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Fever is not a disease; fever is a symptom for a medical condition. In most cases fever represents the struggle of our immune system against a foreign intruder. This intruder can be bacteria, virus, parasite or even a cancer. Common infections usually cause acute short lasting fever that will resolve within a few days if the infection is treated but less common infections and conditions cause long lasting fever with insidious onset and gradual progress. These conditions are usually more difficult to diagnose and treat.

It is not a simple task to diagnose chronic recurrent fever even for an experienced doctor and usually the diagnosis requires many blood tests and analysis. It is very important that you schedule an appointment at your general practitioner as soon as possible. Here I will try to describe some of the most common causes of recurrent fever:

  • Brucellosis is caused by bacteria called Brucella. These bacteria are from animal origin and usually passed among animals. Humans become infected by coming in contact with animals or animal products that are contaminated with these bacteria. In humans this infection causes symptoms that are very similar to the the symptoms caused by flu; these include fever, muscle soreness, headaches, weakness and sweats. In rare cases infection may affect the central nervous systems or the heart and may have serious complications. It is very common for brucellosis to cause long lasting recurrent fever, fatigue and sometimes joint pain. Brucellosis is treated with long term antibiotic regimen.
  • Lymphoma is a cancer of blood cells that initially starts at the lymph nodes. Lymph nodes are considered a part of the immune system. Lymphoma has insidious onset with fatigue, weakness, loss of appetite, sweats, fever, weight loss and swollen lymph nodes. Common locations to find swollen nodes are the neck, armpit and groin. Also lymphoma may cause enlarged spleen and enlarged liver, doctors look for these by palpating the belly. Usually doctors suspect lymphoma in young adults who present with fever, sweats, enlarged lymph nodes even though these symptoms could be caused by a simple viral infection.
  • Tuberculosis is caused by bacteria called mycobacterium. This bacteria attack the lungs and resides there waiting for the immune system to get weaker to take the chance and spread to other locations in the body, common locations are bones, brain and kidney. Tuberculosis is very contagious, one person with active tuberculosis can spread tuberculosis bacteria in the air of entire bus for example. However, people with healthy intact immune defense can fight off the infection and they won't get sick breathing the infected air. Symptoms of tuberculosis are mild and may go unnoticeable, tuberculosis presents with three or more weeks of cough, weight loss, night sweats, fatigue, fever and sometimes it can present with coughing up blood which might seem terrifying to the patient.
  • Occult abscess, the abscess is basically the battlefield of the infection after it is contained by immune system, abscesses are made from accumulated corpuses of dead bacteria surrounded by fibrous tissue. The immune system can feel bacteria corpuses are in the abscess but cannot reach them because of the fibrous tissue as a result of this continuous efforts a low grade fever often presents.
  • Familial Mediterranean Fever. presents with periodic recurrent fever with enlagement of abdomenal organs that can be noticed when palpating the belly.
  • Many viral infections (EBV, CMV) usually these infections are not serious and resolve on their own.

Also recurrent chronic fever also can be caused by:

  • Malaria
  • Typhoid fever
  • Drug induced fever
  • Pelvic Inflammatory Disease
  • Endocarditis
  • Osteomyelitis
  • Sarcoidosis

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