FEVER: PATHOPHYSIOLOGY & CAUSES

DR EMMANUEL IWUOZO
MEDICINE DEPARTMENT
COLLEGE OF HEALTH SCIENCES
BSU, MAKURDI
Email: [email protected]
 Introduction
• Fever, also called pyrexia is an abnormally high
body temperature.
• Fever is a characteristic of many different
diseases
• It occurs as a result of a change in the set point in
thermoregulatory center located in the anterior
hypothalamus and pre-optic area
• Once the hypothalamic set point is raised,
neurons in the vasomotor centre are activated
 Normal body temperature
• Normal body temperature varies over the
course of the day
• It is controlled in the thermoregulatory center
located in the anterior hypothalamus.
• The body is normally able to maintain a fairly
steady temperature between morning and
evening
• The thermoregulatory center balances the
excess heat production derived from
metabolic activity in muscle and the liver
 Normal body temperature -2
• Also heat dissipation occurs from the skin-
vasodilatation and lungs.
• The process of heat conservation
(vasoconstriction) and heat generation
(shivering & non shivering thermogenesis)
• Humans when faced with environmental
extremes cannot maintain the narrow daily
variation of body temperature without the aid
of clothing and protective environments
 Definition
• Fever (pyrexia) is an elevation of body
temperature above the normal daily variation
37±0.5 to 1 °C induced by cytokines
• Usually at least ≥ 38 °C
• It occurs in conjunction with an increase in the
hypothalamic set point e.g. from 37 °C to 39 °C
 Definition - 2
• An increase in the hypothalamic set point can
occur due to infection, metabolic
derangement or increased cell destruction.
• Hyperpyrexia is the term for a high fever
(>41.5°C)
• This can be observed in patients with severe
infections but most commonly occurs in
patients with CNS hemorrhage
 Hyperthermia
• Hyperthermia is a state of elevated core
temperature (internal organs) that rises rapidly
above 40°C
• The thermoregulatory set point is unchanged
• This does not involve pyrogenic molecules
• This occurs when a body produces or absorbs
more heat than it dissipates.
 Aetiology of hyperthermia
• Causes of hyperthermia includes:
 heat stroke
 neuroleptic malignant syndrome
 serotonin syndrome
 malignant hyperthermia
 thyrotoxicosis
 cerebral haemorrhage
 amphetamines
 Hypothermia
• This is when the body core temperature is
< 35 °C
• This is a medical emergency that occurs when
your body loses heat faster than it can
produce heat
• It can be seen in cases of infection in the
elderly, infants and immuno-compromised
persons
• It is a poor prognostic sign in infections
 Monitoring temperature
• They are peripheral and central methods
• Central methods are more reliable
• Peripheral methods are more practicable in
clinical setting than central method
• Peripheral methods of monitoring include
 tympanic membrane (aural)
• Tympanic membrane temperature readings are
close to core temperature.
 temporal artery (forehead)
 axillary
 Monitoring temperature-2
 oral thermometry
• Oral readings are lower probably because of
mouth breathing
• This is important in patients with respiratory
infections and rapid breathing.
• Central methods include:
 Pulmonary artery catheter
 Urinary bladder
 Oesophageal
 Rectal thermometry
 Types of fever
• Continuous/sustained fever: Temperature remains
above normal throughout the day and does not
fluctuate more than 1 °C in 24 hours, e.g. lobar
pneumonia, typhoid fever, urinary tract infection,
brucellosis
• Intermittent fever: The temperature elevation is
present only for a certain period, later cycling
back to normal (i.e. normal temp. between fever
episodes), e.g. malaria or septicemia.
 Fever types-2
• Relapsing fever: Temperature returns to normal
for days or weeks before rising -Tertian fever (48
hour periodicity), typical of Plasmodium vivax or
Plasmodium ovale malaria
• 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 Hodgkins lymphoma
• May be high for 3-10 days with 3-10 days fever
free period
 Fever types - 3
• Hectic fever: Either an intermittent or a
remittent fever is considered hectic if the
temperature range swings widely throughout
the day, with a difference of at least 1.4 degrees
Celsius between the highest and lowest
temperatures.
• Factitious fever: This is fever engineered by the
patient by manipulating the thermometer and/
or temperature chart in order to obtain medical
care
• It may be seen in patients with depression
 Fever classification

• Based on duration
 Acute - < 7 days
 Subacute – 7 -14 days
 Chronic - > 2 weeks
• Based on height of temperature
 Mild/low grade 38.0 -39.0
 Moderate grade 39.0 – 40.0
 High grade 40.0- 41.5
 Hyperpyrexia > 41.5
Pathophysiology - 3
 Causes of fever
• The disorders that may cause fever are:
• Infectious Diseases (Viral, bacterial, fungal,
protozoal)
– Respiratory tract infections
– Gastrointestinal infections
– Urinary tract infections (UTIs)
– Skin infections
– Malaria
 Causes of fever
• Inflammatory conditions
– Rheumatoid arthritis
– Lupus
– Dermatomyositis
– Polymyositis
• Cancer
• Lymphoma