Comprehensive Checklist for History Taking in Fever
A thorough history taking is essential for patients presenting with fever to determine the underlying cause and guide appropriate management. The following checklist provides a structured approach to history taking in febrile patients.
General Information
- Age and gender
- Occupation and work environment
- Recent travel history (locations, dates, duration, activities undertaken) 1
- Living conditions and housing
- Recent contact with sick individuals
- Vaccination status
Fever Characteristics
- Onset (sudden or gradual)
- Duration (acute <7 days, subacute 7-21 days, chronic >21 days)
- Pattern (continuous, intermittent, remittent, hectic, relapsing)
- Temperature readings (maximum recorded, time of day when peaks occur)
- Associated symptoms during febrile episodes (fatigue, warmth, headache, malaise, loss of appetite, muscle cramps) 2
- Response to antipyretics
Associated Symptoms
Systemic Symptoms
- Fatigue/malaise
- Weight loss
- Night sweats
- Chills/rigors
- Myalgia/arthralgia
- Rash (description, distribution, timing in relation to fever)
- Lymphadenopathy (location, size, tenderness)
Respiratory Symptoms
- Cough (productive/non-productive)
- Sputum (color, amount, consistency, blood-tinged)
- Shortness of breath
- Chest pain
- Hemoptysis
Gastrointestinal Symptoms
- Nausea/vomiting
- Diarrhea (frequency, consistency, blood/mucus)
- Abdominal pain (location, character, radiation)
- Jaundice
- Change in appetite
Genitourinary Symptoms
- Dysuria
- Frequency/urgency
- Hematuria
- Vaginal/urethral discharge
- Testicular pain/swelling
Neurological Symptoms
- Headache (location, severity, associated symptoms)
- Neck stiffness
- Altered mental status
- Seizures
- Focal neurological deficits
Risk Factors and Exposures
- Recent travel to endemic areas (within past year for malaria) 1
- Animal contacts or bites
- Insect bites (mosquitoes, ticks)
- Fresh water exposure (swimming, wading)
- Consumption of unpasteurized dairy products or undercooked meat
- Sexual history and risk factors
- Intravenous drug use
- Blood transfusions
- Recent surgical procedures or invasive tests
- Recent dental work
Medical History
- Previous similar episodes
- Chronic medical conditions
- Immunocompromised status (HIV, transplant, chemotherapy)
- Recent hospitalizations or healthcare facility exposure
- Recent antibiotic use or other medications
- Known tuberculosis exposure
- History of malignancy
- History of autoimmune disorders
Medication History
- Current medications
- Recent changes in medications
- Over-the-counter medications
- Herbal supplements
- Drug allergies
Special Considerations for Returned Travelers
For patients with fever returning from travel to tropical regions:
- Exact travel itinerary with dates 1
- Rural vs. urban exposure
- Accommodation type (hotels, camping, local homes)
- Insect protection measures used
- Food and water precautions followed
- Pre-travel vaccinations and prophylaxis
- Activities undertaken (hiking, swimming, caving, safaris) 1, 3
- Time between return and symptom onset (most tropical infections become symptomatic within 21 days of exposure) 1
Specific Questions for High-Risk Exposures
- For malaria risk: Mosquito exposure between dusk and dawn, prophylaxis adherence 1
- For arboviral infections: Daytime mosquito exposure 3
- For tick-borne diseases: History of tick bites or outdoor activities in endemic areas 3
- For schistosomiasis: Freshwater exposure in endemic areas 3
- For viral hemorrhagic fevers: Contact with bodily fluids of infected individuals 1
Red Flag Symptoms Requiring Urgent Attention
- Altered mental status
- Severe headache with neck stiffness
- Petechial or purpuric rash
- Respiratory distress
- Hypotension
- Severe abdominal pain
- Bleeding from any site
- Rapid deterioration in clinical condition
This comprehensive approach to history taking in febrile patients will help identify the underlying cause and guide appropriate investigations and management. Remember that malaria should be excluded in all patients with a history of fever returning from the tropics, as it is the most important potentially fatal cause of febrile illness 1.