FEVER

Sara El Sayed Abd El Ghani

Lecturer of Internal Medicine
Faculty of medicine, Cairo University
 Definition

• Fever is an elevation in core body temperature above the

daily range for an individual.
 Epidemiology

• Fever is one of the most common medical signs.

• It is about 30% of healthcare visits by children.
• Occurs in up to 75% of adults who are seriously sick.
• About 5% of people who go to an emergency room have a fever.
Regulation of body temperature
• Elevated levels of prostaglandin E2 (PGE2) in the hypothalamus appear to be the
trigger for raising the set-point.
• Once the hypothalamic set-point is raised, this activates neurons in the vasomotor
center to commence vasoconstriction and warm-sensing neurons to slow their firing
rate and increase heat production in the periphery.
• The vasoconstriction produces a noticeable cold sensation in the hands and feet.
• Blood is shunted away from the periphery to the internal organs, essentially
decreasing heat loss from the skin, and the patient feels cold. For most fevers, this is
sufficient to raise core body temperature 1 or even 2°C.
 PYROGENS
• The term pyrogen is used to describe any substance that causes fever.
• Pyrogens are either exogenous or endogenous.
• Endogenous pyrogens belong to the class of biologically active proteins
called cytokines.
• Fever-producing cytokines are more precisely termed pyrogenic cytokines.
• Exogenous pyrogens, derived from outside the host, are mainly microbes or
their products, such as toxins.
• The classic example of an exogenous pyrogen is the lipopolysaccharide
endotoxin produced by all gram-negative bacteria.
• Endotoxins are potent substances not only as pyrogens but also as inducers
of various pathologic changes observed in gram-negative infections
 Ways of measuring temperature
• Rectal
• Tympanic
• Forehead (temporal)
• Oral
• Axillary
 Associated Symptoms

• Elevated temperature.
• Chills, shivering, shaking.
• Body aches and headaches.
• Fatigue (tiredness).
• Intermittent or constant sweating.
• Flushed complexion or hot skin.
 Dangerous signs
• A fever accompanied by a stiff neck, confusion or irritability.
• A fever remaining above 39.5°C despite treatment.
• High fever accompanied by rash.
• Photophobia (irritated by light).
• Dehydration (less amount of urine, sunken eyes, no tears).
• Seizures.
 Types

• Continuous fever where temperature remains above normal throughout the day and does
not fluctuate more than 1 °C in 24 hours (e.g. in bacterial pneumonia, typhoid, infective
endocarditis, tuberculosis)
• Intermittent fever where the temperature elevation is present only for a certain period, later
cycling back to normal (e.g., in malaria)
• Remittent fever where the temperature remains above normal throughout the day and
fluctuates more than 1 °C in 24 hours (e.g., in brucellosis)
• Pel–Ebstein fever is a cyclic fever that is rarely seen in patients with Hodgkin's lymphoma.
• Typhoid fever is an example of continuous fever and it shows a characteristic step-ladder
pattern, a step-wise increase in temperature with a high plateau.
 Differential diagnosis

Fever is a common symptom of many medical conditions:

• Infectious disease, e.g., COVID-19, dengue, Ebola, gastroenteritis, HIV, influenza, Lyme
disease, as well as infections of the skin, e.g., abscesses
• Immunological diseases, e.g., autoimmune hepatitis, inflammatory bowel
diseases, Kawasaki disease, lupus erythematosus, sarcoidosis, and Still's disease
• Tissue destruction, as a result of cerebral bleeding, crush
syndrome, hemolysis, infarction, rhabdomyolysis, surgery
• Cancers, particularly blood cancers such as leukemia and lymphomas
• Metabolic disorders, e.g., gout, and porphyria
• Inherited metabolic disorder, e.g., Fabry disease
 Management

Conservative measures
• Limited evidence supports sponging or bathing feverish children with tepid water.
• The use of a fan or air conditioning may somewhat reduce the temperature and
increase comfort.
• If the temperature reaches the extremely high level of hyperpyrexia, aggressive
cooling is required ( by applying numerous ice packs across most of the body or
direct submersion in ice water).
• In general, people are advised to keep adequately hydrated.
Medications
• Medications that lower fevers are called antipyretics.
• Ibuprofen is effective in reducing fevers in children.
• It is more effective than acetaminophen (paracetamol) in children.

Treatement of the cause

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