Permanent fever!

Question

Hello,
the daughter of my nice has been diagnosed with CF recently. The sweat test had been positive 2 times and also the genetic testing. The little one is now 15 months old, did not gain weight anymore in the last months, at the investigations a vitamin D deficiency had been detected, a hypothyreosis, anemia and a reduction of the pancreatic enzyme. She has again and again from time to time spasms of the hands and feet and in the last weeks about every 2-3 days increased temperatures. It is possible that with CF those increased temperatures occur permanently? The doctor in charge at the hospital just did not want to comment on these fever episodes.
Can one really assume CF according to the positive sweat test and genetic testing or could there also other illnesses be a possibility?
Many thanks

Answer

Hello,
you report that the daughter of your nice has been diagnosed with CF according to a positive sweat test and genetic testing. It can be said in general, that in case of such a constellation of results Cystic Fibrosis has to be assumed with all certainity. Also the result of the decrease of pancreatic enzymes underlines the diagnosis. The vitamin D deficiency of the child can be explained by the disturbed function of the pancreas. The finding will normalize fast under a now certainly implemented substitution of pancreatic enzymes and administration of vitamin D.

The hypothyreosis can not be explainded by the CF and has certainly to be clarified causally and treated accordingly.

Under an appropriate substitution of pancreatic enzymes it should come rapidly to a good gain of weight in a newly diagnosed patient with CF. With that, the primary ravenous appetite normalizes to a normal appetite. Most important is the good gain of weight. In case of a poor appetite and insufficient gain of weight one has to take into account in a young CF patient a shift of the salts in the blood (sodium, chloride and potassium) especially in the warm summertimes. Then it can lead to a so-called thirst-fever in the affected patients.

Concerning the fever, one has of course to search for other causes (e.g. chronic infection of the urinary tract).
Yours sincerely,
Dr. H.-G. Posselt

16.06.2009