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Description : 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

Tags : fever,cold and flu,flu

Published on : Apr 04, 2021 | Views : 6074 | Downloads : 38

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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 cell destruction. Body temperature is controlled 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.
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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.
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FEVER B) Based on Height of Fever: Normal and febrile body temperature ranges (rectal temperatures).
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FEVER C) Based on Pattern of Fever: 1. Sustained or Continuous Fever: Fever that oscillates less than 1 ºC or 1.5 ºF daily; doesn’t touch normal • Typhoid fever • Drug fever • Typhus • Neoplasms
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FEVER 2. Remittent Fever: Fever that oscillates more than 1 ºC or ~1.5 ºF ; doesnt touch normal Pattern of most fevers
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FEVER 3. Intermittent Fever: Fever that falls to normal each day.
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FEVER 4. Hectic or Septic Fever: When remittent or intermittent fever shows large variation between the peak and nadir • Kawasaki disease • Pyogenic infections
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FEVER 5. Periodic or Cyclic Fever: Episodes of fever recurring at regular intervals • 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
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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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FEVER 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
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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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FEVER
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FEVER 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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