September 25, 2021

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Persistent Fever – Pyrexia of Unknown Origin (PUO)

Last week, I was almost at my wit’s end, trying to ascertain the root cause of one of my patient’s persistent fever. A foreigner married to a Nigerian. I had ordered all the laboratory investigations imaginable, including blood culture, MRI and CT-Scan. All came out negative. As a last resort, I sent the patient to covid-19 isolation center in Amachara General Hospital, Umuahia. Lo and behold, the patient was positive for covid-19, the Delta variant.

Why am I telling this story? As a lesson to all health officials. Do you know that apart from the persistent fever, which was hitting 38 to 40 degrees centigrade regularly, there were no other symptoms. No cough, no headache, no difficulty in breathing, no rigors, no loss of taste and smell, etc. Now I started reflecting, whether I had maintained covid-19 protocol while examining and treating her. Although as a matter of routine, I always wear a face mask and a pair of gloves while examining patients. I started wondering whether I did enough to protect my Staff and I.

Now you know why the Resident Doctors are agitating. My question becomes. How much is a doctors life worth? Can even a billion naira hazard allowance be equated to a doctor’s life, talk less of the 5,000 pittance, which is grudgingly paid.

When patients come to consult a doctor, they could infect the innocent doctor with any disease imaginable. which the doctor could transmit to members if his family unknowingly. This leads me to my first article as “Doctor Sun”, in Sunday Sun Newspapers, published in May 2003, that is 18 years ago, titled “The Dilemma of a Christian Doctor”. If I were to rewrite that article in today’s covid-19 infested era, I would have added – when a doctor prays in the morning, should he request that God should not allow any patient, with covid-19 to visit his hospital, lest he infests him and his family.

As, I rhetorically asked in 2003, when a doctor kneels down in the morning to pray before going for work. What will he ask God? Is it to allow people with persistent fever of unknown origin to visit his hospital, so that he will conduct, elaborate, extensive, expensive laboratory Investigations, as I did with my above mentioned patient, that costs tens of thousands of naira, so that the doctor, could keep smiling to the bank. Tell me, what should a doctor tell God in the morning while praying, before going for work? Should he ask for a good day, so that people will fall sick and visit his hospital. Just like a coffin seller, what should he tell God in the morning while praying. Even in my donkey years of medical practice, before I retired as a Permanent Secretary, it has always been a dilemma. Sorry for the digression.

Most Pyrexia are due to self limit- ing viral infection, covid-19 being one of them. It is characterized by flu-like illness, that is catarrh-like illness. Prolonged fever, which has resisted diagnosis requires thorough investigation in order to resolve the enigma of persistent Fever.

Next week, we shall discuss the proper management of Pyrexia of Unknown Origin. Always be medically guided.

• Please follow me on Twitter@_ DRSUN.

The post Persistent Fever – Pyrexia of Unknown Origin (PUO) appeared first on The Sun Nigeria.

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