Patient guide

Why is your history so important?

In infectious diseases, the answers to the doctor’s questions are sometimes worth more than several tests. The medical sources say that investigating a prolonged fever starts with a full history: symptoms, travel, job and where you live, recent medicines, and contact with animals or sick people. For brucellosis, they also say that a history of contact with farm animals and dairy helps choose the right test.

So if you cannot remember something, or feel embarrassed, know that the questions are for finding the cause, not for judging you.

What documents should you bring?

• Your ID and insurance card (if you have one)
• Earlier tests and cultures. All the papers, not just the latest. If you have a result only on your phone, print it or bring a photo of it.
• Images and imaging reports. X-rays, ultrasounds, CT scans or MRIs, with the written report and, if possible, the films or a disc
• A discharge summary or operation report, if you have recently been in hospital or had surgery
• A list of medicines. All medicines, supplements and herbs, with names and start dates. The boxes or photos of the labels are better than memory. The sources say that medicines taken in recent months matter when investigating a fever.
• Earlier antimicrobial medicines. Any antibiotic you have taken recently, roughly when, for how long, and what happened. The CDC says to mention it if you were treated in another country, too.
• Your vaccination card, if you have one
• Existing illnesses and allergies. Diabetes, kidney or liver problems, a weak immune system, medicine allergies

If your papers are not complete, do not worry. The doctor will tell you what to add later.

What should you write down?

Before the visit, write a few lines:

• Fever and symptoms: when it started, when it rises, what other symptoms there are (night sweats, weight loss, cough, pain). If you have recorded your temperature, bring that.
• Travel: the CDC has a useful list: destination and dates, activities, where you stayed, food and drink, contact with animals, wounds or insect bites, treatment you received while travelling.
• Contact with farm animals and dairy: farming, slaughter, animal births, local or unpasteurised milk or cheese
• Contact with someone ill: anyone at home or work who has had a cough, fever or a similar illness for a while
• Your job and where you live
• Recent events: surgery or a hospital stay, tattoos or body piercings
• Your own questions. Anything that worries you, even if you think it is unimportant

What questions can you ask?

• What do you think the likely cause is, and what will we do to find it?
• Which tests are needed and when will the results come?
• Until then, do I need an antibiotic or any other medicine? If not, why?
• Should the people around me take care or be tested?
• When should I come back, and which symptoms mean I should come back sooner?
• How will my information be kept? (Ask this if you are worried about confidentiality.)

A few tips

• It is a good idea to bring someone with you to note down the points.
• Do not stop your medicines without your doctor’s advice, even if you think they have nothing to do with the infection. The NHS also says, about tests, that if you do not know whether you should keep taking a medicine, ask before you go.
• Not having documents does not stop you being seen. Come and give your history.

Which tests and treatment you need is for the doctor to decide after an examination.

Why keep a record of the fever?

It makes a difference to the doctor whether your fever rises every afternoon, comes every other day, or happened only once. A patient’s memory of an illness is usually not exact, but a note is. The medical sources also count a temperature recorded on several occasions as important in a prolonged fever (38.3 or above on several occasions).

How do you take your temperature?

The NHS gives this method for a digital thermometer:

1. Wash the tip of the thermometer with cold water and soap.
2. Place the tip under the tongue and close your lips, or place it under the armpit and hold your arm firmly against your body.
3. Wait for the beep.

Notes:

• Forehead strips are not accurate.
• The NHS advises against glass thermometers and some infrared thermometers.
• Use an ear thermometer according to its instruction leaflet.
• The NHS says a fever is usually 38 degrees or above. But you may feel feverish even when the reading is lower. Note that down too.

What should you write down?

For each reading:

• the date and time
• the temperature and where you measured it (under the tongue or under the arm)
• shivering or sweating
• other symptoms: cough, pain, burning when passing urine, diarrhoea, rash, headache, joint pain
• any medicine taken, with its name and time (without changing your treatment)
• how much you have drunk and eaten
• anything new: travel, contact with someone ill, suspect food or dairy

Agree with your doctor how often and at what times to measure. A simple table on paper or in a phone note is enough.

What should you do at home?

The NHS says this for adults with a fever:

• Rest as much as you can.
• Drink plenty of fluids. Your urine should be pale yellow and clear.
• If you are uncomfortable, take a medicine to bring the fever down following the advice of your doctor or pharmacist.
• Stay at home while you have a fever and have less contact with others.

Antibiotics are not recommended to “bring the fever down”. There is more on this in the guide on using antibiotics correctly.

When should you not wait to keep a record?

A log does not take the place of a visit.

• If you are looking after the fever at home and it is not getting better or is getting worse, see a doctor early (the NHS says: an urgent GP appointment or 111).
• If the fever is very high or will not come down, treat it as a possible sign of something more serious and do not wait.
• If the fever comes with confusion, fast breathing, blue or mottled skin, severe shivering, a rash that does not fade when pressed, or a stiff neck, call 115 (Iran’s emergency number). The full list is in the guide on when to seek urgent care.

The cause of your fever and the treatment you need are for the doctor to decide after an examination.

What do antibiotics do?

An antibiotic is a medicine to treat or prevent some bacterial infections. The CDC states clearly that antibiotics do not work on viral infections such as colds, flu and most sore throats and coughs. The NHS also says antibiotics do not work for colds, flu and most coughs. Some bacterial infections, such as some sinus and ear infections, also get better on their own.

So “I have a fever, so I should take an antibiotic” is not always right. Which infection is bacterial and needs a medicine is for the doctor to decide after an examination (and sometimes tests).

Why is taking them on your own risky?

• They do not work, and they have side effects. The CDC says an antibiotic that was not needed does no good, and its side effects can still harm you. Minor side effects include rash, dizziness, nausea and diarrhoea. A more serious one is a bowel infection called Clostridioides difficile, which causes severe diarrhoea and damage to the large bowel.
• They add to antimicrobial resistance. The WHO counts unnecessary or incorrect use of antibiotics as one of the main causes of germs becoming resistant. A resistant infection is harder, and sometimes impossible, to treat (CDC). It is the germ that becomes resistant, not your body.
• They may delay finding the real cause. Clinical sources on prolonged fever say that a trial of antibiotics has no proven benefit and can delay the search for the cause.

Simple rules

1. Only on a doctor’s prescription. CDC: do not take an antibiotic prescribed for someone else, and do not share your own. The NHS also says never to “borrow” them from friends or relatives.
2. Do not keep them for later. CDC: do not save leftover medicine, because the wrong medicine for a later illness may delay the right treatment and cause serious side effects.
3. Take it exactly as directed. Follow the times, number of doses and length of treatment that the doctor or pharmacist told you (or that are on the leaflet).
4. If you miss a dose, take it as soon as you remember, unless it is nearly time for the next one. Never take a double dose to make up for it (NHS).
5. Finish the course. For infections such as bone infection, cellulitis and TB, the sources stress finishing the course even if you feel better. In TB, stopping early or without a doctor’s advice is dangerous. If you think you no longer need it or you have side effects, talk to the doctor first and do not stop on your own.
6. Tell the doctor if you are not getting better. For cellulitis, for example, the NHS says to tell the doctor if you do not feel better 2 to 3 days after starting the antibiotic. The right time for your infection is for the doctor to tell you.

Side effects and allergic reactions

Most antibiotics cause no problem when used correctly, and serious side effects are rare (NHS). Common side effects are nausea, vomiting, bloating and indigestion, and diarrhoea.

Diarrhoea. The CDC says to contact the doctor if you have diarrhoea three or more times in 24 hours.

A severe allergy is rare but is an emergency. If after taking a medicine you get a rash, wheezing, tightness in the chest or throat, trouble breathing, or swelling of the face or mouth, call 115 (Iran’s emergency number) at once or go to the emergency department (NHS).

What should you tell the doctor?

• any earlier medicine allergies, even if you are not sure
• all the medicines you take
• pregnancy or breastfeeding
• antibiotics you have taken recently
• travel or treatment you have recently had in another country (CDC, on resistance)

A reminder

Not getting an antibiotic when it is not needed is not a failure by the doctor or by you. The CDC says antibiotics do nothing against viruses and will not make you feel better.

Talk to your doctor about your own situation.

Why tests and cultures?

The symptoms of different infections look alike. Fever, tiredness and joint pain can have many causes, so tests are usually needed to find the cause and choose the medicine. For brucellosis, the CDC says early symptoms are not specific and tests are needed for diagnosis.

A culture means a sample of blood, urine or wound fluid is examined by the laboratory to identify the germ. The culture result helps the doctor choose a medicine that works on that germ.

Tell the doctor before the test

• Any antibiotic or other medicine you have taken recently. When investigating a fever, medicine taken in recent months is part of the history (AAFP).
• All the medicines you take. The NHS says some medicines (for example blood thinners) may be stopped before a blood test. Only the doctor decides this. If you are not sure, ask before you go.
• A fear of needles. You can tell the staff and bring someone with you (NHS).
• Contact with animals, dairy or travel. For brucellosis, the CDC says the history of contact helps choose the right test, and it is best if the laboratory knows the doctor suspects brucellosis.

What not to change on your own

• Do not stop or start a medicine, unless the doctor has said so.
• Fasting. The NHS says fasting (water only) is needed for only some tests, and the doctor will tell you beforehand. If you have not been told anything, ask.

What does sampling involve?

• Blood test. The NHS says it usually takes about 10 minutes, blood is taken from a vein in the elbow with a needle, you may feel a short sting, and then a cotton pad or plaster is put on. A small bruise may stay for a few days.
• Other samples (urine, wound fluid, phlegm and so on). The doctor or the laboratory will explain the right way to collect it on the day. If you have to collect the sample yourself, get the instructions in full and ask.
• Sometimes two rounds. In brucellosis, a second sample is sometimes needed 2 to 4 weeks after the first (CDC). In hepatitis C an antibody test comes first, and if it is positive, a second test (RNA) confirms whether the virus is active (WHO). In HIV, a positive rapid test must be confirmed with another test (WHO).

When do the results come?

The NHS says blood test results may come after a few days and usually within a few weeks. If you hear nothing after a few weeks, contact the office or the specialist. Ask the laboratory itself how long culture results and special tests take.

If the result is negative or unclear

• One negative result is not always the end of the investigation. The NHS says about urinary infection that a urine test does not always show an infection.
• For HIV, if there was a recent high-risk contact, you may need to repeat the test after a few weeks (WHO: 28 days).
• Go over the result with your doctor and do not interpret it yourself.

Before you go

• Take your earlier test and culture results with you.
• If you are going to have an important test whose result is sensitive for you (such as hepatitis or HIV), ask how your information will be kept.
• If you do not understand something, ask again.

Which tests you need is for the doctor to decide.

First of all

Not all infections spread in the same way. Some travel through the air, some through blood, some through food and dairy, and some are not passed on by daily life at all. So instead of a general fear, ask your doctor how your own illness spreads. Do not separate a patient from the home and family unless the doctor has said to.

Habits that help with all infections

Washing hands. The CDC says hand washing helps stop the spread of respiratory and diarrhoeal infections. Important moments:

• before and after cooking, and before eating
• after using the toilet and changing nappies
• after coughing, sneezing and blowing your nose
• when caring for someone with vomiting or diarrhoea, and before and after caring for a wound
• after touching animals and rubbish

Method: wet your hands with running water and soap, lather, rub for at least 20 seconds, rinse and dry with a clean towel. If there is no water and soap, use a hand sanitiser with at least 60 percent alcohol.

When you have a fever, the NHS says to stay at home and avoid close contact with others while you have a fever.

By illness

TB

• Active TB of the lungs spreads through the air by coughing and sneezing. The risk is greater for people who spend every day with the patient, and closed, unventilated spaces raise the risk (CDC).
• The NHS says latent (symptom-free) TB is not passed on to others.
• If the patient has active TB, household members should tell the doctor so that the doctor can decide who needs testing.
• From when the patient is no longer a risk to others is for the doctor to decide.
• According to the CDC, completing treatment helps both the patient’s recovery and preventing others from getting infected.

Brucellosis

• Spread from person to person is very rare (CDC, WHO).
• The problem is usually food: unpasteurised dairy and undercooked meat. If the family ate the same dairy, tell the doctor.

Hepatitis B and C

• Hepatitis B and C are not passed on by food, water, kissing, hugging, coughing or sneezing (CDC). With hepatitis C, a person with the infection can go to work and school.
• Do not share razors, toothbrushes or other things that may get blood on them (NHS, hepatitis B).
• The hepatitis B vaccine protects healthy people. Talk to the doctor about vaccinating family members.

HIV

• According to the NHS, HIV is not passed on by kissing, hugging, shaking hands, or sharing cups, dishes and toilets.
• The WHO and CDC say that when effective treatment brings the virus in the blood down to an undetectable level, the virus is not passed on through sex. For other routes of spread and a prevention plan, ask the doctor.

What is not necessary?

• You do not need to keep the food or dishes of a person with hepatitis C or HIV separate, because the sources do not list shared food or dishes as a route of spread.
• You do not need to fear hugging or kissing a person with HIV or hepatitis.

Where should you take more care?

• The NHS says babies, people over 75, pregnant women and people with weak body defences are more at risk of serious infections. If there is such a person at home, wash your hands more while someone is ill, and tell a doctor early if that person develops a fever or any new symptom.
• If your patient has active TB or another infection that can spread, be sure to coordinate with the doctor.

Talk to your doctor about your own illness and how it spreads.

The first rule

If you think something is seriously wrong, do not wait. The NHS says that if you or your child are unwell and you feel it is serious, get help straight away. In Iran the emergency number is 115.

In these situations, do not drive yourself. Ask someone to take you, or call 115.

Sepsis (a dangerous reaction of the body to infection)

Sepsis is when the body’s response to an infection harms the body itself. The CDC calls it a medical emergency and says that without quick treatment it can lead to tissue damage and organ failure. Anyone can get it.

Call 115 or go to the emergency department if an adult, or a child over 5, who has an infection or is unwell:

• is confused, has slurred speech or talks nonsense
• is breathing very fast
• has skin, lips or tongue that are blue, pale or mottled
• has a very high or very low temperature
• has shivering they cannot control
• has a rash that does not fade when pressed
• has severe, unusual pain

The NHS says that in older people the temperature may not be high. Not passing urine for 18 hours is also a warning sign. Diagnosis is harder in babies, young children, people with dementia and people who cannot speak well.

Who is more at risk?

The NHS says the risk is higher in:

• babies under one year old and people over 75
• pregnant women and women who have recently given birth
• people whose body defences are weak (for example people with HIV, on chemotherapy or on medicines that suppress the immune system)
• people with burns, cuts, wounds or a skin infection such as cellulitis
• people who have a urinary catheter

Fever in a person with weak body defences

If your body defences are weak (for example chemotherapy, an organ transplant, HIV or medicines that suppress the immune system), do not treat a fever as routine. The NHS counts this group as being at higher risk of sepsis. Contact a doctor the same day, and if you have any of the signs above, go to the emergency department.

Meningitis (infection of the lining of the brain)

Symptoms come on suddenly and at first look like flu or a stomach bug. The NHS says that in adults and children over 5 you should watch for: fever, cold hands and feet, a stiff neck, a worsening headache, eyes sensitive to light, vomiting, confusion, unusual drowsiness and seizures.

The glass test. Press the side of a clear glass firmly against the spots or rash. If the marks do not fade, it is an emergency. On darker skin they may be harder to see; look at the palms, soles, inside the mouth, the whites of the eyes and under the eyelids.

In babies: refusing feeds, a high-pitched or moaning cry, a floppy or stiff body, and a bulging soft spot on the head (NHS).

Call 115 if you have any sign that makes you suspect meningitis, even if you do not have all of them.

Fever in babies and children

The NHS gives these for children under 5: a temperature of 38 degrees or above in a baby under 3 months, or 39 or above at 3 to 6 months; a temperature below 36; a weak, high-pitched cry; not responding as usual; no urine for 12 hours; fast breathing. These mean go to the emergency department straight away.

Severe dehydration

Dehydration happens with diarrhoea, vomiting, fever and heat. The NHS says babies, children and older people are more at risk.

Call 115 or go to the emergency department if, with dehydration, there is:

• skin, lips or tongue that are blue, grey, pale or mottled
• cold skin
• fast or difficult breathing
• confusion
• extreme drowsiness or not waking up

These can be signs of shock (NHS). Milder signs of dehydration to tell a doctor about early: unusual tiredness, dizziness on standing that does not go away, very dark or little urine.

The NHS says that if you feel sick, start with small sips of fluid and slowly take more. If you have the warning signs above, do not rely on drinking at home.

Signs specific to some infections

• Cellulitis. Skin that is painful, hot and swollen, with a very high temperature, a fast heartbeat or fast breathing, purple patches, dizziness, confusion, or cold clammy skin. Call 115 and do not drive yourself.
• Urinary infection. If you become confused, drowsy or have trouble speaking, go to the emergency department. If you have pain under the ribs, fever with shivering, or blood in the urine, see a doctor the same day; it could be a kidney infection and could lead to sepsis.
• TB. Coughing blood: contact a doctor the same day. A stiff neck with severe headache, a seizure, sudden confusion or weakness in an arm or leg: emergency department. The NHS says TB may have reached the brain.
• Diabetic foot wound or a wound after surgery. Fever, redness that is spreading, discharge, increasing pain. Show it to a doctor the same day.

Animal bite or scratch

Wash the wound straight away with soap and water for at least 15 minutes (WHO). Then, even if the wound is small, get it assessed by a doctor or health centre the same day, and do not wait for symptoms. The WHO says deaths from rabies can be prevented with prompt preventive treatment, but once symptoms begin it is almost always fatal. That is why timing matters. The doctor decides what treatment is needed from the type of contact.

Possible contact with HIV or blood (including a needle injury)

If you think you were exposed to HIV in the last 72 hours, go as soon as you can to an emergency department or an authorised counselling centre. The NHS gives this 72-hour window and says emergency preventive treatment may stop you becoming infected. So do not wait, and do not feel shame; the only aim is to protect your health.

Fever during or after travel to a malaria area

The NHS says that if you have travelled to a country with a malaria risk and have a high temperature or feel hot, cold or shivery, you should get help quickly and not wait until you are home. The NHS gives this advice for up to 12 months after the trip. Tell the doctor where you travelled.

If you are not sure

If you feel something is seriously wrong, even if you do not have all of the signs above, get help. The NHS says the same for meningitis and sepsis. If in doubt, call early.

This page is not a complete list and does not take the place of an examination.