What negative history should be asked to a patient with cough and fever?

From the Guidelines

When evaluating a patient with cough and fever, it is crucial to ask about the absence of key symptoms and exposures to guide management and narrow the differential diagnosis. To determine the underlying cause of cough and fever, it is essential to inquire about the absence of certain symptoms and exposures. Important negative history to ask includes:

• Absence of hemoptysis, chest pain, shortness of breath, night sweats, weight loss, and sputum production 1
• Lack of recent travel, especially to areas with endemic respiratory diseases, and no exposure to sick contacts or individuals with tuberculosis 1
• No history of immunocompromising conditions like HIV, diabetes, or cancer, and confirm the absence of previous lung diseases such as asthma, COPD, or bronchiectasis 1
• Determine if there's no history of smoking, occupational exposures to irritants, or allergies 1
• Also, important is the absence of recent hospitalizations, antibiotic use, or healthcare facility exposure that might suggest healthcare-associated infections 1 These negative findings are crucial because their absence helps narrow the differential diagnosis and guides appropriate management. For example, absence of hemoptysis and weight loss makes tuberculosis less likely, while no recent antibiotic use decreases concern for resistant organisms 1. Collecting this information allows for more targeted testing and treatment approaches for common causes of cough and fever like viral or bacterial respiratory infections. Key aspects of the medical history, such as the presence of fever, sweats, or weight loss, and a history of cancer, tuberculosis, or AIDS, are also vital in determining the cause of cough and fever 1.

From the Research

Negative History for Cough and Fever

When evaluating a patient with cough and fever, it's essential to ask about negative history to rule out potential causes. Some key aspects to consider include:

• Immunocompromised status: Has the patient been diagnosed with a condition that weakens the immune system, such as HIV/AIDS or taking immunosuppressive medications 2?
• Previous infections: Has the patient had previous infections, such as tuberculosis, or been exposed to someone with a contagious disease 3, 4?
• Travel history: Has the patient recently traveled to an area where certain diseases are prevalent, such as tuberculosis or pneumocystis pneumonia 2?
• Occupational exposure: Has the patient been exposed to substances or environments that could increase the risk of respiratory infections, such as working in healthcare or construction 5?
• Medication history: Is the patient taking any medications that could increase the risk of infections, such as immunosuppressants or corticosteroids 3, 2?

Specific Questions to Ask

Some specific questions to ask when taking a negative history for cough and fever include:

• Has the patient ever been diagnosed with tuberculosis or taken medications for it 3, 4?
• Has the patient been vaccinated against diseases such as influenza or pneumococcus 5?
• Has the patient had any recent contact with someone who has been diagnosed with a contagious disease, such as tuberculosis or influenza 3, 4?
• Has the patient recently traveled to an area where diseases such as tuberculosis or pneumocystis pneumonia are common 2?
• Is the patient taking any medications that could increase the risk of infections, such as immunosuppressants or corticosteroids 3, 2?