Fever
Clinical thermometer 38.7.JPG

An analog medical thermometer showing a temperature of 38.7 °C or 101.7 °F
ICD-10 R50
ICD-9 780.6
DiseasesDB 18924
eMedicine med/785
MeSH D005334

Fever (also known as pyrexia[1]) is a common medical sign characterized by an elevation of temperature above the normal range of 36.5–37.5 °C (98–100 °F) due to an increase in the body temperature regulatory set-point.[2] This increase in set-point triggers increased muscle tone and shivering.

As a person's temperature increases, there is, in general, a feeling of cold despite an increasing body temperature. Once the new temperature is reached, there is a feeling of warmth. A fever can be caused by many different conditions ranging from benign to potentially serious. There are arguments for and against the usefulness of fever, and the issue is controversial. With the exception of very high temperatures, treatment to reduce fever is often not necessary; however, antipyretic medications can be effective at lowering the temperature, which may improve the affected person's comfort.

Fever differs from uncontrolled hyperthermia,[1] in that hyperthermia is an increase in body temperature over the body's thermoregulatory set-point, due to excessive heat production and/or insufficient thermoregulation.

Contents

Definition [link]

A wide range for normal temperatures has been found.[5] Fever is generally agreed to be present if the elevated temperature is caused by a raised set point and:

  • Temperature in the anus (rectum/rectal) is at or over 37.5–38.3 °C (99.5–100.9 °F)[1][5]
  • Temperature in the mouth (oral) is at or over 37.7 °C (99.9 °F)[8]
  • Temperature under the arm (axillary) or in the ear (otic) is at or over 37.2 °C (99.0 °F)

In healthy adult men and women, the range of normal, healthy temperatures for oral temperature is 33.2–38.2 °C (91.8–100.8 °F), for rectal it is 34.4–37.8 °C (93.9–100 °F), for tympanic membrane (the ear drum) it is 35.4–37.8 °C (95.7–100 °F), and for axillary (the armpit) it is 35.5–37.0 °C (95.9–98.6 °F).[9] Harrison's textbook of internal medicine defines a fever as a morning temperature of >37.2°C (>98.9°F) or an evening temperature of >37.7°C (>99.9°F) with the normal daily temperature variation is typically 0.5°C (0.9°F).[10]

Normal body temperatures vary depending on many factors, including age, sex, time of day, ambient temperature, activity level, and more. A raised temperature is not always a fever. For example, the temperature of a healthy person rises when he or she exercises, but this is not considered a fever, as the set-point is normal. On the other hand, a "normal" temperature may be a fever, if it is unusually high for that person. For example, medically frail elderly people have a decreased ability to generate body heat, so a "normal" temperature of 37.3 °C (99.1 °F) may represent a clinically significant fever.

Types [link]

Performance of the various types of fever
a) Fever continues
b) Fever continues to abrupt onset and remission
c) Fever remittent
d) Intermittent fever
e) Undulant fever
f) Relapsing fever

The pattern of temperature changes may occasionally hint at the diagnosis:

  • Continuous fever: Temperature remains above normal throughout the day and does not fluctuate more than 1 °C in 24 hours, e.g. lobar pneumonia, typhoid, urinary tract infection, brucellosis, or typhus. Typhoid fever may show a specific fever pattern (Wunderlich curve of typhoid fever), with a slow stepwise increase and a high plateau. (Drops due to fever-reducing drugs are excluded.)
  • Intermittent fever: The temperature elevation is present only for a certain period, later cycling back to normal, e.g. malaria, kala-azar, pyaemia, or septicemia. Following are its types [11]
    • Quotidian fever, with a periodicity of 24 hours, typical of Plasmodium falciparum
    • Tertian fever (48 hour periodicity), typical of Plasmodium vivax and Plasmodium ovale
    • Quartan fever (72 hour periodicity), typical of Plasmodium malariae.
  • Remittent fever: Temperature remains above normal throughout the day and fluctuates more than 1 °C in 24 hours, e.g., infective endocarditis.
  • Pel-Ebstein fever: A specific kind of fever associated with Hodgkin's lymphoma, being high for one week and low for the next week and so on. However, there is some debate as to whether this pattern truly exists.[12]

A neutropenic fever, also called febrile neutropenia, is a fever in the absence of normal immune system function. Because of the lack of infection-fighting neutrophils, a bacterial infection can spread rapidly; this fever is, therefore, usually considered to require urgent medical attention. This kind of fever is more commonly seen in people receiving immune-suppressing chemotherapy than in apparently healthy people.

Febricula is an old term for a low-grade fever, especially if the cause is unknown, no other symptoms are present, and the patient recovers fully in less than a week.[13]

Hyperpyrexia [link]

Hyperpyrexia is a fever with an extreme elevation of body temperature greater than or equal to 41.5 °C (106.7 °F).[14] Such a high temperature is considered a medical emergency as it may indicate a serious underlying condition or lead to significant side effects.[15] The most common cause is an intracranial hemorrhage.[14] Other possible causes include sepsis, Kawasaki syndrome,[16] neuroleptic malignant syndrome, drug effects, serotonin syndrome, and thyroid storm.[15] Infections are the most common cause of fevers, however as the temperature rises other causes become more common.[15] Infections commonly associated with hyperpyrexia include: roseola, rubeola and enteroviral infections.[16] Immediate aggressive cooling to less than 38.9 °C (102.0 °F) has been found to improve survival.[15] Hyperpyrexia differs from hyperthermia in that in hyperpyrexia the body's temperature regulation mechanism sets the body temperature above the normal temperature, then generates heat to achieve this temperature, while in hyperthermia the body temperature rises above its set point.[14]

Hyperthermia [link]

Hyperthermia is an example of a high temperature that is not a fever. It occurs from a number of causes including heatstroke, neuroleptic malignant syndrome, malignant hyperthermia, stimulants such as amphetamines and cocaine, idiosyncratic drug reactions, and serotonin syndrome.

Signs and symptoms [link]

A fever is usually accompanied by sickness behavior, which consists of lethargy, depression, anorexia, sleepiness, hyperalgesia, and the inability to concentrate.[17][18][19]

Differential diagnosis [link]

Fever is a common symptom of many medical conditions:

Persistent fever that cannot be explained after repeated routine clinical inquiries is called fever of unknown origin.

Pathophysiology [link]

Hyperthermia: Characterized on the left. Normal body temperature (thermoregulatory set-point) is shown in green, while the hyperthermic temperature is shown in red. As can be seen, hyperthermia can be conceptualized as an increase above the thermoregulatory set-point.
Hypothermia: Characterized in the center: Normal body temperature is shown in green, while the hypothermic temperature is shown in blue. As can be seen, hypothermia can be conceptualized as a decrease below the thermoregulatory set-point.
Fever: Characterized on the right: Normal body temperature is shown in green. It reads "New Normal" because the thermoregulatory set-point has risen. This has caused what was the normal body temperature (in blue) to be considered hypothermic.

Temperature is ultimately regulated in the hypothalamus. A trigger of the fever, called a pyrogen, causes a release of prostaglandin E2 (PGE2). PGE2 then in turn acts on the hypothalamus, which generates a systemic response back to the rest of the body, causing heat-creating effects to match a new temperature level.

In many respects, the hypothalamus works like a thermostat.[20] When the set point is raised, the body increases its temperature through both active generation of heat and retaining heat. Vasoconstriction both reduces heat loss through the skin and causes the person to feel cold. If these measures are insufficient to make the blood temperature in the brain match the new setting in the hypothalamus, then shivering begins in order to use muscle movements to produce more heat. When the fever stops, and the hypothalamic setting is set lower; the reverse of these processes (vasodilation, end of shivering and nonshivering heat production) and sweating are used to cool the body to the new, lower setting.

This contrasts with hyperthermia, in which the normal setting remains, and the body overheats through undesirable retention of excess heat or over-production of heat.[20] Hyperthermia is usually the result of an excessively hot environment (heat stroke) or an adverse reaction to drugs. Fever can be differentiated from hyperthermia by the circumstances surrounding it and its response to anti-pyretic medications.

Pyrogens [link]

A pyrogen is a substance that induces fever. These can be either internal (endogenous) or external (exogenous) to the body. The bacterial substance lipopolysaccharide (LPS), present in the cell wall of some bacteria, is an example of an exogenous pyrogen. Pyrogenicity can vary: In extreme examples, some bacterial pyrogens known as superantigens can cause rapid and dangerous fevers. Depyrogenation may be achieved through filtration, distillation, chromatography, or inactivation.

Endogenous

In essence, all endogenous pyrogens are cytokines, molecules that are a part of the innate immune system. They are produced by phagocytic cells and cause the increase in the thermoregulatory set-point in the hypothalamus. Major endogenous pyrogens are interleukin 1 (α and β),[21] interleukin 6 (IL-6) and tumor necrosis factor-alpha. Minor endogenous pyrogens include interleukin-8, tumor necrosis factor-α, tumor necrosis factor-β, macrophage inflammatory protein-α and macrophage inflammatory protein-β as well as interferon-α, interferon-β, and interferon-γ.[21]

These cytokine factors are released into general circulation, where they migrate to the circumventricular organs of the brain due to easier absorption caused by the blood–brain barrier's reduced filtration action there. The cytokine factors then bind with endothelial receptors on vessel walls, or interact with local microglial cells. When these cytokine factors bind, the arachidonic acid pathway is then activated.

Exogenous

One model for the mechanism of fever caused by exogenous pyrogens includes LPS, which is a cell wall component of gram-negative bacteria. An immunological protein called lipopolysaccharide-binding protein (LBP) binds to LPS. The LBP–LPS complex then binds to the CD14 receptor of a nearby macrophage. This binding results in the synthesis and release of various endogenous cytokine factors, such as interleukin 1 (IL-1), interleukin 6 (IL-6), and the tumor necrosis factor-alpha. In other words, exogenous factors cause release of endogenous factors, which, in turn, activate the arachidonic acid pathway.

PGE2 release [link]

PGE2 release comes from the arachidonic acid pathway. This pathway (as it relates to fever), is mediated by the enzymes phospholipase A2 (PLA2), cyclooxygenase-2 (COX-2), and prostaglandin E2 synthase. These enzymes ultimately mediate the synthesis and release of PGE2.

PGE2 is the ultimate mediator of the febrile response. The set-point temperature of the body will remain elevated until PGE2 is no longer present. PGE2 acts on neurons in the preoptic area (POA) through the prostaglandin E receptor 3 (EP3). EP3-expressing neurons in the POA innervate the dorsomedial hypothalamus (DMH), the rostral raphe pallidus nucleus in the medulla oblongata (rRPa), and the paraventricular nucleus (PVN) of the hypothalamus . Fever signals sent to the DMH and rRPa lead to stimulation of the sympathetic output system, which evokes non-shivering thermogenesis to produce body heat and skin vasoconstriction to decrease heat loss from the body surface. It is presumed that the innervation from the POA to the PVN mediates the neuroendocrine effects of fever through the pathway involving pituitary gland and various endocrine organs.

Hypothalamus [link]

The brain ultimately orchestrates heat effector mechanisms via the autonomic nervous system. These may be:

In infants, the autonomic nervous system may also activate brown adipose tissue to produce heat (non-exercise-associated thermogenesis, also known as non-shivering thermogenesis). Increased heart rate and vasoconstriction contribute to increased blood pressure in fever.

Usefulness [link]

There are arguments for and against the usefulness of fever, and the issue is controversial.[22][23] There are studies using warm-blooded vertebrates[24] and humans[25] in vivo, with some suggesting that they recover more rapidly from infections or critical illness due to fever. A Finnish study suggested reduced mortality in bacterial infections when fever was present.[26]

In theory, fever can aid in host defense.[22] There are certainly some important immunological reactions that are sped up by temperature, and some pathogens with strict temperature preferences could be hindered.[27]

Research[28] has demonstrated that fever assists the healing process in several important ways:

Management [link]

Fever should not necessarily be treated.[30] Most people recover without specific medical attention.[31] Although it is unpleasant, fever rarely rises to a dangerous level even if untreated. Damage to the brain generally does not occur until temperatures reach 42 °C (107.6 °F), and it is rare for an untreated fever to exceed 105 °F (41 °C).[30] Some limited evidence supports sponging or bathing feverish children with tepid water.[32] 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.[15] In general, people are advised to keep adequately hydrated.[33] Whether increased fluid intake improves symptoms or shortens respiratory illnesses such as the common cold is not known.[34]

Medications [link]

The antipyretic ibuprofen is effective in reducing fevers in children.[35] It is more effective than acetaminophen (paracetamol) in children. Ibuprofen and acetaminophen may be safely used together in children with fevers.[36][37] The efficacy of acetaminophen by itself in children with fevers has been questioned.[38] Ibuprofen is also superior to aspirin in children with fevers.[39] Additionally, aspirin is not recommended in children and young adults (those under the age of 16 or 19 depending on the country) due to the risk of Reye's syndrome.[40]

Epidemiology [link]

About 5% of people who go to an emergency room have a fever.[41]

Society and culture [link]

Fever phobia [link]

Fever phobia is the name given by medical experts to parents' misconceptions about fever in their children. Among them, many parents incorrectly believe that fever is a disease rather than a medical sign, that even low fevers are harmful, and that any temperature even briefly or slightly above the oversimplified "normal" number marked on a thermometer is a clinically significant fever.[42] They are also afraid of harmless side effects like febrile seizures and dramatically overestimate the likelihood of permanent damage from typical fevers.[42] The underlying problem, according to professor of pediatrics Barton D. Schmitt, is "as parents we tend to suspect that our children’s brains may melt".[43]

As a result of these misconceptions parents are anxious, give the child fever-reducing medicine when the temperature is technically normal or only slightly elevated, and interfere with the child's sleep to give the child more medicine.[42]

Etymology [link]

Pyrexia is from the Greek pyr meaning fire. Febrile is from the Latin word febris, meaning fever, and archaically known as ague.

In other animals [link]

Fever is an important feature for the diagnosis of disease in domestic animals. The body temperature of animals, which is taken rectally, is different from one species to another. For example, a horse is said to have a fever above 101.0 °F (38.3 °C).[44]

In species that allow the body to have a wide range of "normal" temperatures, such as camels,[45] it is sometimes difficult to determine a febrile stage.

References [link]

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  25. ^ Schulman CI, Namias N, Doherty J, Manning RJ, Li P, Elhaddad A, Lasko D, Amortegui J et al. (2005). "The effect of antipyretic therapy upon outcomes in critically ill patients: a randomized, prospective study". Surgical infections 6 (4): 369–75. DOI:10.1089/sur.2005.6.369. PMID 16433601. 
  26. ^ Rantala S, Vuopio-Varkila J, Vuento R, Huhtala H, Syrjänen J (2009). "Predictors of mortality in beta-hemolytic streptococcal bacteremia: a population-based study". The Journal of infection 58 (4): 266–72. DOI:10.1016/j.jinf.2009.01.015. PMID 19261333. 
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  31. ^ "What To Do If You Get Sick: 2009 H1N1 and Seasonal Flu". Centers for Disease Control and Prevention. 2009-05-07. https://www.cdc.gov/h1n1flu/sick.htm. Retrieved 2009-11-01. 
  32. ^ Meremikwu M, Oyo-Ita A (2003). Meremikwu, Martin M. ed. "Physical methods for treating fever in children". Cochrane Database Syst Rev (2): CD004264. DOI:10.1002/14651858.CD004264. PMID 12804512. 
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  34. ^ Guppy, MP; Mickan, SM, Del Mar, CB, Thorning, S, Rack, A (2011 Feb 16). "Advising patients to increase fluid intake for treating acute respiratory infections.". Cochrane database of systematic reviews (Online) (2): CD004419. DOI:10.1002/14651858.CD004419.pub3. PMID 21328268. 
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  36. ^ Hay AD, Redmond NM, Costelloe C et al. (May 2009). "Paracetamol and ibuprofen for the treatment of fever in children: the PITCH randomised controlled trial". Health Technol Assess 13 (27): iii–iv, ix–x, 1–163. DOI:10.3310/hta13270 (inactive 2010-09-13). PMID 19454182. https://www.hta.ac.uk/fullmono/mon1327.pdf. 
  37. ^ Southey ER, Soares-Weiser K, Kleijnen J (September 2009). "Systematic review and meta-analysis of the clinical safety and tolerability of ibuprofen compared with paracetamol in paediatric pain and fever". Curr Med Res Opin 25 (9): 2207–22. DOI:10.1185/03007990903116255. PMID 19606950. 
  38. ^ Meremikwu M, Oyo-Ita A (2002). Meremikwu, Martin M. ed. "Paracetamol for treating fever in children". Cochrane Database Syst Rev (2): CD003676. DOI:10.1002/14651858.CD003676. PMID 12076499. 
  39. ^ Autret E, Reboul-Marty J, Henry-Launois B et al. (1997). "Evaluation of ibuprofen versus aspirin and paracetamol on efficacy and comfort in children with fever". Eur. J. Clin. Pharmacol. 51 (5): 367–71. DOI:10.1007/s002280050215. PMID 9049576. 
  40. ^ "2.9 Antiplatelet drugs". British National Formulary for Children. British Medical Association and Royal Pharmaceutical Society of Great Britain. 2007. pp. 151. 
  41. ^ Nassisi, Denise (January 2012). "Evidence-Based Guidelines For Evaluation And Antimicrobial Therapy For Common Emergency DepartmentInfections". Emergency Medicine Practice 14 (1). 
  42. ^ a b c Crocetti M, Moghbeli N, Serwint J (June 2001). "Fever phobia revisited: have parental misconceptions about fever changed in 20 years?". Pediatrics 107 (6): 1241–6. DOI:10.1542/peds.107.6.1241. PMID 11389237. 
  43. ^ Klass, Perri (10 January 2011). "Lifting a Veil of Fear to See a Few Benefits of Fever". The New York Times. https://www.nytimes.com/2011/01/11/health/11klass.html. 
  44. ^ "Equusite Vital Signs". www.equusite.com. https://www.equusite.com/articles/health/healthVitalSigns.shtml. Retrieved 2010-03-22. 
  45. ^ "Body Temperature of the Camel and Its Relation to Water Economy". ajplegacy.physiology.org. https://ajplegacy.physiology.org/cgi/content/abstract/188/1/103. Retrieved 2010-03-22. 

Further reading [link]

  • Rhoades, R. and Pflanzer, R. Human physiology, third edition, chapter 27 Regulation of body temperature, p. 820 Clinical focus: pathogenesis of fever. ISBN 0-03-005159-2

External links [link]


https://wn.com/Fever

Klinik

Klinik, (sometimes called The Klinik), is an industrial music band from Belgium, originally formed around 1982 by electro-synthpop practitioner Marc Verhaeghen, who is the only constant member.

History

Marc Verhaeghen originally formed Klinik in the early-to-mid 1980s; the exact date varies depending on the source. The group is normally described as one of the most influential Belgian industrial bands in history.

In 1985, Verhaeghen joined forces with two other bands, Absolute Body Control (with Dirk Ivens and Eric van Wonterghem), and "The Maniacs" (Sandy Nys) to form one "super group" "Absolute Controlled Clinical Maniacs". This rather unwieldy name was soon dropped in favour of the shorter name "The Klinik". Nys soon left the band to form "Hybryds", followed in 1987 by van Wonterghem, leaving The Klinik as the "classic" duo of Dirk Ivens and Marc Verhaeghen.

The Klinik soon made a name for themselves with their cold and harsh EBM sound and their live shows, where both Ivens and Verhaeghen performed with their heads wrapped in gauze, wearing long black leather coats. Ivens' hissing vocals and minimalist lyrics were complemented by Verhaeghen's synthesizer skills and distorted trombone playing. This however, did not last forever; after Time, an album neither member was fully pleased with, musical differences became too great, and they decided to go their separate ways. In a 2013 interview, Ivens said the due were moving in different directions musically, and that compromise between only two members was challenging.

Fedz

Fedz (originally based on a short film titled Fever) is a 2013 British crime thriller film directed by, written by and starring Q. The film is about a renegade policeman attempting to investigate a terrorist group intending to release an airborne virus in London.

Plot

Policeman, Mike Jones (Q), is given information by his athlete friend, Joey (Silvio Simac), about a terrorist group testing a virus on people. Whilst undercover, Mike tries to earn the trust of Slick Pete (Bradley Gardner), who is planning a bank robbery heist. Later Joey is murdered by his girlfriend, Ty (Shanika Warren-Markland), after refusing to throw his next martial arts fight at the request of Fast Eddie (Joseph Marcell). After Mike finds Joey dead and he suspects Ty was involved after seeing her with a few gangsters earlier. He pursues her for information, after she disregards him, he and his partner are followed back to his house by Rizzle (Gary McDonald) and Big D (Micheal White). Everyone except Mike is killed in a shootout, Mike suspects he was set up and resigns. Ty then orders Barry (Richie Campbel) and Tyson (Ashley Chin) to kill Mike.

Sitti

Sitti Navarro (born November 29, 1984 in Las Piñas), also known as Sitti, is a Filipino bossa nova singer. After releasing her first album, Café Bossa, in 2006, other bossa nova acts in the Philippines followed. Navarro is also featured in the segment "A.S.A.P. Sessionistas" of the variety show ASAP.

Early life

Sitti Navarro was born to lawyer Rolando Navarro and Lydia Baiddin, in Manila, Philippines. Sitti is of Samal and Tausūg descent. She identifies herself as being Jama Mapun (Sama Kagayan), one of the Sama-Bajau subgroups in Tawi-Tawi. She graduated from the University of the Philippines Diliman in April 2005 with a degree in Business Economics and was a dean's lister at said university. In high school, she was editor-in-chief of the school paper and graduated as valedictorian of her class.

In college, she was an active member of the AIESEC Local Committee where she was the Vice President for Outgoing Exchange from 2003 to 2004. She was also a member of the Organization of Business Economics Majors (OBEM).

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