A fever that persists beyond 5 days despite treatment — or that was treated for malaria without improvement — is not malaria until proven otherwise. This page covers the common causes of persistent fever in Lagos and the tests that identify the real diagnosis.
In Lagos, malaria is the most common cause of acute fever — but typhoid, hepatitis, urinary infection, pneumonia, and other conditions all cause fever that malaria treatment will not resolve.
Persistent fever (> 5 days), headache, abdominal pain, and anorexia — Salmonella typhi infection. Does not respond to antimalarials. Widal test and blood culture confirm. Treated with ciprofloxacin or azithromycin.
Should respond to a full course of artemether-lumefantrine within 3–4 days. If it does not — recheck with RDT, consider treatment failure or mixed infection.
High fever + loin pain + nausea — kidney infection (pyelonephritis). Urine culture confirms. Requires antibiotics (often IV initially for severe cases).
Fever + cough + chest pain + breathlessness — bacterial pneumonia. Chest X-ray + FBC confirm. Requires antibiotics.
Fever + jaundice + dark urine + anorexia — acute hepatitis A or E. Liver function tests and hepatitis serology confirm. Supportive treatment.
Fever + sore throat + rash + lymph node swelling 2–6 weeks after potential HIV exposure — acute HIV. HIV antigen/antibody test required.
Malaria RDT + Blood Film — Confirms or excludes malaria definitively — even if already treated. Results in 15 minutes.
Widal Test — Screens for typhoid fever — significant if O titre ≥ 1:160 in the clinical context.
Blood Culture — Gold standard for typhoid and bacteraemia — takes 48–72 hours but provides the definitive diagnosis.
Full Blood Count + CRP — Leucopenia suggests typhoid; elevated WBC suggests bacterial infection; CRP quantifies inflammation.
Liver Function Tests — Elevated transaminases with fever suggest hepatitis or malaria-associated liver involvement.
Urine Dipstick + Culture — Excludes urinary tract infection as the source of fever.
Two completed courses of artemether-lumefantrine that have not cleared fever means it is probably not malaria. Get an RDT before any further antimalarials.
A malaria RDT, Widal test, FBC, and urine dipstick at Mascot Healthcare gives a near-complete picture of the most likely causes within 1–2 hours.
Fever causes significant fluid loss through sweating. Drink water, ORS, or diluted juice regularly. Avoid alcohol entirely.
Malaria often spikes every 24–48 hours. Typhoid tends to be sustained. Step-ladder pattern rising daily is classic typhoid. Pattern helps guide testing.
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