Fever Li Shuang. Definition An elevation of core body temperature above the normal range.
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Transcript of Fever Li Shuang. Definition An elevation of core body temperature above the normal range.
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Fever
Li Shuang
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Definition
An elevation of core body temperature
above the normal range
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Normal temperature
• Normal temperature 36~37℃
• Core body temperature varies throughout the day
<1 ℃
• Fever:
Oral>37.3 Rectal> 37.6 difference>1.2℃ ℃ ℃
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Pathogenesis
Anterorhypothalamus
thermostat
Heat gain effector system
Heat loss effector system
Organ:skin
Organ: skeletal muscle, liver
Set-point theory
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pathogenesis
Endogenous pyrogens
Exogenous pyrogensBacteria ,viruses,
immune complexes
Interleukin ,TNFInterferon
Fever
Hypothalamic set point
Disruption of hypo-thalamic thermostat
Production of heat↑ Loss of heat↓
Failure of body`s temperature-regulating mechanisms
•CNS disease•Inherited malignant• hyperthermia
•Strenous exercise or other stress•Chills•Thyrotoxicosis
•Heat stroke•Heart failure•Skin conditions
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Etiology and classification
• Infective fever
various microorganisms , such as bacteria ,
virus, mycoplasma, fungus
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• None-infective fever
Absorption of necrotic substances: injury; ischemic necrosis;
Endocrine and metabolic disturbances: hyperthyroidism and dehydration
Decreased elimination of heat from skin: heat failure
Dysfunction of central heat regulation:
a: Physical, as heat stroke;
b: chemical , as barbiturate poisoning;
c: Mechanical, as cerebral hemorrhage.
Dysfunction of vegetative nervous system; as the cases of sympathetic
overactivity.
Etiology and classification
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The effects of Fever
• Enhanced neutrophil migration
• Increased production of antibacterial substances by
neutrophils
• Increased production of interferon
• Increased antiviral and antitumor activity of
interferon
• Increased T-cell proliferation
• Decrased growth of microorganisms in iron-poor
environment
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Clinical manifestation
• Grade of fever
Hyperthermia fever: over 41 ℃
High fever: 39.1~41 ℃
Moderate fever: 38~39 ℃
Low grade fever: 37.3~38℃ 37℃
38℃
39℃
40℃
41℃
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• The clinical course and character of fever
Clinical manifestation
37℃
onset
persistence
subsidence
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Patterns of FeverContinued Fever
•Above normal throughout the day
•Fluctuate less than 1 in 24 hours℃
•Lobar pneumonia , typhoid
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• Remittent Fever
Patterns of Fever
Temperature above 39℃
Fluctuate more than 2 in 24 hours℃
Sapraemia , acute infectious endocarditis
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• Intermittent Fever
Patterns of Fever
•Episodes of fever separated by days of normal temperature
•Malaria
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• Undulant Fever
Patterns of Fever
•Increase to 39 in several days and then slowly return to the ℃
normal
•Brucellosis , tumor
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• Irregular Fever
Patterns of Fever
•No regular pattern
•tuberclosis
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Caution
• Using Antibiotic
• Using antipyretic or glucocorticoid
• Individual difference. e.g. medically frail
elderly people with pneumonia
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Associated symptoms
• Chills or rigor
acute infective disease, transfusion reaction
• Lymph node enlargement
infectious mononucleosis , lymphoma , leukemia
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• Enlargement of liver and spleen
infectious mononucleosis . lymphoma. Leukemia .hepatitis
• Coma
cerebritis . Cerebral hemorrhage
Associated symptoms
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Associated symptoms
• Rash
measles . Connective tissue diseases . Drug fever
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History taking
• When, acute or chronic, fever grade, pattern
• Chilly, sweating
• Systemic symptoms: respiratory system, digestive system, urinary system
• General condition
• Treatment course (antibiotic? antipyretic?)
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Diagnostic points
• Other symptoms besides Fever
• Duration and magnitude of Fever
• Close contact with similar illness
• Occupational , travel , recreational exposure
• History of disease
• Current medication
• Allergy
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Case
Repeated chill then fever
bacteremia
Local infectionSeek for Infection site
History taking and examination
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Case 2Patient with hepatitisChill and feverleukocytosis
Local infection
abdominal infection?
ultrasonic testing 1st normal
1week, hiccup ,position change aggravation
diaphragm subphrenic abscess
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Summary
• Definition
• Pathogeneses
• Etiology
• Clinical course
• Patterns
• Associated symptoms
• Diagnosis points
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Thanks !