Firstly, all of us have experienced fever or a spike in body temperature multiple times in our lives. But, actually, have we ever taken out the time to wander and explore our body through this process. Moreover, all we actually do is start googling up on symptoms, get real freaky and start worrying our selves and the people around us. Further, we also shove in one or two pills that we keep in handy to tackle these kinda situations. Further, to worsen things up, in the spur of the moment we don’t even properly look up the name of the pills, the intended use and the expiry dates.
So, today in this article let us set aside 5 minutes of our time. Also, let’s read and try answering questions like, why fever occurs and what the body is actually trying to tell us by that process. Moreover, we oftentimes associate this fever with a feeling of illness and agony. Also, our brains are deeply wired to support this theory. But, we instantly start feeling that something is terribly wrong with us. Though partly this theory stands correct. Further, fever can be taken as the body’s way of conveying that something is wrong with it. So far, we should be thankful. Also, from what we have read you can totally understand that fever is purely a symptom of a lot of underlying conditions.
CDC’S DEFINITION OF FEVER:
According to the Centre for disease control and prevention (CDC), a person is said to run a fever, if he/she has a temperature that measures more than 100.4 degrees Fahrenheit or greater than 38 degrees celsius. Further, the body’s temperature is the degree or the measure of hotness or coldness of the body. Moreover, an increase in body temperature is known as hyperthermia. Likewise, a decrease in body temperature is hypothermia. To sum up, it is a somatic sensation and the measure of the difference between the body’s core and the temperature in relation to the external environment.
THE HIGHER CENTRE:
Firstly, the anterior hypothalamus, preoptic and temperature-sensitive areas and certain thermal set points are involved in maintaining body temperature. Further, these complex regulatory mechanisms all work in unison to maintain this temperature.
Body temperature = Thermogenesis – Heat loss
Further, the body temperature can be classified as,
- Core body temperature (interal body temperture)
- Surface body temperature (temperature at surface the skin and subcutaneous surface)
Apart from all this, there are certain factors that can affect body temperature. Some of them include,
- Firstly, the age of the person
- Secondly, the hormonal levels at a given point of time
- Further, the circardian rythmn of the body
- Moreover, stress the person is undergoing at a given point of time
- Also, exercise and the environmental conditions.
All the above-mentioned factors should be considered before coming to a conclusion.
Pyrogens are nothing but fever causing agents. Further, they can be classified as exogenous and endogenous.
WHAT IS THE BODY TRYING TO CONVEY THROUGH A FEVER?
There are a lot of reasons for a person to run a fever. Some of the classic or known causes include,
- Firstly, a hot environment (sometimes singly or combined with workouts or exercises)
- Secondly, injury or damage to the neurogenix centres of the hypothalamus
- Certain chemical factors in the blood can also cause fever (Example – Caffeine)
- Infection and severe haemorrhage (both internal and external)
- Also, desired or undesired side effect of drugs
SIGNS AND SYMPTOMS OF FEVER:
As mostly all of us have experienced this phenomenon at least once in a lifetime, the symptoms are very easy to diagnose. Moreover, the symptoms include,
- Flushing of the face and a hot dry skin
- Dark coloured urine
- Nausea and vomiting
- Anorexia and body aches
- Further, the vitals are not normal – Increased heart rate and respiratory rate
- Shivering is also common ccompanied by chills
- Also, bluish shade of the skin and nail beds (cyanosis)
GRADING OF FEVER:
The fever can be graded or classified based on the temperature,
|GRADING OF FEVER||TEMPERATURE|
|Low-grade fever||37.1 -38.2 degree celsius (98.8-100.6 F)|
|High-grade fever||38.2- 40.5 degree celsius (100.6 -104.9 F)|
|Hyperpyrexia||Greater than 40.5 degrees Celsius (104.9 F)|
TYPES OF FEVER:
There are 4 major types of fever, they include
|TYPE OF FEVER||FEATURES OF THE FEVER|
|Intermittent fever||In this type, the temperature wavers and frequently returns to normal in a 24-hour window as in septicaemia|
|Remittent fever||The fever rises and falls to normal temperature as in tuberculosis|
|Sustained fever||The temperature constantly remains above 38 degrees celsius with barely any fluctuation|
|Relapsing fever||The febrile periods are interspersed with periods of normal body temperature|
FEVER OF UNKNOWN ORIGIN:
Pyrexia of unknown origin is a very important concept when it comes to talking about running a temperature. PUO can be defined as a persistent temperature of more than or equal to 38.3 degrees celsius for more than 14 days.
The patient is usually admitted to the hospital. He/she is admitted for more than a week or has 3 outpatient visits without a successful result. Also, common causes include,
- Autoimmune conditions
- Infections (This comprises aproximately 30% of the cases)
- Idiopathic or undiagnosed conditions
- Other or miscellaneous causes
Further, a systematic approach is needed to diagnose this condition.
- Getting a past medical history
- Past surgical history
- Drug history
- Further, the family history.
A glimpse of the personal history like,
- History of the person’s diet
- Any close contact with people affected with tuberculosis
- Sexual orientation of the patient
- Residential area
- Contact with animals and birds
- The occupation of the patient
Pyrexia of unknown origin can occur by the use of certain drugs.
CLASSIFICATION OF PYEXIA OF UNKNOWN ORIGIN:
- Pyrexia of unknown origin with HIV infection
INVESTIGATING PYREXIA OF UNKNOWN ORIGIN:
There are certain investigations that are helpful to diagnose pyrexia of unknown origin,
|GENERAL SCREENING TESTS||IMAGING AND OTHER MODALITIES|
|Complete blood count||Chest X-ray|
|ESR and CRP||Protein electrophoresis|
|Blood urea nitrogen (BUN OR BUSE TEST)||CT of the chest, abdomen and pelvis|
|Blood culture and urine analysis||Bone marrow examination|
|Stool test and occult blood||HIV test counselling|
|Liver function test||Temporal artery biopsy|
|Serum virology||Lumbar puncture|
|Sputum culture and sensitivity||Autoantibody screening|
|Repeat history and examination||ECG or electrocardiogram|
Obviously, performing all the tests is not an option. Moreover, only certain tests based on the history of the patient and the presenting symptoms are done. Further, sometimes none of the above tests can help us to arrive at a diagnosis. Further, the doctors have to ponder upon other ways of management.
MANAGING PYREXIA OF UNKNOWN ORIGIN:
Firstly, in certain patients, tests cannot be performed. This is due to the sickness of the patient or most of the above-mentioned tests have failed to uncover the aetiology or the cause of the illness. Also, in such cases, the patient is put on broad-spectrum antibiotics and therapeutic trials.
Further, the prognosis of this condition is highly determined by the underlying disease or condition. The prognosis is usually worse when the underlying cause is neoplasm. Also, in case of the fever being undiagnosed for a period of more than 4-5 weeks, the prognosis is usually good.
To sum up, fever is a normal way of expressing an abnormality in the body. Further, it is important to listen to the body and assess the actual problem rather than treating the fever alone. Also, assessing the vital signs and measuring the temperature frequently is also important.