Fever: stages, symptoms, causes, treatment. With endocrine diseases

An increase in body temperature above normal is called fever. Normal body temperature in the armpit ranges from 36,0-36,9 degrees, and in the morning it can be a third or half a degree lower than in the evening. in the rectum and oral cavity the temperature is usually half a degree or a degree higher than in the armpit, but no more 37,5 degrees.

Fever may occur for different reasons. The most common causes of its occurrence are diseases infectious nature. Microorganisms, their waste products and toxins affect the thermoregulatory center located in the brain, resulting in an increase in body temperature.

Fever is of several types. So, according to the degree of temperature rise, fever is:
subfebrile - not exceeding 37,5 degrees,
febrile.

When diagnosing daily temperature fluctuations are taken into account. But today the situation is such that the picture of diseases is often erased due to the intake of antipyretic drugs, and in some cases independent application antibiotics. Therefore, the doctor has to use other diagnostic criteria.

Manifestations of fever are known to everyone: headache, muscle aches, weakness, pain in the eyes, chills. The chill is nothing but in a physiological way increase body temperature. During muscle contractions, heat production increases, resulting in an increase in body temperature.

For infectious diseases body temperature does not rise by chance. Physiological significance fever is very high. Firstly, most of the bacteria at high temperatures lose their ability to reproduce or die altogether. In addition, with an increase in temperature in the body, activity increases. defense mechanisms designed to fight infection. Therefore, if the fever is benign and there are no other symptoms, medication is not needed, plenty of drink and rest is enough.

However, fever can be Negative consequences. Besides what she delivers discomfort to a person, it also causes increased loss fluids and excessive expenditure of energy. This can be dangerous for patients with heart and vascular disease, as well as those with other chronic diseases. Fever is extremely dangerous for children who have an increased tendency to convulsions.

When to lower the temperature?

In what cases it is necessary to reduce the temperature:
body temperature exceeds 38,5 degrees,
sleep is disturbed
there is marked discomfort.

How to lower the temperature?

Recommendations for lowering the temperature:
it is allowed to take a warm (not cold!) bath
the room must be regularly ventilated, it should not be hot there,
you need to drink as much warm liquid as possible,
in order to avoid increased chills, it is forbidden to rub the patient with alcohol,
drugs to reduce fever: ibuprofen, paracetamol,
if chills appear, the patient should not be wrapped up,
always consider the dosage of the drug - be sure to read the instructions on the packaging,
aspirin allowed to be taken only by adults; children without a special doctor's recommendation to give aspirin prohibited,
special attention should be paid to alcohol intake: with an increase in body temperature, alcohol is allowed, however, provided that the patient is in bed,
after drinking alcohol, any hypothermia is very dangerous, since with a subjective sensation of warming, heat transfer increases significantly.

Helping a child with a fever

As a rule, in the first day or two of acute viral infection the temperature rises about three or four times a day, on the third or fourth day - twice a day. The duration of the general febrile period in most cases is two to three days, however, with some types of viral infection, such as entero- and adenovirus fevers, influenza, the “norm” can reach up to a week. In any schedule a child with a fever needs medical attention.

In the fight against fever, medications and physical methods combat high temperatures.

If the child has a pronounced fever (the body and limbs are dry, hot), the following physical methods of dealing with fever are used:
wiping with vinegar solution ( 9% (strictly!) Vinegar is diluted with water in a ratio of 1:1). When wiping, do not touch the nipples, face, pimples, genitals, diaper rash, wounds. Wiping can be carried out repeatedly until the temperature drops to 37-37,5 degrees;
vinegar wraps. If there is no damage and inflammation on the child's skin, during the procedure, cover the nipples and genitals with napkins and a dry diaper. The diaper must be soaked in an acetic solution (mixed with water, as when wiping) and wrap the child in it (with one edge of the diaper cover his stomach, chest, legs, arms while lifting up; then press the child’s hands to the body and wrap the other edge of the diaper ). To restrict inhalation vinegar vapor, put a roller rolled up from a dry diaper on the child's neck. If necessary, having previously measured the temperature, the wrapping can be repeated later. 20-30 minutes;
in the region large vessels(armpits, groin, subclavian region), back of the head, forehead apply cold (filled cold water or ice pack wrapped in a diaper, or wet compresses);
drink at room temperature.

If chills are present, feet and hands are cold, it is forbidden to use rubdowns and cold: the child, on the contrary, needs to be additionally covered, it is allowed to use a heating pad filled with hot water and wrapped in a diaper (water temperature not higher than 60 degrees), apply it to the child's feet, give a warm drink.

If the temperature rises to 38 degrees and the child feels normal, it is not recommended to use antipyretics. The child is given plentiful drink: warm water, sour compotes, fruit drinks, sharp emotions and physical activity should be limited.

The exception is cases when there is a pronounced malaise, weakness, chills in a child, the temperature rises rapidly, especially closer to the night (you need to measure it every half an hour), the presence of aches in the joints and muscles, and also transferred in the past convulsive syndrome. In such a situation, you can give the child antipyretic drugs from the paracetamol group ( cefecon, efferalgan, kalpol, panadol and so on.). single dose should be no more 10 mg per 1 kg of the child's weight.

If the temperature rises from 38 before 38,5-38,8 degrees, it is necessary to give the child antipyretics: ibuprofen (nurofen) based on 5 mg per kilogram of body weight or paracetamol(or analogues) based on 10 mg/kg. Simultaneous use of a combination of single doses is allowed paracetamol And ibuprofen or finished product"Ibuklin for children" (if separate use is ineffective or there is a pronounced inflammatory process).

When the temperature rises to 39 degrees, the dose of antipyretic drugs should be as follows: paracetamol - 15 mg/kg, ibuprofen - 10 mg/kg (allowable single dose 15 mg/kg). Allowed to enter analgin: 0.1 percent solution from the calculation 0,15 ml/kg plus papaverine (or [i] no-shpa) 2 percent - 0.1 ml/kg plus tavegil (suprastin) 1 percent - 0.1 ml/kg as an injection or as an enema (with the addition of a small amount of warm water).

In addition, you can give the child a means of "nise for children" ( nimesulide) based on 5 mg / kg per day, divided into two or three doses - the antipyretic and anti-inflammatory effects of this drug are higher than those of ibuprofen or paracetamol, however, it is also more toxic.

To reduce and remove toxic products from the body, which are formed during high and prolonged fever, the child is additionally given "enterodesis" (1 sachet for 100 ml of water two to three times a day).

When is an ambulance needed?

In what cases should you immediately consult a doctor:
if the fever lasts longer 48-72 hours for a teenager or adult (for a child under two years old - longer 24-48 hours),
if the temperature is higher 40 degrees,
if there are disturbances of consciousness: hallucinations, delusions, agitation,
if present seizures, severe headache, respiratory failure.

Elevated body temperature that is not caused by changes in the hypothalamus is commonly referred to as hyperthermia. Many patients use the term "fever" very inaccurately, often referring to feeling warm, cold, or sweating, but they did not actually take their temperature.

The symptoms are mainly due to the condition causing the fever, although the fever itself can cause discomfort.

Fever pathogenesis

The purpose of the body's thermoregulation system in the norm is to maintain the actual internal body temperature at a given level of about 37 ° C (with daily fluctuations). In contrast to passive hyperthermia, the mechanisms of thermoregulation are preserved during fever, and under the influence of the pyrogenic factor, the setpoint of temperature homeostasis increases. In this regard, thermoregulatory mechanisms begin to maintain an elevated temperature (green line). Clinically, this becomes noticeable during an increase in body temperature. Because the actual body temperature does not correspond to the elevated set point, the body reduces heat loss due to reduced cutaneous blood flow resulting in skin cooling (cold sensation). In addition, heat production is also increased by trembling (tremor). This continues until the actual temperature level (red line) approaches the new set point (plateau). When the temperature homeostasis set point decreases, body temperature drops because the actual level is now too high. Accordingly, skin blood flow increases, a person feels hot and sweats profusely.

Fever is especially characteristic of infections as a manifestation of a reaction acute phase, at which pyrogens are the cause of the change in the set point. Exogenous pyrogens are the structural elements of the pathogen, and the most active of them are lipopolysaccharide complexes (endotoxins) Gram-negative bacteria. These pathogens, or pyrogens, are opsonized and phagocytosed by macrophages, such as Kupffer cells in the liver. Macrophages secrete many cytokines, including endogenous pyrogenic interleukin, interferon, tumor necrosis factors TNF-α (cachectin) and TNF-β (lymphotoxin), macrophage inflammatory protein MIP-1, and many others. It is believed that these cytokines (with a molecular weight of approximately 15-30 kDa) reach the circumventricular regions of the brain, which do not have a blood-brain barrier. Cytokines, therefore, can cause temperature reaction in these organs or in the nearby preoptic zone and in the vascular organ of the terminal lamina through prostaglandin PGE2. In this case, antipyretic drugs (antipyretics) are effective.

For example, acetylsalicylic acid inhibits enzymes that convert arachidonic acid in PGE2.

Given that after intravenous injection of lipopolysaccharides, the above-mentioned cytokines are released only 30 minutes after the onset of fever, and their release is delayed during subdiaphragmatic vagotomy, it should be assumed that exogenous pyrogens activate the preoptic region and the vascular organ of the terminal plate also through afferent fibers from abdominal cavity. It is possible that signaling substances secreted by Kupffer cells of the liver activate the afferent fibers closest to them. vagus nerve, which transmit a pyrogenic signal through the solitary nucleus to groups of noradrenergic neurons of types A1 and A2. They, in turn, transmit a signal from the ventricular noradrenergic pathway to thermoregulatory neurons in the preoptic region and the terminal lamina vascular organ. Norepinephrine released there causes the formation of PGE2, and through it - fever. This usually causes the release of ADH (V 1 receptor effect), α-melanocyte-stimulating hormone (α-MSH) and corticotropin-releasing hormone (CRH; corticoliberin), preventing the development of fever through negative feedback due to the release of endogenous antipyretics.

Due to an increase in body temperature, the heart rate increases (by 8-12 beats / min per degree) and energy metabolism increases, as a result, fatigue, joint pain and headache develop, the phase lengthens slowly wave sleep(which performs a restorative function for the brain), as well as, under certain circumstances, there are disorders of consciousness, sensory disturbances (febrile delirium) and convulsions. The role of fever is also to counter infection. Elevated temperature inhibits the replication of some pathogens and kills others. In addition, the concentration of metals necessary for the reproduction of bacteria, such as iron, zinc and copper, decreases in plasma. In addition, cells affected by viruses are destroyed, which slows down the replication of viruses. Therefore, exogenous antipyretics should be used only if the fever is accompanied by convulsions (usually in infants and young children) or rises so high (> 39 ° C) that convulsions should be feared.

During a 24-hour period, body temperature changes from the most low levels early morning to highest late afternoon. The maximum change is approximately 0.6 °C.

Body temperature is determined by the balance between heat production by tissues, especially the liver and muscles, and heat loss in the periphery. Normally, the thermoregulatory center of the hypothalamus maintains an internal temperature between 37°C and 38°C. Fever is a consequence of the hypothalamic checkpoint rising, causing vasoconstriction and shunting of blood from the periphery to reduce heat loss; sometimes there is shivering, which increases the production of heat. These processes continue until the temperature of the blood surrounding the hypothalamus reaches a new point. Rebooting the hypothalamic point down (for example, with antipyretic drugs) provokes heat loss through sweating and vasodilation. The ability to generate fever is reduced in certain patients (eg, alcoholics, very old people, very young people).

Pyrogens are those substances that cause fever. External pyrogens are common microbes or their products. The best studied Gram-negative bacterial lipopolysaccharides (commonly referred to as endotoxins) and toxin Staphylococcus aureus, which calls toxic shock. External pyrogens usually induce fever by producing the release of endogenous pyrogens that elevate the hypothalamic point. The synthesis of prostaglandin E 2 plays a critical role.

Consequences of a fever. Although many patients worry that fever itself can be harmful, the mild fevers associated with most acute illnesses are well tolerated by healthy adults. However, excessive temperature rises (typically >41°C) can be dangerous. This increase is more typical of severe hyperthermia due to environment, but sometimes is the result of exposure to illegal drugs (eg, cocaine, phencyclidine), anesthetics, or antipsychotics. At this temperature, protein denaturation occurs and inflammatory cytokines are released, which activate the inflammatory cascade. As a result, cellular dysfunction occurs, leading to malfunctions and, ultimately, failure of most organs; the coagulation cascade is also activated, leading to disseminated intravascular coagulation.

Because fever can increase, basal metabolic rate above 37°C rises by approximately 10-12% for every 1°C, fever can produce physiological stress in adults with pre-existing cardiac or lung failure. Fever can also worsen mental health in patients with dementia.

Fever in healthy children can cause febrile seizures.

Causes of fever

Many disorders can cause fever. Broadly, they are classified as:

• infectious (most common);
• neoplastic;
• inflammatory (including rheumatic, non-rheumatic and drug-related).

The cause is acute (i.e., with duration<4 дней) лихорадки у взрослых чаще всего инфекционная. Когда у пациентов появляется лихорадка из-за неинфекционной причины, лихорадка является почти всегда хронической или рецидивирующей. Кроме того, изолированная острая лихорадка у пациентов с установленными воспалительным или неопластическим процессами с большой вероятностью является инфекционной. У здоровых людей острая лихорадка вряд ли будет первоначальным проявлением хронического заболевания.

infectious causes. Virtually all infectious diseases can cause fever. But in general, the most likely reasons are:

• infections of the upper and lower respiratory tract;
• gastrointestinal infections;
• infections urinary tract;
• skin infections.

Most acute respiratory and gastrointestinal infections are viral.

Certain factors on the part of the patient and external factors also determine which causes are most likely.

Patient factors include health status, age, occupation, and risk factors (eg, hospitalization, recent invasive procedures, presence of intravenous or urinary catheters, use of mechanical ventilation).

External factors - those that place patients at high risk of contracting certain diseases - for example, through infectious contacts, local outbreaks, disease vectors (eg, mosquitoes, ticks), shared objects, food, water, or geographic location (eg, place of residence in endemic area or recent travel there).

Some reasons based on these factors are predominant.

Two main questions are important in the initial assessment of acute fever:

• Identification of any local symptoms (eg, headache, cough). These signs help narrow down the range of possible causes. The localizing feature may be part of the patient's main complaint or identified only on certain issues.
• Determining whether the patient is severely or chronically ill (especially if no such illness has been identified). Many causes of fever in healthy people resolve spontaneously, and many (with viral infections) are difficult to diagnose accurately. Limiting testing to the severely or chronically ill can help avoid many costly, unnecessary, and often fruitless searches.

Story. The history of present illness should include the level and duration of fever and the method used to measure temperature. Severe, shaking, chattering chills (rather than just feeling cold) suggest fever due to infection. Pain is an important clue to the possible cause of illness; the patient should be asked about pain in the ears, head, neck, teeth, throat, chest, abdomen, side, rectum, muscles and joints.

Other local symptoms include nasal congestion and/or discharge, cough, diarrhea, and urinary symptoms (frequency of urination, incontinence, dysuria). The presence of the rash (including its pattern, location, and time of onset relative to other features) and enlarged lymph nodes may aid in the diagnosis. The contacts of the patient must be identified.

Review of systems should rule out symptoms of chronic disease, including recurrent fevers, night sweats, and weight loss.

Previous medical history should include the following:

• recent transactions;
• known diseases that predispose to infection (eg, HIV infection, diabetes, cancer, organ transplant, sickle cell anemia, heart valve disease - especially if there is an artificial valve);
• other known disorders that predispose to fever (eg, rheumatologic disorders, systemic lupus erythematosus, gout, sarcoidosis, hyperthyroidism, cancer).

Questions to ask about recent travel include inquiries about place of travel, time since return, location of specific stay (e.g. off the beaten track, urban areas only), vaccinations given prior to travel, and use of malaria prophylaxis medications (if required) .

All patients should be asked about the possibility of infection (eg, through suspicious food or water, insect bites, contact with animals, or unprotected sex).

A history of vaccinations, especially against hepatitis A and B and against microorganisms that cause meningitis, influenza, or pneumococcal infection, should also be studied.

The history of drug use should include specific questions about the following:

• drugs known to cause fever;
• drugs that predispose to an increased risk of infection (eg, corticosteroids, anti-TNF drugs, chemotherapy and anti-rejection (eg, transplant) drugs, other immunosuppressants);
• illegal use of injectables (predisposing to endocarditis, hepatitis, septic pulmonary embolism, and skin and soft tissue infections).

Physical examination. Physical examination begins with confirmation of fever. Fever is most accurately diagnosed by measuring rectal temperature.

The temperature in the mouth is usually about 0.6°C lower and may even be lower for many reasons, such as a recent cold drink, mouth breathing, hyperventilation, and inappropriate measurement time (mercury thermometers require up to several minutes) . Measurement of tympanic membrane temperature with an infrared sensor is less accurate than rectal temperature. Skin temperature monitoring using temperature-sensitive crystals fused into plastic strips placed on the forehead is counterproductive for detecting increases in core temperature.

Other vital signs are evaluated in the presence of tachypnea, tachycardia, or hypotension.

For patients with local symptoms, examination continues as described in this Guide. For patients with fever without local symptoms, a complete examination is necessary because clues to the diagnosis may lie in any organ system.

The general appearance of the patient should be taken into account, including any weakness, lethargy, confusion, cachexia, and depression.

The entire skin should be examined for a rash, especially a petechial or hemorrhagic rash, and any lesions or areas of erythema or blistering suggestive of skin or soft tissue infection. The armpits and areas of the internal epicondyle of the humerus and groin should be examined for adenopathy. In hospitalized patients, the presence of any intravenous, internal (NGT), urinary catheters, and any other tubes inserted into the body should be noted. If the patient has recently had surgery, then the surgical sites should be carefully examined.

When examining the head and neck, you need to pay attention to the following:

• eardrums: examination for infection;
• sinuses (frontal and maxillary): percussion;
• temporal arteries: palpation for pain;
• nose: examination for congestion and discharge (clean or with pus);
• eyes: examination for conjunctivitis or jaundice;
• fundus: examination for Roth's spots (suggesting infective endocarditis);
• oropharynx and gums: examination for inflammation or ulceration (including any lesions of candidiasis, which suggests a decrease in immunity);
• neck: tilt to look for discomfort, stiffness, or both, indicative of meningismus, and palpate for adenopathy.

The lungs are examined for abnormal sounds or signs of consolidation, and the heart is auscultated for murmurs (suggesting possible endocarditis).

The abdomen is palpated for hepatosplenomegaly and tenderness (suggesting infection).

Percussion is performed along the lateral surfaces to detect tenderness in the kidney area (suggesting pyelonephritis). A pelvic exam is done in women to check for cervical pathology or adnexal tenderness; examination of the genitals is performed in men to check for urination and local tenderness.

The rectum is examined for tenderness and swelling, suggesting a pararectal abscess (which may be occult in immunocompromised patients).

All major joints are examined for swelling, erythema, and tenderness (suggesting joint infection or rheumatologic disorder). The hands and feet are examined for signs of endocarditis, including hemorrhages from splinters under the nails, painful erythematous subcutaneous nodules on the fingertips (Osler's nodes), and nonpainful hemorrhagic patches on the soles of the feet (Janeway lesions).

danger signals. The following phenomena should be given special attention:

• change in mental state
• headache, neck stiffness, or both
• petechial rash,
• hypotension,
• dyspnea,
• significant tachycardia or tachypnea,
• temperature >40 °С or<35 °С,
• recent travel to a malaria-endemic area,
• recent use of immunosuppressants.

Interpretation of results. The degree of fever is usually unrelated to the cause of the infection. The fever pattern once thought to be significant is not.

The likelihood of severe illness is considered. If a serious illness is suspected, immediate and rapid testing is necessary, and often hospitalization.

Danger signals to a large extent suggest a severe violation. Headache, neck stiffness, and a petechial or purplish rash suggest meningitis. Tachycardia (below the usual elevation usually associated with fever) and tachypnea, with or without hypotension or altered mental status, suggest sepsis. Malaria should be suspected in those patients who have recently been in an endemic area.

Decreased immunity, whether due to a known cause, use of immunosuppressants, or suspected by examination findings (eg, weight loss, oral candidiasis) are also of concern, as are other known chronic diseases, intravenous drugs, and heart murmurs.

The elderly, especially those living in nursing homes, are at particular risk.

Local events identified in the history of the disease or on physical examination are evaluated and interpreted. Other suggestive symptoms are generalized adenopathy and rash.

Generalized adenopathy may occur in older children and young adults with acute mononucleosis; usually accompanied by significant pharyngitis, malaise, and hepatosplenomegaly. Primary HIV infection or secondary syphilis should be suspected in patients with generalized adenopathy, sometimes accompanied by arthralgias, rash, or both. HIV infection develops 2-6 weeks after exposure (although patients may not always report unprotected sex or other risk factors). Secondary syphilis is usually preceded by a chancre with systemic signs developing 4 to 10 weeks later.

Fever and rash have many causes associated with infection or drug use. A petechial or purpuric rash should be given particular attention; it suggests possible meningococcemia, Rocky Mountain spotted fever (especially if the palms or soles of the feet are affected), and, less commonly, some viral infections (eg, dengue fever, hemorrhagic fevers). Other suggestive skin lesions include classic erythema migrans in Lyme disease, lesions in Stevens-Johnson syndrome, and painful erythema in cellulitis and other bacterial soft tissue infections. The possibility of delayed hypersensitivity to the drug (even after long periods of use) must be taken into account.

If there are no local events, healthy individuals with acute fever and only nonspecific events (eg, malaise, generalized pain) are very likely to have a self-limiting viral disease if there is no history of exposure to a source of infection (including new, unprotected sexual contact), a carrier illness or stay in an endemic area (including recent travel).

Drug-associated fever (with or without rash) is a diagnosis of exclusion, often requiring a decision to discontinue the drug. The difficulty is that if antibiotics are the cause, the disease being treated can also cause the fever. Sometimes the clue is that the fever and rash begin after clinical improvement from infection and without worsening or reappearance of underlying symptoms (eg, a patient being treated for pneumonia reappears with fever without cough, dyspnea, or hypoxia).

Carrying out analyzes. Conducting analyzes depends on whether there are local phenomena.

If there are local phenomena, testing is carried out in accordance with clinical hypotheses and symptoms. This applies to the following situations:

• mononucleosis or HIV infection - serological analysis;
• Rocky Mountain spotted fever - biopsy of skin lesions to confirm the diagnosis (serological analysis in the acute period is useless);
• bacterial or fungal infection - blood cultures to diagnose possible bloodstream infections;
• meningitis - immediate lumbar puncture and intravenous dexamethasone and antibiotics (computed tomography of the head should be done before lumbar puncture if patients are at risk for herniated brain syndrome; intravenous dexamethasone and antibiotics should be given immediately after blood cultures are taken and before CT tomography of the head);
• specific studies based on evidence of possible exposure (eg, contacts, vectors, or exposure to endemic areas): testing for these diseases, especially a peripheral blood smear for malaria.

If there are no local events in otherwise healthy patients and no serious illness is suspected, patients can usually be followed up at home without testing. In most of them, the symptoms disappear quickly; and the few who develop disturbing or localized symptoms should be re-examined and tested based on new findings.

If a patient is suspected of having a serious illness, but there are no local effects, tests should be performed. Patients with danger signs suggestive of sepsis require cultures (urine and blood), chest x-ray, and evaluation of metabolic abnormalities with measurements of serum electrolytes, glucose, aota urea, creatinine, lactate, and liver enzymes. As a rule, a complete blood count is done, but the sensitivity and specificity of diagnosing a severe bacterial infection is low. However, the number of blood leukocytes is prognostically important for immunocompromised patients (their low number may be associated with poor prognosis).

Patients with severe impairment may need testing even if they do not have any local symptoms and do not appear to be seriously ill. Because of the risk and devastating effects of endocarditis, intravenous drug users who have a fever are usually hospitalized for serial blood cultures and often echocardiography. Patients taking immunosuppressants require a complete blood count; if neutropenia is present, begin testing and chest X-ray, and cultures of blood, sputum, urine, stool, and any suspicious discharge from skin lesions.

Elderly patients with fever often require testing.

Fever Treatment

In certain cases, anti-infective therapy is prescribed; empiric anti-infective therapy is required if severe infection is suspected.

Whether fever due to infection should be treated with antipyretics is debatable. Experimental data, but not clinical studies, suggest that fever increases host defenses.

Fever may need to be treated in certain patients at particular risk, including adults with heart or lung failure or dementia. Drugs that inhibit brain oxygenase are effective in reducing fever:

• acetaminophen 650-1000 mg orally every 6 hours;
• ibuprofen 400-600 mg orally every 6 hours

The daily dose of acetaminophen should not exceed 4 g to avoid toxicity; patients should be asked not to take non-prescription cold and flu remedies that contain acetaminophen at the same time. Other non-steroidal anti-inflammatory drugs (eg, aspirin, naproxen) are also effective antipyretics. Salicylates should not be used to treat fever in children with viral diseases because such use has been associated with Reye's syndrome.

If the temperature is >41°C, other measures to cool the body (eg, evaporative cooling with a cool water environment, cooling blankets) should also be used.

Fundamentals of Geriatrics

In the frail elderly, an infection is less likely to cause a fever, and even if the temperature rises due to the infection, it may be lower than a normal fever. Similarly, other signs of inflammation, such as focal pain, may be less obvious. Often, a change in mental status or a decrease in the performance of daily functions may be the only initial manifestations of pneumonia or urinary tract infection.

Despite less severe manifestations of the disease, older people with fever are significantly more likely to develop severe bacterial disease compared to younger people. For younger adults, the cause is usually respiratory infection or urinary tract infection, and in the elderly, infections of the skin and soft tissues are among the main causes.

Focal events are assessed as in younger patients. But unlike younger patients, older patients probably need a urinalysis, urine culture, and x-rays. Blood cultures should be done to rule out sepsis; if septicemia is suspected or vital signs are abnormal, patients should be hospitalized.

What is a fever? The stages of this condition, causes and symptoms will be discussed below. We will also tell you about how to treat the disease.

Definition of a medical term

Non-specific pathological processes, characterized by a temporary increase in body temperature due to the dynamic restructuring of the thermoregulatory system under the influence of pyrogens (that is, elements that cause fever), are called fever. In medicine, it is believed that such a condition arose as a protective and adaptive reaction of a person or animal to an infection. It should also be noted that fever, the stages of which will be listed below, is accompanied not only by an increase in body temperature, but also by other phenomena characteristic of infectious disease.

The essence of the febrile syndrome

It is no secret to anyone that many infectious and viral diseases are accompanied by a rise in the patient's body temperature. Moreover, earlier all diseases that proceeded in this way were called fever. However, experts argue that in the modern scientific understanding, this condition is not a disease. But, despite this, the term is still present in some names of nosological units (for example, hemorrhagic pappatachi, Rocky Mountain spotted fever, etc.).

Why does the temperature rise with certain diseases? The essence of fever is that the thermoregulatory apparatus of humans and higher homoiothermic animals responds to specific substances called pyrogens. As a result of this, there is a temporary shift in the set point of homeostasis (temperature) by more high level. At the same time, the mechanisms of thermoregulation are preserved. This is the fundamental difference between hyperthermia and fever.

Causes of fever

Why does the temperature rise in a person or animal? There are many reasons for the development of fever. However, the most common are the following:

Other causes of febrile syndrome

Why does fever occur? The provoking disease may be associated with a disorder of heat transfer in violation of autonomic work in adolescents, children and young women (that is, with thermoneurosis). Also, fever can occur under the influence of the following factors:

• Taking some medicines. Experts say that a number of medications can affect the thermoregulatory center, causing a slight rise in body temperature.
• Hereditary violation in the process of thermoregulation. For example, some perfectly healthy children are already born with a temperature of 37.2-37.4 degrees. For them, this is the norm.
• often occurs due to overheating, regular physical activity, being in a stuffy room and intense heat.
• emotional stress and stressful situations very often accompanied by an increase in heat production and activation of the hypothalamus, which contributes to the onset of fever.
• An increase in the hormone progesterone in pregnant women also causes a slight increase in temperature. At the same time, other signs of a viral or infectious disease are completely absent. This state can be maintained until the end of the first trimester. However, some representatives of the weaker sex subfebrile temperature accompanies almost the entire pregnancy.

What are pyrogens?

As mentioned above, infectious and viral diseases very often contribute to an increase in body temperature. This happens under the influence of pyrogens. It is these substances that enter the body from the outside or are formed right inside that cause fever. Most often, exogenous pyrogens are elements infectious agents. The strongest of these are thermostable capsular lipopolysaccharides of bacteria (gram-negative). Such substances act indirectly. They contribute to the shift of the set point in the thermoregulatory center of the hypothalamus. Most of them are of leukocyte origin, which directly affects others. important symptoms diseases. Cells are the source of pyrogens immune system human, as well as granulocytes.

Fever: stages

In the process of development, fever goes through three main stages. On the first - a person's temperature rises, on the second - it is held for some time, and on the third - it gradually decreases, reaching the initial one. About how such pathological processes occur, and what symptoms are inherent in them, we will describe further.

Rise in temperature

The first stage of fever is associated with the restructuring of thermoregulation, as a result of which heat production begins to significantly exceed heat transfer. The limitation of the latter occurs due to a decrease in the influx of warm blood into the tissues and narrowing of the vessels in the periphery. More important in this process is a spasm of the skin vessels, as well as the cessation of sweating under the influence of sympathetic nervous system. The signs of fever in the first stage are as follows: blanching of the skin and a decrease in its temperature, as well as restriction of heat transfer due to radiation. Reduced sweat production prevents heat from escaping through evaporation.

The contraction of muscle tissue leads to the manifestation of the phenomenon " goose bumps» in humans and ruffling of wool in animals. The subjective feeling of chills is associated with a decrease in skin temperature, as well as irritation of cold thermoreceptors located on the integument. From them, the signal enters the hypothalamus, which is an integrative center of thermoregulation. After that, he informs the cerebral cortex about the situation where human behavior is formed: he begins to wrap himself up, take appropriate postures, etc. By lowering the temperature skin human muscle trembling is also explained. It is caused by the activation of the trembling center, which is localized in the medulla oblongata and midbrain.

temperature hold

The second stage of fever begins after reaching the set point. It can take several hours or days, and also be long. In this case, heat transfer and heat production balance each other. There is no further increase.

Skin vessels in the second stage expand. Their pallor also disappears. At the same time, the covers become hot to the touch, and chills and trembling disappear. A person at this stage experiences a fever. In such a state, diurnal temperature fluctuations persist, but their amplitude rather sharply exceeds the normal one.

Depending on the degree of rise in body temperature, fever in the second stage is divided into types:

• subfebrile temperature - up to 38 degrees;
• mild fever - up to 38.5;
• febrile or moderate - up to 39 degrees;
• pyretic or heat- up to 41;
• hyperpyretic or excessive - over 41 degrees.

It should be noted that hyperpyretic fever is extremely dangerous for human life, especially for young children.

temperature drop

The decrease in body temperature can be abrupt or gradual. This stage of fever begins after the exhaustion of the supply of pyrogens or the cessation of their formation under the influence of natural or medicinal factors. As the temperature drops, the setpoint reaches normal level. This leads to vasodilation in the skin. At the same time, excess heat begins to be gradually removed. In humans, perspiration and diuresis increase. Heat transfer at the third stage of fever sharply exceeds heat production.

Types of fevers

Depending on the changes daily temperature body of the patient, fever is divided into several types:

• Constant is a long and steady increase in temperature, the daily fluctuations of which do not exceed 1 degree.
• Remitting - noticeable daily changes can be in the range of 1.5-2 degrees. In this case, the temperature does not reach normal numbers.
• Intermittent - such a pathology is characterized by a rapid and significant rise in temperature. It lasts for several hours, after which it is replaced by a fairly rapid drop to normal values.
• Exhausting or hectic - with this type of daily fluctuations can reach 3-5 degrees. At the same time, rises with a rapid decline are repeated several times throughout the day.
• Perverted - such a fever is characterized by a change in the daily rhythm with high rises in the morning.
• Incorrect - characterized by fluctuations in body temperature during the day without a definite pattern.
• Return - with this type, periods of increased body temperature alternate with periods of normal values, which last for several days.

It should also be noted that the temperature - 35 degrees - does not contribute to the appearance of fever. To find out the reasons for this condition, you should consult a doctor.

Common fever symptoms

Low temperature (35 degrees) does not cause fever, as it is characterized by a rise of more than 37 degrees. Common features such pathological condition are:

• feeling of thirst;
• redness of the skin of the face;
• rapid breathing;
• aches in the bones, headache, unmotivated good mood;
• poor appetite;
• chills, trembling, intense sweating;
• delirium (delirium) and confusion, especially in elderly patients;
• irritability and crying in children.

It should also be noted that sometimes a rise in temperature may be accompanied by swelling and painful sensations in the joints, rash and blistering of a dark red color. In this case, you should immediately consult a doctor.

Treatment

How to get rid of a condition such as a fever, the stages of which were listed above? To begin with, the doctor must establish the cause of the rise in body temperature, and then prescribe the appropriate therapy. If required, the doctor can send the patient to additional examination. If you suspect serious pathology the specialist recommends hospitalization to the patient. Also, to eliminate the fever, the patient is advised to observe. It is forbidden to dress too warmly.

The patient needs to drink plenty of fluids. As for food, he is shown light and well digestible food. Body temperature should be measured every 4-6 hours. If necessary, you can take an antipyretic. But this is only if the patient has a severe headache, and a temperature of more than 38 degrees is also observed. To improve the patient's condition, it is recommended to use Paracetamol. Before taking this medicine, you must carefully study the instructions. If a child has a fever, then he is forbidden to give acetylsalicylic acid. This is due to the fact that such a drug can cause the development of Reye's syndrome. This is extremely serious condition leading to coma or even death. Instead, paracetamol-based medicines are recommended for kids to relieve fever: Efferalgan, Panadol, Kalpol and Tylenol.

At fever body temperature rises above thirty-seven degrees.

Causes of fever.

2. heat stroke

3. chronic diseases, turned into an acute form

4. heart attack

5. thyrotoxicosis (thyroid disease)

6. poisoning or other diseases of the digestive tract

7. lymphoma and other forms of cancer

Fever symptoms.

Chills, trembling, headache, increased sweating, aching bones and muscles, poor appetite, thirst, rapid breathing and pulse, possible delirium, redness of the face. Newborn babies are irritable, cry and do not breastfeed.

If a child has a fever, it is imperative to consult a doctor. Children from six months to six years of age with a fever may experience convulsions. It is necessary to protect the child, remove all sharp and piercing objects to the side, and free the child's breath.

Sometimes with fever, convulsions, rash, pain in the abdominal cavity, stiffness of the muscles of the neck are noted.

If the fever is accompanied by joint pain, blistering rash, swelling, then immediately consult a doctor, because these can be symptoms of serious diseases.

If, with fever, there is a cough with a discharge of green or yellow sputum, pain in the head, ears, throat, stomach, dry mouth, thirst, confusion, rash, vomiting, then you need to call a doctor immediately.

If a pregnant woman feels a rise in temperature, she should tell her obstetrician-gynecologist about it.

Fever treatment.

What should a person with a fever do?

Do not overexert yourself, stay in bed, drink more ( warm milk and tea with herbs or raspberries), do not dress too warmly. You need to eat easily digestible food. If the body temperature is kept above 380C, it is necessary to take an antipyretic. If you suffer from severe pain in the bones and muscles, you can take a pain reliever. Children with high temperature shown children's paracetamol in suspension. For children, the dose of antipyretic is calculated depending on the weight of the child. It is contraindicated to give children aspirin!!! Its use can lead to coma or death.

Physician's actions in case of fever.

The doctor determines the cause of the fever. Depending on the cause, prescribes the optimal drug treatment. If the disease is serious, then he writes out a referral to the hospital.

Fever is a protective and adaptive mechanism human body, which develops as a reaction to the influence of pathogenic stimuli. Sometimes fever also appears with non-communicable diseases. This is how the body reacts to the action of endotoxins, endogenous pyrogens, which are released when they are destroyed, a septic inflammatory process occurs, and metabolic disorders and autoimmune processes are also observed.

How does fever manifest itself?

The processes of thermoregulation in the human body determines the center of thermoregulation, which is located in a person. These processes can be disrupted exogenous or endogenous factors. Sometimes the temperature rises in case of violation of the processes of heat production and heat transfer and when normal condition thermoregulation center.

The main symptoms of fever are fever body. If normal temperature body, measured in the armpit, should be 36.0-36.9, then with fever, these figures increase. With a fever, a person experiences chills, headache, weakness, strong ache in the muscles.

Classification of fevers is practiced depending on various factors. Given the cause of development given state determined infectious And non-infectious fever.

Taking into account the level of increase in body temperature, the patient differs subfebrile fever (body temperature 37-37.9 °С), febrile fever (body temperature 38-38.9 °С), pyretic or high fever(Body temperature 39-40.9 °С) And hyperpyretic or excessive fever (body temperature 41 °С and more).

Depending on the duration of this state varies acute , subacute And chronic fever.

According to the assessment of body temperature and the time when they appear, it is determined constant , laxative , intermittent , returnable , undulating , wrong , perverted , hectic fever. All types of fever have features of the course. For example, hectic fever develops when there are large fluctuations in body temperature. These types of fever are manifested in the development of certain diseases.

A number of diseases associated with fever and associated symptoms are identified.

Types of fevers

Crimean hemorrhagic fever is a viral disease that develops as a result of exposure to a pathogen transmitted by ticks. Crimean fever was first diagnosed in the Crimea. signs this disease were also found in 1944. His trigger is RNA virus, which enters the body through the skin when a person is bitten by a tick.

Symptoms of hemorrhagic fever are acute: body temperature rises sharply, intoxication is noted, as well as hemorrhagic syndrome (high bleeding). The patient may experience vomiting, initial period there is noticeable redness of the face. After 2-6 days, hemorrhagic syndrome is observed, which is characterized by the appearance hemorrhagic rash on shoulders, legs, hands.

If hemorrhagic fever develops with renal syndrome, then the acute onset of fever is combined with symptoms of intoxication and severe kidney damage. As a result, hemorrhagic kidney fever leads to kidney damage and liver failure. There is bleeding gums, nosebleeds, a person may lose consciousness. Viral diseases, Related hemorrhagic syndrome, are also dangerous because a person can develop bleeding in the stomach and intestines. The development of complications ( sepsis , pulmonary edema , pneumonia ) and improper treatment can lead to death. Therefore, prevention of infection is important: immediately after a tick bite, you need to contact a specialist. Hemorrhagic Far East fever - serious illness requiring urgent treatment.

prolonged fever of unknown origin can be diagnosed if a high body temperature (above 38 degrees) keeps the patient for more than two weeks, and the reasons for this phenomenon remain unidentified. At the same time, a comprehensive examination was carried out and all diagnostic standards were taken into account. Very important point is differential diagnosis fever of unknown origin, as sometimes this diagnosis can be made erroneously. According to some experts, this type of fever is based on infection, the development of a malignant tumor, and systemic diseases of the connective tissue. Approximately at 20% cases, the cause of this type of fever, both in children and adults, remains unclear. Treatment of the disease is prescribed depending on the intensity of the fever.

yellow fever a person becomes infected from animals and people, the carriers of the pathogen are mosquitoes. First symptoms yellow fever appear about 3-6 days after mosquito bite. The onset of yellow fever is acute: body temperature rises to 40 degrees, there is a severe headache and pain in the joints, back, legs. There is also a hemorrhagic component: the patient's face becomes very red and swollen. Already on the second day, a person suffers from severe vomiting, nausea and thirst. Around the fifth day, a period of remission begins, when the person begins to feel better. But this improvement lasts only a few hours. Further, the person becomes worse, as thrombohemorrhagic syndrome develops. Possible bleeding, hematemesis. The disease is fraught with development serious complications — sepsis , pneumonia , myocarditis . Treatment of this disease consists of symptomatic therapy and prevention of further progression of the disease. Main preventive measures is vaccination. Vaccination against yellow fever is mandatory if a person travels to areas where there is an endemic situation for this disease. Over 45 endemic countries identified in Latin America And Africa where you need to get vaccinated when you leave ( Colombia, Peru, Brazil, Ecuador, Kenya and etc.)

West Nile fever It has infectious nature. Transmission of the pathogen occurs with mosquito bites. The disease can occur both sporadically and manifest as serious outbreaks. In Russia, such an outbreak was recorded in 1962-64, later outbreaks were observed in the CIS countries. Therefore, the prevention of West Nile fever is very important both in Africa and in Europe. The disease in humans begins acutely, with chills and a sharp rise in body temperature. The state of fever can last up to two weeks in a person. Symptoms of Nile fever are expressed by sweating, painful intoxication for the patient. A person is plagued by vomiting, headache, drowsiness, etc. If the diagnosis was carried out on time, and symptomatic treatment relieves the patient's condition, then the Nile fever is successfully cured.

mouse fever Humans become infected through contact with rodents. Mice and rats do not get sick themselves, but only endure this dangerous disease. The virus is shed through the feces and urine of animals. First symptoms mouse fever in children and adults on initial stage disease progression is similar to acute form ORZ . Before the first signs of mouse fever appear in adults and children, it takes from 7 to 46 days from the moment of infection. What symptoms of mouse fever occur in men and women in adulthood, most often you can find out already on the 25th day. Initially, the symptoms in adults are renal and hemorrhagic manifestations, and in children the disease manifests itself gradually: body temperature rises, nausea, vomiting, migraine worries, vision deteriorates.

Infection leads to grave consequences: the patient's kidneys are affected, serious intoxication of the body occurs, thrombohemorrhagic syndrome is noted. If the first symptoms appear, and the treatment was not taken in time, then kidney damage can eventually lead to death.

Mouse fever in children in the initial period is often mistaken for another disease, since its signs in the initial period can be taken for severe cold or another infectious disease. Sometimes, even during the diagnosis process, the doctor may suspect that other types of fevers are developing. Prolonged fever, pale skin, and other features common to some types of fever sometimes make the diagnosis difficult.

Treatment takes place under bed rest. Complex therapy includes taking antipyretic, antiviral painkillers. It is also practiced to assign infusion therapy, glucocorticoids, hemodialysis.

Acute rheumatic fever in children indicates that rheumatic pathology is already developing in the body. Acute rheumatoid fever is a very dangerous disease, as it primarily affects the cardiovascular system.

Classification of the disease is carried out according to the course of the disease: acute rheumatic fever and recurrent rheumatic fever are distinguished. The cause of the disease is exposure to beta-hemolytic streptococcus. This microorganism infects connective tissues, this is facilitated by some additional factors. Acute rheumatic fever is caused by hypothermia, malnutrition, malfunctions of the immune system, etc.

Symptoms of the disease are general intoxication, fever, joint pain, pale skin, irritability. After establishing the correct diagnosis, it is necessary to immediately begin treatment, since timely complex therapy determines the success of treatment. Prevention of the disease consists in preventing infection with streptococcal infection.

hay fever in children older than five years and adults develops due to an allergic reaction of the body to plant pollen. Hay fever symptoms are primarily allergic rhinitis And allergic conjunctivitis . Many people also have some other signs - fatigue, problems with appetite. The disease is more likely to affect men, as well as those who have already observed certain allergic reactions. Treatment for hay fever is often lengthy and complex process, especially if the goal of a person is to get rid of this disease forever. The main cure for hay fever is antihistamines. Also used vasoconstrictors, glucocorticosteroids. There is also treatment folk remedies. However, often people suffer from this ailment for many years, since with the help of treatment it is only possible to reduce the symptoms.

Symptoms of Dengue Fever , which is also called dengue fever, are manifested due to infection of the body with an infection carried by one of the types of mosquitoes. Tropical fever symptoms are severe muscle pain, high performance body temperature, diarrhea, cough, runny nose, conjunctivitis. The disease is curable, but tropical hemorrhagic fever, which affects young people and children, causes acute bleeding and therefore very dangerous. The consequences of this disease can be fatal. Treatment is carried out immediately after an accurate diagnosis. Prevention is mandatory consultation from a specialist before traveling to countries such as Thailand, etc. Vaccination is carried out against other types of fever, dengue fever vaccination for this moment not practiced.

Ebola and Marburg have a lot in common, as their pathogens are similar. These diseases are very dangerous, contagious and in most cases end lethal outcome. Symptoms Ebola and Marburg immediately manifest acutely, the person is worried chills, a strong rise in temperature, general intoxication of the body. Symptoms appear after a few days gastrointestinal lesions, consciousness is disturbed. Ebola hemorrhagic fever, like Marburg hemorrhagic fever, can lead to lethal outcome in the period from 4 to 27 days after infection. Treatment is to keep you alive important functions, also practiced symptomatic therapy. Marburg fever ends in death in more than 80% of cases.

Lassa hemorrhagic fever characterized by the development hemorrhagic syndrome, myocarditis, pneumonia, kidney damage. The mortality rate in this case is very high.

Family mediterranean fever , which is also called periodic illness manifests itself in a person with recurring cases of fever, inflammatory process lungs, bodies abdominal cavity, joints. This disease is more common in indigenous people Caucasus, mediterranean. The disease is diagnosed in childhood. It is impossible to completely cure it, so symptomatic treatment is practiced.

Marseille fever also characteristic of the inhabitants of the above regions. The disease is characterized high body temperature, rash, pain in the limbs And headache,regional lymphadenitis, changes in the work of the cardiovascular system. Treatment is carried out using tetracycline antibiotics .

Rocky Mountain Spotted Fever appears intoxication, rash, defeat of cardio-vascular system, vessels And CNS. The disease is common in Northern And South America . Carriers of the disease are rodents, some domestic animals. Treatment involves taking drugs of the tetracycline or levomycetin group.

In addition to the types of fever described, there are a number of other types of fevers that are dangerous to human life.

Fever is treated with bed rest . It is important to establish the nature of the rise in temperature and to put correct diagnosis. For fever caused by colds, should be used antipyretic if the temperature rises above 38 degrees. Children are recommended to give funds based on to reduce the temperature.

After establishing the diagnosis, the doctor prescribes the treatment of the disease that has been diagnosed. It is important not to delay contacting a specialist for conditions that cause anxiety. Eg, white fever in children, inadequate heat transfer is manifested, so there is a danger of serious overheating of the body. In this case, the doctor should be contacted immediately to establish the causes of this condition and prescribe treatment. You need to consult a doctor if your child has post-immunization fever , that is, the temperature rise after vaccination.

If a woman shows milk fever , that is, the reaction of the body to the appearance of milk in the breast of a nursing mother, you should not wait until this condition passes by itself. This is fraught with complications, so the chest must be examined by a doctor.

Fever on the lips (as rashes are called among the people) periodically appears in people who are infected with the herpes virus. How to cure herpes completely, doctors still do not know. Nevertheless, local funds can reduce the symptoms of the disease. How to treat a fever on the lip, you should ask your doctor.