A few years ago, seasonal fevers often followed predictable patterns. A patient with high fever and falling platelet counts would immediately raise suspicion of dengue. Persistent fever with abdominal symptoms would point towards typhoid. Today, however, things are no longer that straightforward. Dr Brij Vallabh Sharma, senior consultant, internal medicine, Narayana Hospital, Jaipur, explains why some seasonal fevers are becoming harder to identify.
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“So, if your doctor says, ‘Let’s wait another 24 hours before confirming the diagnosis,’ it isn’t a sign of uncertainty. It is often the safest and most evidence-based approach,” said Dr Brij.
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Dr Brij highlighted that as the monsoon season sets in, doctors are seeing a growing number of patients with high fever, body aches, headache, fatigue, and stomach discomfort. During the first day or two of illness, these symptoms often overlap across multiple infections, making it difficult, and in many cases unsafe, to arrive at a definite diagnosis immediately.
Another common misconception is that more tests automatically lead to a quicker diagnosis. In reality, doctors often learn more by carefully monitoring how symptoms and blood reports change over the next one or two days than by ordering every possible test on the very first day.
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
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According to Dr Brij, one of the biggest reasons is that infectious diseases don’t always behave the way textbooks describe them. He highlighted that dengue may begin before platelet counts start falling. Typhoid can appear without the usual gastrointestinal symptoms. Influenza, COVID-19, scrub typhus, leptospirosis, and several viral infections can all start with nearly identical symptoms like fever, headache, body pain, weakness, and fatigue.
During the first 48–72 hours, these illnesses can look remarkably similar, making it difficult to distinguish one from another based on symptoms alone.
Dr Brij highlighted that many people assume that blood tests provide an instant diagnosis, but infectious diseases don’t work that way. Several diagnostic tests are accurate only during a specific stage of the illness. If a test is done too early, it may not detect the infection even though symptoms have already started. Similarly, doctors also look for changes in blood parameters over time rather than relying on a single report. “That is why repeating a test after 24 or 48 hours doesn’t mean the first test was wrong. It simply allows doctors to reach a more accurate diagnosis,” said Dr Brij.
According to Dr Brij, the infection itself is only one part of the story. The body’s immune response also plays a major role. Age, previous infections, vaccination history, diabetes, kidney disease, obesity, nutritional status, and even genetics can influence how someone responds to the same infection. That’s why two people, even members of the same family, may experience very different symptoms and recover at different speeds despite being infected by the same virus.
According to Dr Brij, one of the most common problems is self-medication. Many people start antibiotics or take multiple medicines within hours of developing a fever. However, most seasonal fevers in the early stages are caused by viruses, against which antibiotics offer no benefit. Unnecessary medication can also alter symptoms, affect certain blood test results, and contribute to antibiotic resistance, making diagnosis even more challenging.
