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FEVER
FEVER(Pyrexia)
Is an elevation of body temperature above the normal circadian range (daily variation) as a
result of a change in the thermoregulatory center located in the anterior hypothalamus and pre
-optic area (i.e. an increase in the hypothalamic set point of 37 C) due to infection, metabolic
derangements or increased cel destruction.
Body temperature is control ed in the hypothalamus,which is directly sensitive to changes in
core Temperature. The normal 'set-point' of core temperature is tightly regulated within 37 ?
0.5?C, as required to preserve normal function of many enzymes and other metabolic
processes.
CLASSIFICATION OF FEVERS
A) Based on Duration of Fever:
1. Acute fevers (<7 days): infectious diseases such as malaria and viral-related
upper respiratory tract infection
2. Sub-acute fevers (usually not more than 2 weeks in duration): typhoid fever
and intra-abdominal abscess
3. Chronic or persistent fevers (>2 weeks duration): chronic bacterial infections
such as tuberculosis, viral infections like HIV, cancers and connective tissue
diseases. However, any cause of acute fever can become persistent or chronic if
untreated.
FEVER
B) Based on Height of Fever:
Normal and febrile body temperature ranges (rectal temperatures).
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C) Based on Pattern of Fever:
1. Sustained or Continuous Fever: Fever that oscil ates less than 1 ?C or 1.5 ?F daily; doesn't
touch normal
? Typhoid fever
? Drug fever
? Typhus
? Neoplasms
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2. Remittent Fever:
Feverthatoscillatesmorethan1?Cor~1.5?F;doesnttouchnormal
Patternofmostfevers
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3. Intermittent Fever:
Fever that fal s to normal each day.
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4. Hectic or Septic Fever:
Whenremittentorintermittentfevershowslargevariationbetweenthepeakandnadir
? Kawasaki disease
? Pyogenic infections
FEVER
5.PeriodicorCyclicFever:Episodesoffeverrecurringatregularintervals
? Quotidian (24 hour periodicity): P. falciparum
? Double quotidian (12 hour periodicity): Kala-azar, Gonococcal arthritis, Juvenile RA, Some drug fevers
(carbamazepine
? Tertian (48 hour periodicity): P. vivax, P. ovale
? Quartan (72 hour periodicity): P. malariae
? Pel-Ebstein Fever: bouts of fever lasting 3 to 10 days followed by asymptomatic periods of the same
length (Hodgkin's disease)
? Relpasing fever (every 10-14 days): Borrelia recurrentis
FEVER
? Undulant fever :
(gradual increase in temperature that remains high for a few days, and then
gradually decreases to normal):Brucellosis
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6. Recurrent Fever:
Illness involving the same organ (e.g. urinary tract) or multiple organ systems in
which fever recurs at irregular interval:
Familial Mediterranean Fever
GENERALISED APPROACH TO FEVER / FUO
The approach to a patient presenting with fever of unknown origin (FUO) should
include:
a comprehensive history,
physical examination and
appropriate diagnostic testing
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History: A comprehensive history should include questions about:
A. The fever itself (e.g. route of measurement, peak temperature, patterns, time
of day, etc.)
B. Systemic symptoms (e.g. weight loss, decreased appetite, rash, myalgias,
arthralgias, etc.)
C. Localized symptoms (e.g. cough, urinary symptoms, headache, abdominal pain,
bone pain, etc.)
D. Travel history, sick contacts, animal contacts, family history, and sexual history
E. Potential causes of drug-induced fever: diuretics, pain relievers, salicylates, anti-
arrhythmic agents, anti-seizure drugs, sedatives, antihistamines, barbiturates,
cephalosporins, penicillins, sulfonamides.
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This post was last modified on 12 August 2021