Fever should not be seen as a disease condition in itself but rather as a marker for the body to defend itself against infection. It is still unclear whether fever is only harmful or at the same time helpful.
Fever plays a function in the immune system and strengthens the primary immune system while reducing the growth of infectious substances.
What is normal fever temperature?
The normal temperature varies between 36.8 +/- 0.5 degrees C. Normally you have the lowest value in the daily variation in the morning after waking up and the highest in the late afternoon or evening. The temperature also varies between individuals so that what is a fever for one person is a completely normal temperature for another person. The chain of events in the biology of fever is fairly well known and encompasses a number of substances and processes in the body.
The body regulates the temperature through increased metabolism or through muscle work. The heat is mainly produced by the musculature and therefore shatters, shakes, or is allowed to freeze if needed at higher temperatures. The temperature can also be raised for other reasons than the thermostat (in the hypothalamus of the brain) controls. If you stay in warm surroundings, strong sunlight or warm climates and it is humid so that cooling with increased blood flow in the skin and sweating does not work well enough, a fever can occur. Sweating increases heat loss through the energy consumed as the water evaporates. In extreme physical exertion, the temperature can go up to 39 degrees.
Fever lowers physical performance. Normally the temperature also varies so that before menstruation it is 0.5 degrees higher. Temperatures above 41 degrees are very uncommon and the highest measured values of 44.5 degrees have been in patients with heat stroke. Above this temperature level, hardly any adults survive.
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Sarcoidosis – a chronic disease that manifests itself in tuberculosis-like skin changes.
Hepatitis – inflammation of the liver.
Ulcerative Colit – chronic inflammation of the colon.
Crohn’s disease – chronic local inflammation of the intestines.
Fabry’s disease – an unusual, hereditary storage disease with nerve pain.
Porphyrin – a group of iron-free substances found in blood and urine, among other things.
Gout – metabolic disease that can cause painful joint inflammation
Toxic trauma – morbid enlargement of the thyroid gland.
Pheochromocytoma – tumor (usually benign) from certain adrenal gland cells.
Connective tissue disease – a disease group with more or less convincing immune responses to own tissues.
Giant cell arthritis – a type of inflammation, thickening of the innermost cell layer in small arteries with connective tissue.
Vasculitis – inflammation of a vessel wall.
SLE – autoimmune disease that can involve many organ systems.
Pulmonary embolism – blood clot in the pulmonary arteries.
Infections by bacteria, viruses or fungi are the most common causes of fever
The most common causes are respiratory or urinary tract infections. But also other inflammatory diseases and diseases such as infarcts (most often, coronary artery blood vessels in the brain, lung, heart), hypothyroidism and malignant tumors including blood disorders.
A group of individuals who deserve special attention in this context are elderly, often multi-sick individuals, in care homes. By 2030, about 20 percent of the population will be over 65, and many of these will need residential care. Already, infections are difficult to manage in this environment, partly because of spreading reasons, but also because the infection symptoms are difficult to interpret. Infection in this group of individuals can cause confusion, incontinence (difficult to keep urine and feces), falling tendency, decreased mobility, reduced hunger, or difficulties in communicating with caregivers. Fever is not always a prominent feature of these patients, so there is a special guideline for these patients, see the references.
If you omit diseases that damage the brain’s self-regulating center, type of brain tumors, bleeding in brain tissue or clogs in the blood vessels or heat stroke, there are many disease states that can be accompanied by fever:
1. All infections caused by bacteria, viruses, rickettsia, chlamydia or parasites (especially protozoa) are accompanied by fever.
2. Diseases due to the involvement of the immune system such as connective tissue diseases, drug reactions, immune deficiency syndrome (AIDS).
3. Diseases characterized by inflammation of the blood vessels or a plug in vessels, infarction of tissue. Traumatic injuries are often associated with fever.
4. Granulomatous diseases such as sarcoidosis and granulomatous hepatitis usually have fever as a dominant symptom.
5. Inflammatory bowel disease such as ulcerative colitis and Crohn’s disease as well as other inflammatory processes in the abdomen, type of acute pancreatitis and hepatitis usually have fever as a symptom.
6. Malignant tumors and especially those involving bone marrow blood, or lymphatic tissue often have fever as an early and prominent symptom, while other malignant tumors such as kidney cancer, pancreas, lung, liver and bone tissue are more rarely directly accompanied by fever. However, when there are daughter tumors (metastases) and cell destruction in the tumor (necrosis) or blockage or infection in the exit organs, the fever is more often a marked symptom.
7. Some acute metabolic disorders such as gout, Fabry’s disease and porphyrin can often cause fever, while adrenal failure and thyroid crises rarely cause fever as a symptom and even more rarely in pheochromocytoma. The cause of fever in these conditions varies from activation of the inflammatory response to the disease (gout) to changes in heat regulation (for example, toxic currents and pheochromocytoma).
How should fever be treated?
The general recommendations for adults are to keep the room cool, get dressed in cool clothes, bathe your forehead and wrists with a towel moistened with cold water, drink plenty and use antidepressants if needed. For children, the same rules apply, but measure the temperature of the child after half an hour of rest in the landscape. If the child gets fever cramps (loses consciousness, gets stiff in the body, can get blue around the mouth, gets twitches in the arms and legs) then the child should be put to the side, swallowed quickly by the child with towel moistened with cold water and immediately contact a doctor for examination and advice.
Cause of fever in adults is often known
Most often, the cause of fever in adults is known even if you do not know exactly which virus or bacteria caused the urinary tract infection or respiratory infection. If you have multiple fever peaks above 38.3 degrees for at least three weeks (without diagnosis after one week) it is called unclear fever.
Not very rarely can it be very difficult to find the cause of fever in the acute stage. These conditions are then classified as a fever for unknown reasons. In studies of these patients, it is later found that 30 percent is due to infection, 20 percent to malignant cancer, 16 percent connective tissue disease, 16 percent “other” and 18 percent who were never diagnosed. In particular, infections are noted infection of the heart valves (often with sepsis = “blood poisoning”), tuberculosis and abdominal scarring. In particular, malignancies include lymphoma (cancer of the lymphatic tissue) and of connective tissue diseases; giant cell arthritis, systematic vasculitis and SLE. Other causes include pulmonary embolism, drug-triggered fever, and inflammatory bowel disease. Thus, a whole flora of medical conditions can cause fever at an early stage. In those with “other causes” the fever usually disappears by itself, but only for the patient.
Obscure fever in children
Unclear fever in children is defined as rectal temperature above 38.5 C on more than four occasions for more than two weeks in a child, where the fever has no known cause from medical history or physical examination.
Infections completely dominate in these with over 50 percent of which over 65 percent are virus-caused in children under the age of six. Upper respiratory tract infections and viral infections are clearly most common in children under the age of two. Endocarditis and mononucleosis become more common over the age of six. Connective tissue diseases and inflammatory bowel diseases account for 20 percent of these fever conditions and malignant tumors account for ten percent (most blood and lymphatic cancers). Finally, a flora of various diseases accounts for ten percent of the unclear fever diseases.
When should I consult a doctor?
As an adult, you should seek medical attention if you have had a fever for more than four to five days. Likewise if the fever disappears after a few days but then returns. If you are severely included, have a fever or have difficulty getting fluid, consult a doctor immediately.
If children under three months have a fever, are tired or do not want to drink, it is time to seek medical attention. If children have fever cramps, are poorly included, have a fever, or have difficulty getting fluid, contact healthcare immediately.
The word fever comes from Latin fever and is defined as an increase in body temperature above 37.5 degrees Celsius (C) in the morning and 38 degrees in the afternoon, as measured in the rectum (rectally). You can also measure the temperature of the oral cavity (orally), the armpit (axillary) or the ear canal. Measurement in the rectum provides the highest accuracy. The fever thermometer began to be used in the mid-1800s, although it has been known since the days of Hippocrates that fever usually marks disease. However, it took until 1924 before the interest in why one gets a fever and what it earns became clear in an article by Oliver Heath.