What should I do if I'm experiencing symptoms like fever, pain, or difficulty breathing?

What to Do If Experiencing Fever, Pain, or Difficulty Breathing

If you are experiencing fever, pain, or difficulty breathing, you should seek immediate medical evaluation—call 9-1-1 or go to the emergency department if you have shortness of breath, chest pain, or severe symptoms, as these may indicate life-threatening conditions requiring urgent assessment. 1

Immediate Action Based on Symptom Severity

Red Flag Symptoms Requiring Emergency Care (Call 9-1-1)

• Shortness of breath or labored breathing 1
• Chest pain, especially if accompanied by weakness, slurred speech, or diaphoresis 1
• Fever over 101°F (38.3°C) combined with difficulty breathing 1
• Altered mental status, confusion, or seizures 2
• Persistent hypotension (systolic blood pressure <90 mmHg) 2
• Oxygen saturation <92% or respiratory distress 2
• Petechial or purpuric rash 2

Symptoms Requiring Urgent Medical Evaluation (Same Day)

• Fever ≥38°C with cough or breathing difficulty, particularly if you have recent travel history, tick exposure, or outdoor activities in rural/wooded areas 1, 2
• Pleuritic chest pain (sharp, stabbing pain worsening with breathing) that may indicate pneumonia, pulmonary embolism, or pericarditis 1, 3
• Increasing pain, vision changes, swelling of the face, or diffuse skin rash 1
• Fever with cough, dyspnea, sweating/shivers, or new chest examination findings suggesting pneumonia 1

Diagnostic Approach for Fever and Respiratory Symptoms

Clinical Assessment Priorities

• Obtain travel history immediately—any travel to malaria-endemic regions within the past 2-10 days to several months mandates immediate malaria evaluation 2
• Assess for tick exposure or outdoor activities suggesting rickettsial disease with typical incubation of 5-7 days 2
• Examine entire skin surface including palms and soles for rash, though absence does not exclude tick-borne disease 2
• Check for neck stiffness, though Kernig and Brudzinski signs have low sensitivity and their absence does not rule out meningitis 2

When Pneumonia is Suspected

For outpatients with acute cough and suspected pneumonia, chest radiography should be ordered when abnormal vital signs are present to improve diagnostic accuracy. 1

• Clinical features suggestive of pneumonia include: cough, dyspnea, pleural pain, sweating/fevers/shivers, temperature ≥38°C, tachypnea, and new localizing chest examination signs 1
• Absence of runny nose and presence of breathlessness, crackles, and/or diminished breath sounds on auscultation, tachycardia, and fever (≥38°C) are particularly suggestive 1
• Measure C-reactive protein (CRP) if available—CRP ≥30 mg/L in addition to suggestive symptoms increases likelihood of pneumonia 1
• Acute cough is less likely pneumonia when CRP <10 mg/L or between 10-50 mg/L in the absence of dyspnea and daily fever 1

Treatment Recommendations

For Suspected Pneumonia

• Use empiric antibiotics according to local and national guidelines when pneumonia is suspected in settings where imaging cannot be obtained 1
• Do not routinely use antibiotics when there is no clinical or radiographic evidence of pneumonia (normal vital signs and lung exam) 1
• Initiate antiviral treatment within 48 hours if influenza is suspected, which may decrease antibiotic use and hospitalization 1

For Fever and Tick-Borne Disease Concerns

Start doxycycline 100 mg twice daily immediately if tick exposure or thrombocytopenia/leukopenia is present, as this is the drug of choice for all tick-borne rickettsial diseases, and delayed treatment can result in severe complications or death. 2

• Do not delay empirical doxycycline if clinical suspicion of rickettsiosis exists, especially in endemic areas or with tick exposure history 2
• Start oral artemisinin-based combination therapy immediately if travel to malaria-endemic areas is suspected, without delaying for test results 2

Symptomatic Pain and Fever Management

• Use acetaminophen (Tylenol) for pain and fever, as it does not increase bleeding risk 1, 4
• Ibuprofen or other NSAIDs can be used for fever and discomfort, but should be avoided if you have history of stomach ulcers, bleeding problems, kidney disease, heart failure, or are taking blood thinners 5
• NSAIDs should be used at the lowest dose for the shortest time needed 5
• Provide adequate hydration (drink fluids regularly but no more than 2 liters per day) 4
• Rest until resolution of symptoms 2

Critical Pitfalls to Avoid

• Do not exclude tick-borne diseases based on absence of rash, as rash may appear late or be absent in significant percentage of cases 2
• Do not rule out meningitis based solely on absence of Kernig or Brudzinski signs, as these have low sensitivity 2
• Do not ignore the possibility of co-infections, as ticks can transmit multiple pathogens simultaneously 2
• Do not assume minor outdoor exposure is insignificant, as even brief exposure can result in tick-borne illness 2
• Avoid NSAIDs if you are pregnant (especially after 20 weeks), have kidney disease, heart failure, or history of stomach ulcers 5
• Stop NSAIDs immediately and seek medical care if you develop nausea, vomiting blood, black tarry stools, yellowing of skin/eyes, unusual fatigue, or skin rash 5

When to Return for Follow-Up

• Return immediately if symptoms worsen, high fever develops (>39°C), difficulty breathing, severe headache, or inability to swallow 4
• Viral pharyngitis symptoms typically last up to 2 weeks with gradual improvement expected 4
• Consider additional testing if symptoms persist beyond 2 weeks 4