain. This makes the parents worry, and they take him to the same doctor. Note that it is the 6th day of his illness. So the doctor checked and urged them to do some blood investigations immediately to check his type of fever. So he wrote some blood tests, which I will explain in detail.

The parents were sceptical about whether to do all these tests as the cost was high. But they accepted it and did these tests, and they were requested to come and collect the results on the following day.

7th DAY:

The following day, his parents woke up and searched for John, who usually would be playing around. But what they saw was shocking. They saw their son standing in front of a mirror and speaking to his reflection. Victor asked John, who you are talking to. John replied that he was talking to his grandfather and playing with him in the park! His father is shocked in horror! At that time, Victor’s father passed away two years ago!

Victor gets terrified and lifts John, and he calls his wife and tells her that a GHOST haunts their son and they have to take him to a person who specialises in this field. They started the vehicle, went to all the people they knew, and performed all the rituals to extract the ghost from his body. They are least bothered about the results of the blood tests. And his condition was getting worse minute by minute.

And finally, FINALLY!  In the evening, they decided to go to the doctor. But they got stuck in traffic. By the time they reached his clinic, it was nearly 10 PM, and the doctor had already left. Their son started showing an "Altered state of consciousness". His parents put him in their vehicle and rushed him to a 24-hour multi-speciality hospital, and as soon as they reached the hospital, their son started throwing seizures (fits). Victor carried his son in his arms, and with tears in his eyes, he screamed for the doctor, who immediately administered emergency medications to control the seizures and transferred John to an Intensive care unit. The doctor asked about the history in detail, including the haunting incidents in the morning. The doctor asked his parents not to worry, and they performed blood investigations to determine the type of fever.

8th DAY:

       Early in the morning, the doctor came in and told their parents to relax. The blood reports have come; they diagnosed what type of fever John had and were doing the necessary treatment.

The parents asked the doctor what type of fever it was. The doctor replied that it was MALARIA. Victor shouted in anger, do you think I am a fool? Do I look stupid to you? I recently had malaria and had treatment for it. It was nothing like what my son is having right now”. The doctor replied, “Calm down, Victor, your son is not having any ordinary type of malaria; he is having a dangerous, fatal type of malaria known as   “CEREBRAL MALARIA.”

       Victor apologised to the doctor and asked what that was. And the doctor explained everything and said that you should thank god that your son didn’t go into a coma. As it would have complicated things and it would have caused irreversible brain damage. 

John gets better in a week and goes home feeling better. Also, the story ends.   

Wait, why did I tell this story to you?

I will explain all the details from the beginning of this story, including what should have been done and what should not have been done.

So, what are these tests? 

Now, I would like to tell some facts from a doctor’s point of view this story.

So let us take the events happening in the story from the beginning,

John had a fever for three days and didn't go to the doctor.

I have had a fever for three days and am not taking treatment. OK!  If it is okay, what’s the reason for it?

Because our body has an immune system, correct? To fight off infections, correct? So, for it to work correctly, we must let it do its thing. How?

For example, "A kid is learning to ride a bicycle; he will fall every time in the beginning. Finally, he will ride it like everybody:" Our immune system is like that only. It has to learn to fight infections.

4th day of fever

So, on the 4th day of fever, he developed shivering, followed by sweating, a typical characteristic of malarial fever. So first, what is shivering? In the case of malaria fever, shivering typically means teeth chattering, and the person will be covered in sheets. During cold seasons, we will be covered in sheets entirely different from shivering in case of malarial fever. So, in what other conditions does shivering manifest? Urinary tract infections, any abscess     (pus-filled boils anywhere in the body when left untreated) anywhere in the body and a typical malarial fever.

So he had a dry cough, which is nothing to worry about, as it would be due to many infections, or it would have been even an allergic cough.

       He had some mild abdominal pain, which is ok. You may think having a fever will cause stomach upset, but abdominal pain is an inclusive term, and it may also take the diagnosis in a completely different path. But the child’s complaint is abdominal pain; the question arises, where is the abdominal pain?

●If the abdominal pain is in the epigastrium (centre in the midline of the chest just where the stomach starts), it may take the diagnosis towards gastritis, which is not typically considered in a 6-year-old child.

●If there is lower abdominal pain may point the diagnosis towards urinary tract infections.

●If there is pain in the left and right side of the stomach while passing stools, it may point the diagnosis towards Amoebiasis (which is an infection caused by an amoeba and it will indeed be followed by diarrhoea or, in some cases, there will be even blood in stools).

● Abdominal pain on the right side may indicate problems in the liver.

●Abdominal pain on the left side may indicate problems in the spleen or gall bladder.

       So, if I start to explain all the causes of abdominal pain, then there will be no end to this article.

So, let's see this case.

Fever + Shivering followed by sweating + Abdominal pain on the left side may point to a diagnosis of malaria, but we have to confirm it by blood investigations.

So, the parents refused to do the blood test; that’s okay for any parent refusing to see their son get pricked for a blood test.  So the doctor prescribed some medicines and asked them to come the next day. That's what most doctors do. 

6th day of fever.

So, on the 6th day, all blood tests were done, and they were asked to collect the results the other day.

First, let me tell you a peculiar thing about the blood test for malaria.

On the day the test is being done, the parasites should be strong enough, and the numbers should be large enough for the test to be positive. So, a person having a negative malaria test has a 1 per cent chance that the test could be falsely negative.

A female Anopheles mosquito transmits malaria, and it carries the pathogenic parasite in its salivary glands, so the disease is transferred to humans when the mosquito bites it. The main pathogenic (disease-causing) parasites causing the disease in humans are Plasmodium vivax and Plasmodium falciparum. Plasmodium is vivax, the common cause of uncomplicated malaria, and Plasmodium falciparum is the main culprit, which, when left untreated, can even cause death. 

So, most of the time, we falsely assume that malarial fever will not be fatal. The malarial blood test will show which parasite is present in the blood. So, any fever lasting more than three days with shivering, headache, and body pain should be suspected of malaria, and necessary blood tests should be done.

I will not go into the details of the life cycle of a malarial parasite as it would be boring. So, to be short and precise, Plasmodium falciparum has a characteristic feature of sequestrating the red blood cells and reaching the small blood vessels in the brain, which is responsible for causing seizures, altered consciousness and in some cases, even coma and death. Now, let's go to the 7th day.

7th day of fever

So, on the seventh day, he developed some symptoms that made the parents think that a ghost had haunted him. These symptoms occur when the disease or a pathogen has infiltrated the cells in the brain, or it may even be due to conditions like hypoglycemia (low blood sugar level, meningitis (inflammations of the coverings of the brain due to infection). So the parents thought that something was wrong with him and felt he was haunted and took him to people who were specialising in that field, and they delayed the treatment till night. That time frame is critical. He could have had seizures at any point in time, which would have been followed by a coma, so they went to the hospital and got treated in the night.

So I will put up some frequently asked questions that run through every parent's mind when their son gets affected by any illness, maybe a fever or anything and what they should be doing.

1.       Should I take my children to a doctor if I suspect a fever? - That depends on the co-existing symptoms, like a cough with yellow sputum coming from the nose or mouth; we have to note the breathing pattern of the child, whether it is rapid breathing or not if the child passes blood in stools if the child cries while passing urine or if the urine output has decreased compared to before or if passes dark-coloured urine despite drinking a lot of water, is shivering a lot if the child has a severe headache when you can hear a whistling sound when the child breathes while sleeping. These are some of the conditions that require a visit to a nearby physician despite the day of fever. Suppose the child has a history of having seizures when getting a high fever at any time during childhood, known as febrile seizures. In that case, a visit to the physician is mandatory whenever a high fever is suspected.

2.       Should I be worried about Plasmodium vivax malarial fever, as it says in the report? - All malarial fevers should be treated no matter what the parasite may be involved. In the case of Falciparum, no further delay should be made, as treatment should be given as soon as possible.

3.       Are all other blood tests needed? - All the other blood tests would be equally essential to give an idea about what infection it might be.