Fever

-

Introduction: 

                       Fever is a temporary increase in your body temperature above the normal temperature variations.

The name of feeling feverish is not the same thing as having a real fever and a real fever if felt then it should be measured by a thermometer.

Normal Variation: 

                         There is a normal daily diurnal variation of 0.5 degrees centigrade(0.9- degrees Fahrenheit) between the morning and evening and t is most in the late afternoon and early evening and the lowest in the early morning. A persistent morning temperature of more than 37.2 degrees centigrade(greater than 98.9 degrees Fahrenheit) or an evening temperature is more than 37.7 degrees centigrade(more than 99.9 degrees Fahrenheit) would define a fever.

There are many factors that cause a difference in the normal body temperature variation such as gender. Body temperature is also very sensitive to body hormones and there is a 0.9 degrees Fahrenheit increase in temperature in females that are ovulating(going through the phase of ovulation.

In addition to that exercise, digestion and the underlying disorders such as chronic renal failure and underlying neuropsychiatric disorders such as chronic depression may alter the temperature regulation function. Ambient temperature and humidity have also been shown experimentally to affect body temperature.

Site of temperature measurement:

                                                          The body temperature can be measured in different places in the human body called the mouth, armpit, rectum, and ear. The oral temperature has long been used in clinical practice, largely because of its availability and because it reacts to the changes in the core temperatures. Temperatures measured in the armpit are usually used at homes and in some clinics due to its convenience and safety and because measure from the mouth can be very unhygienic, but the accuracy of the temperature taken from the armpit is questioned because of the presence of axillary folds. Taking temperature from the rectum is culturally inappropriate. Whereas temperature taken from the ear is not standardized.

Approach to fever:

                                Attention must always be paid to the chronology of events and other signs and symptoms that precede the fever. Soe infections have a characteristic pattern where the febrile episodes are separated by intervals of normal temperature. For e.g; Plasmodium vivax causes fever every 3rd day and P.malariae causes fever every 4th day. Typhoid fever typically starts low grade and after 3-4 days is elevated and gives chills and it remains elevated until it is treated. Fever patterns can be modified by antipyretics but we should not completely depend on them.

Clinical examination is necessarily looking for possible bradycardia, jaundice, rash, purpura, palpable lymph nodes, auscultating for abnormal heart sounds or crepitations on the chest, and joint involvement.

Clinical investigations: 

                                       3 preliminary investigations may include a CDC, erythrocyte sedimentation rate, urinalysis, and basic cultures.

Treatment: 

                         Most fevers due to common viral infections are self-limited. The use of antipyretics is not contraindicated in these infections: There is no clinical evidence that antipyretics delay the resolution of bacterial or viral infection nor is there sufficient clinical evidence that fever helps the immune response of the body. In bacterial infection, it is useful to hold off the antipyretic therapy because due to that we can see the effectiveness of a particular antibiotic therapy, particularly in the absence of the identification of the organism. Frequent use of antipyretics can mask an inadequately treated bacterial infection.

Aspirin is a type of non-steroidal, anti-inflammatory drug.NSAIDs are non-narcotic pain relievers.NSAIDs and aspirin are used to treat pain and reduce inflammation from a variety of causes, such as headaches, injuries, arthritis, menstrual cramps, and muscle aches. NSAIDs also are used as fever relievers and so are aspirin. Acetaminophen is typically prescribed for fevers of unknown cause.

Urgent treatment of some patients is highly recommended. Fever increases the need for oxygen and can aggravate the already existing cardiac, pulmonary, or cerebrovascular disorders. Fever may cause mental damage to patients with already pre-existing mental conditions. and children may develop febrile convulsions. We need to pay attention to the patients who are elderly, and those who with high fever present with other symptoms like severe pain, headache, vomiting, or mental confusion.

Causes:

              Determining the cause of a fever can be very challenging. We have to look at every clue, every blood test, and every examination to find out the cause of the fever and we must keep looking for it until the answer is not found. It is also important to realize that fever may also be due to non-infectious causes like pregnancy 




 

Comments

Post a Comment

Popular posts from this blog

The Common Cold

-
  Case Scenario:                             A 2-year-old girl presents with a 3-day history of 38.7-degree centigrade fever, nasal congestion with cloudy rhinorrhea, and conjunctivitis. The pharynx is erythematous and the rest of the exam is normal. She has remained healthy and the rest of the vaccination is completed. The mother is worried and wants to know which antibiotic you will prescribe, as her brother is allergic to penicillin.                     Definition:                              It is a viral infection that is acute, self-limiting, and usually targets the upper respiratory tract(nose and throat). It is usually harmless and many types of viruses can cause a common cold. Epidemiology:                           ...
Read more

Helminthiasis

-
Introduction:                   Helminths are parasites/worms which infest the human body and can cause helminthiasis. These infections are very common in the tropics and subtropics. Children who have a habit of walking barefoot in mud or those that eat paint or sand or those who have a history of PICA are more prone to such infections. Etiology:         Most common worm infestations are caused by flatworms(like tapeworms and flukes) and roundworms(like ascariasis, pinworm, and hookworm infection). Epidemiology:                    Studies have suggested that within the USA, approximately 1.3 to 2.8 million people have serological evidence with Toxocara species, 4 million with soil-transmitted helminths, 41,400 to 169,000 with cysticercosis, and approximately 8000 with schistosomiasis. A recent study done in Chicago shows that approximately 12% of subjects providing samples ...
Read more

GLOMERULONEPHRITIS

-
  Case scenario:                          A 25-year-old woman presented to her primary care physician complaining of swollen hands since last week. She had also noticed that over the last 2 days she was swelling around her eyes and was short of breath. Epidemiology:                     Glomerulonephritis is rare, with an estimated worldwide incidence of 0.5-2.5 per 100,000 patients per year depending on the specific type. In contrast, the risk of progression to end-stage renal disease(ESRD) is high, explaining why glomerulonephritis accounts for 14-20% of cases of end-stage renal disease. Causes: Toxins and medicine Viral infections like hepatitis C and B virus. IgA nephropathy lupus-related kidney inflammation Symptoms: Fatigue High blood pressure Swelling of the hands, feet, belly, and face Blood and protein in the urine Decreased urine output. Complications: Acute k...
Read more