Evaluation of thermometry results. Types and types of fever Type of fever Morning temperature higher than evening temperature
4. What is the degree of temperature rise?
moderate fever
5. Explain the mechanism of development of weakness, drowsiness and loss of appetite.
IL1 affects the center of hunger because of this, exhaustion develops.
Because there is no normal metabolism in-in muscle proteolysis develops
IL1 acts on the CNS, causing drowsiness
Task 5
Patient K., aged 18, was admitted to the therapeutic department for lobar pneumonia. Body temperature 40.5 o C. The patient is pale, the skin is dry. The tongue is coated with white. The patient complains of headache complete absence appetite, drowsiness, severe cough with phlegm, shortness of breath, soreness in the muscles and joints. BP - 130/90 mm Hg Pulse 98 beats / min. The borders of the heart are within the normal range. Heart sounds are muffled. Breathing is frequent and shallow. Crepitus is heard in the lower parts of the right lung. The liver is slightly enlarged. In the blood: leukocyte count 18 x 10 9 /l, neutrophilic leukocytosis, ESR - 22 mm/hour. The content of sugar in the blood is 7 mmol / l, the albumin / globulin coefficient is reduced.
1. Make a pathogenetic chain that characterizes the mechanism of body temperature increase in this patient.
Croupous inflammation is caused by a pathogenic bacterial nature. OOF mediators caused the formation of prostaglandin E2, which acts on the thermoregulatory center of the hypothalamus -> increases the sensitivity of cold and reduces heat receptors. An impulse is transmitted along a chain of neurons to target organs -> heat production increases, heat transfer decreases -> body T increases
2. What is the degree of temperature rise?
Hyperpyretic
3. Explain the connection between the inflammatory process in the lungs and the general reactions of the body.
Inflammation caused the activation of OOF and the production of OOF mediators. Mediators act on the vessels, causing an increase in their permeability, which contributed to the emigration of leukocytes with exudate and delimitation of inflammation.
4. What phenomenon of inflammation can be associated with the appearance of crepitus?
With croupous pneumonia, fibrin exudate is released. During exhalation, the alveoli stick together, and at the height of inhalation they come apart with great difficulty at the moment of increasing air pressure in the lumen of the bronchi. This is how crepitus appears.
5. Explain the mechanisms: tachycardia, neutrophilia, hyperglycemia, decrease in A/G ratio.
IL1 acts on the endocrine system: the action is on the hypothalamus and pituitary gland, there is an increase in the synthesis of ACTH, which acts on the adrenal glands -> an increase in the synthesis of glucocorticoids, which increase protein breakdown and gluconeogenesis. The sympathetic-adrenal system also causes the destruction of glycogen.
An increase in blood glucose leads to an increase in BCC, an increase in blood pressure -> tachycardia. (Also, baroreceptors respond to an increase in BCC and an increase in temperature affects the carotid sinus node, which also causes tachycardia)
IL1 and IL6 affect monocytes, macrophages and fibroblasts, which secrete GM-CSF (granulocyte-macrophage colony-stimulating factor), which leads to increased differentiation of neutrophils - neutrophilia
The decrease in the A / G ratio is explained by the fact that the liver is busy with the formation of BOF and gamma globulins, therefore, the synthesis of albumins is reduced.
Task 6
In a patient with a reliably diagnosed oncological disease within last year subfebrile temperature was constantly observed. After the appointment of drugs that inhibit protein synthesis, normalization of temperature was recorded.
What pathological process (infectious fever, non-infectious
fever, endogenous hyperthermia) caused an increase in temperature in
this case?
non-infectious fever
How do you justify your conclusion?
There are no exogenous pyrogens, the temperature decreased after taking cytostatics that affected endogenous pyrogens
What is the mechanism of antipyretic action of drugs that suppress
protein synthesis?
These drugs act on IL6, which is the main stimulator of the synthesis and secretion of OP proteins by hepatocytes. Once it is blocked, there is no protein synthesis, no reaction
Are they able to normalize the temperature during endogenous
hyperthermia?
No, because with hyperthermia, the relationship between heat production and heat transfer is violated
Name the possible mechanisms of weight loss in a patient.
Temperature(from Lat. temperatura - proportionality, normal state) is a physical quantity that characterizes the state of thermodynamic equilibrium of the system. If the system is not in equilibrium, then heat exchange occurs between its parts that have different temperatures. A higher temperature is possessed by those substances in which the average kinetic energy of the molecules is higher. That is, the temperature quantitatively characterizes the measure of the average kinetic energy of the thermal motion of the molecules of a substance.
It follows from the definition of temperature that it cannot be measured directly and can only be judged by a change in physical properties (volume, electrical resistance, radiation intensity, etc.) special devices - thermometers. When taking measurements, it should be remembered that any thermometer always measures its own temperature. When thermodynamic equilibrium occurs between the thermometer and the body under study, the thermometer shows not only its own temperature, but also the temperature of the body under study.
Normal temperature of various organs and tissues
human body temperature- this is a balance between the formation of heat in the body (as a product of all metabolic processes in the body) and the release of heat through the surface of the body, especially the skin (up to 90-95%), as well as through the lungs, feces and urine.
Heat generation occurs in all organs and tissues, but not equally intense. Functionally active tissues and organs (eg, muscles, liver, kidneys) produce more heat than less active ones (connective tissue, bones). Heat loss by organs and tissues depends to a large extent on their location. The superficially located skin and skeletal muscles give off more heat and cool more than the internal organs.
From this it is clear that the temperature of different organs is different. Thus, the liver, located inside the body and giving greater heat production, has a higher temperature (38 degrees) compared to the skin, the temperature of which is much lower (especially in clothing-covered areas) and depends on the environment.
Moreover, different parts of the skin have different temperatures. Usually the skin of the head, trunk and upper extremities is 5-7 degrees warmer than the skin of the feet, the temperature of which varies between 24-35 degrees. The temperature may be different in the left and right armpits, the bowl on the left is 0.1-0.3 0 C higher.
Normal body temperature in the armpit: 36.3-36.9 0 C.
Normal body temperature in the oral cavity: 36.8-37.3 0 C.
Normal body temperature in the rectum: 37.3-37.7 0 C.
Physiological fluctuations in body temperature
Body temperature is not a constant value. The temperature value depends on:
Time of day. The minimum temperature is in the morning (3-6 hours), the maximum - in the afternoon (14-16 and 18-22 hours). Night workers may have the opposite relationship. The difference between morning and evening temperature in healthy people does not exceed 1 0 C.
motor activity. Rest and sleep help to lower the temperature. Immediately after eating, there is also a slight increase in body temperature. Significant physical stress can cause a temperature rise of 1 degree.
As already mentioned, the most intense heat generation in the body occurs in the muscles. small physical activity leads to an increase in heat generation by 50-80%, and heavy muscular work - by 400-500%. In cold conditions, heat generation in the muscles increases, even if the person is stationary. This is due to the fact that the low ambient temperature, acting on receptors that perceive cold irritation, reflexively excites chaotic involuntary muscle contractions, manifested in the form of tremors (chills). At the same time, the metabolic processes of the body are significantly enhanced, the consumption of oxygen and carbohydrates by muscle tissue increases, which entails an increase in heat generation. Even arbitrary shaking increases heat generation by 200%.
Phases of the menstrual cycle. In women with a normal temperature cycle, the morning vaginal temperature curve has a characteristic biphasic shape. The first phase (follicular) is characterized by a low temperature (up to 36.7 degrees), lasts about 14 days and is associated with the action of estrogens. The second phase (ovulation) is manifested by a higher temperature (up to 37.5 degrees), lasts about 12-14 days and is due to the action of progesterone. Then, before menstruation, the temperature drops and the next follicular phase begins. The absence of a decrease in temperature may indicate fertilization. Characteristically, the morning temperature, measured in the axilla, in the oral cavity, or in the rectum, gives similar curves.
Deviations from the norm
- Hypothermia
- hyperthermia
- Fever
Hypothermia- this is a condition in which the body temperature under the influence of external factors drops below 35 degrees. Hypothermia most quickly occurs when immersed in cold water. With hypothermia, a state similar to anesthesia is observed: the disappearance of sensitivity, weakening of reflex reactions, a decrease in the excitability of nerve centers and metabolic rate, slowing of breathing and heart rate, and a decrease in cardiac output and blood pressure.
Short-term and not excessively intense effects of cold do not cause changes in the body's heat balance and do not lead to hypothermia. But they contribute to the development of colds and exacerbation of chronic inflammatory processes. In this connection important role acquires hardening of the body. Hardening is achieved by repeated exposure to low temperatures of increasing intensity. In weakened people, hardening should begin with neutral temperature water procedures (32 degrees) and lower the temperature by 1 degree every 2-3 days. Unfortunately, the hardening effect disappears after the cessation of training, so the hardening regimen must be continuous. The hardening effect is manifested not only during water procedures, but also when exposed to cold air. At the same time, hardening occurs faster if the exposure is combined with active muscular activity (for example, exercise in the fresh air).
hyperthermia- this is a condition in which the body temperature rises above 37 degrees (when measured in the armpit). It occurs during prolonged exposure to high ambient temperatures, especially in humid air (eg heat stroke). Fever should be distinguished from hyperthermia - an increase in temperature, when external conditions are not changed, but the body's thermoregulation process is disturbed.
Fever- this is a protective and adaptive reaction of the body that occurs in response to the action of stimuli (often infectious) and is expressed in the restructuring of thermoregulation to maintain a higher than normal level of heat content and body temperature. The temperature during infectious fever usually does not exceed 41 0 C, in contrast to hyperthermia, in which it is higher than 41 0 C (for more details, see the file "Fever").
Temperature registration
The thermometer readings are recorded on the temperature sheet, where the dots indicate the morning and evening temperatures. Based on the marks made over several days, a temperature curve is obtained which has characteristic appearance in some pathological conditions.
The temperature sheet may contain other information: heart rate, blood pressure, respiratory rate, with diarrhea - the number of bowel movements, periodically (once every 5-10 days) body weight, the number of red blood cells, white blood cells, hemoglobin level, ESR, etc. d.
Sources
- Gurevich-Ilyin G.Ya. General medical technology: Practical guide for doctors and medical students. - M.: "Medgiz", 1946. - 436 p.
- Murtha J. Physician's Handbook general practice . Per. from English. - M.: "Practice", 1998. - 1230 p.
- Pavelski S., Zawadzki Z. Physiological constants in the clinic of internal diseases. Per. from Polish. M.I. Salman. - M.: "Medicine", 1964. - 264 p.
- Propaedeutics of internal diseases. Ed. V.Kh. Vasilenko, A.L. Grebnev. - 2nd ed., revised. and additional - M.: "Medicine", 1982. - 640 p.
Concept definition
Fever is an increase in body temperature as a result of changes in the thermoregulatory center of the hypothalamus. It is a protective and adaptive reaction of the body that occurs in response to the action of pathogenic stimuli.
Hyperthermia should be distinguished from fever - an increase in temperature, when the process of thermoregulation of the body is not disturbed, and an elevated body temperature is due to a change external conditions such as overheating. Body temperature during infectious fever usually does not exceed 41 0 C, in contrast to hyperthermia, in which it is above 41 0 C.
Temperatures up to 37 °C are considered normal. Body temperature is not a constant value. The temperature value depends on: time of day(the maximum daily fluctuations are from 37.2 °С at 6 am to 37.7 °С at 4 pm). Night workers may have the opposite relationship. The difference between morning and evening temperature in healthy people does not exceed 1 0 C); motor activity(Rest and sleep help to lower the temperature. Immediately after eating, there is also a slight increase in body temperature. Significant physical exertion can cause a temperature increase of 1 degree); phases of the menstrual cycleamong women with a normal temperature cycle, the morning vaginal temperature curve has a characteristic biphasic shape. The first phase (follicular) is characterized by a low temperature (up to 36.7 degrees), lasts about 14 days and is associated with the action of estrogen. The second phase (ovulation) is manifested by a higher temperature (up to 37.5 degrees), lasts about 12-14 days and is due to the action of progesterone. Then, before menstruation, the temperature drops and the next follicular phase begins. The absence of a decrease in temperature may indicate fertilization. Characteristically, the morning temperature, measured in the axilla, in the oral cavity, or in the rectum, gives similar curves.
Normal body temperature in the armpit:36.3-36.9 0 C, in the oral cavity:36.8-37.3 0 , in the rectum:37.3-37.7 0 C.
Causes
The causes of fever are many and varied:
1. Diseases that directly damage the centers of thermoregulation of the brain (tumors, intracerebral hemorrhages or thromboses, heat stroke).
3. Mechanical injury (disintegration).
4. Neoplasms (Hodgkin's disease, lymphomas, leukemia, kidney carcinomas, hepatomas).
5. Acute metabolic disorders (thyroid crisis, adrenal crisis).
6. Granulomatous diseases (sarcoidosis, Crohn's disease).
7. Immune disorders (connective tissue diseases, drug allergy, serum sickness).
8. Acute vascular disorders (thrombosis, heart attacks of the lung, myocardium, brain).
9. Violation of hematopoiesis (acute hemolysis).
10. Under the influence of medications (malignant neuroleptic syndrome).
Mechanisms of emergence and development (pathogenesis)
The human body temperature is a balance between the formation of heat in the body (as a product of all metabolic processes in the body) and the release of heat through the surface of the body, especially the skin (up to 90-95%), as well as through the lungs, feces and urine. These processors are regulated by the hypothalamus, which acts like a thermostat. In conditions that cause an increase in temperature, the hypothalamus instructs the sympathetic nervous system to vasodilate the blood vessels of the skin, increased sweating, which increases heat transfer. When the temperature drops, the hypothalamus gives the command to retain heat by constricting the blood vessels of the skin, muscle tremors.
endogenous pyrogen - a low molecular weight protein produced by blood monocytes and macrophages in the tissues of the liver, spleen, lungs, and peritoneum. In some tumor diseases - lymphoma, monocytic leukemia, kidney cancer (hypernephroma) - there is an autonomous production of endogenous pyrogen and, therefore, fever is present in the clinical picture. Endogenous pyrogen, after being released from cells, acts on thermosensitive neurons in the preoptic region of the hypothalamus, where synthesis of prostaglandin E1, E2 and cAMP is induced with the participation of serotonin. These biologically active compounds, on the one hand, cause an intensification of heat production by restructuring the hypothalamus to maintain the body temperature at a higher level, and on the other hand, they affect the vasomotor center, causing constriction of peripheral vessels and a decrease in heat transfer, which generally leads to fever. The increase in heat production occurs due to an increase in the intensity of metabolism, mainly in muscle tissue.
In some cases, stimulation of the hypothalamus may not be caused by pyrogens, but by dysfunctions of the endocrine system (thyrotoxicosis, pheochromocytoma) or the autonomic nervous system (neurocirculatory dystonia, neuroses), the influence of certain medications (drug fever).
The most common causes of drug fever are penicillins and cephalosporins, sulfonamides, nitrofurans, isoniazid, salicylates, methyluracil, novocainamide, antihistamines, allopurinol, barbiturates, intravenous infusions of calcium chloride or glucose, etc.
Fever of central origin is caused by direct irritation of the thermal center of the hypothalamus as a result of an acute violation of cerebral circulation, a tumor, or a traumatic brain injury.
Thus, an increase in body temperature may be due to the activation of the system of exopyrogens and endopyrogens (infections, inflammation, pyrogenic substances of tumors) or other reasons without the participation of pyrogens at all.
Since the degree of body temperature increase is controlled by the "hypothalamic thermostat", even in children (with their immature nervous system) fever rarely exceeds 41 0 C. In addition, the degree of temperature increase largely depends on the state of the patient's body: with the same disease it can be different for different people. For example, with pneumonia in young people, the temperature reaches 40 0 C and above, and in old age and in malnourished persons, such a significant rise in temperature does not occur; sometimes it does not even exceed the norm.
Clinical picture (symptoms and syndromes)
The fever is considered acute", if it lasts no more than 2 weeks, the fever is called" chronic» with a duration of more than 2 weeks.
In addition, during a fever, a period of temperature increase, a period of fever peak and a period of temperature decrease are distinguished. The decrease in temperature occurs in different ways. A gradual, step-like decrease in temperature over 2-4 days with slight evening rises is called lysis. The sudden, rapid end of a fever with a drop in temperature to normal within a day is called crisis. As a rule, a rapid drop in temperature is accompanied by profuse sweating. Before the beginning of the era of antibiotics, this phenomenon was given special meaning, because it symbolized the beginning of a period of recovery.
Elevated body temperature from 37 to 38 0 C is called subfebrile fever. Moderately elevated body temperature from 38 to 39 0 C is called febrile fever. High body temperature from 39 to 41 0 C is called pyretic fever. Excessively high body temperature (over 41 0 C) is a hyperpyretic fever. This temperature in itself can be life-threatening.
There are 6 main types of fever and 2 forms of fever.
It should be noted that our predecessors attached great importance to temperature curves in the diagnosis of diseases, but in our time all these classical types of fever are of little help in work, since antibiotics, antipyretics and steroid drugs change not only the nature of the temperature curve, but the entire clinical picture. diseases.
Type of fever
1. Persistent or persistent fever. Constantly elevated body temperature is observed and during the day the difference between morning and evening temperatures does not exceed 1 0 C. It is believed that such an increase in body temperature is characteristic of lobar pneumonia, typhoid fever, and viral infections (for example, influenza).
2. Laxative fever (relapsing). A constantly elevated body temperature is observed, but daily temperature fluctuations exceed 1 0 C. A similar increase in body temperature occurs with tuberculosis, purulent diseases (for example, with a pelvic abscess, gallbladder empyema, wound infection), as well as with malignant neoplasms.
By the way, fever with sharp fluctuations in body temperature (the range between morning and evening body temperature is more than 1 ° C), accompanied in most cases by chills, is commonly called septic(see also intermittent fever, hectic fever).
3. Intermittent fever (intermittent). Daily fluctuations, as in remitting, exceed 1 0 C, but here the morning minimum lies within the normal range. Moreover, elevated body temperature appears periodically, approximately at regular intervals (most often around noon or at night) for several hours. Intermittent fever is especially characteristic of malaria, and is also observed in cytomegalovirus infection, infectious mononucleosis, and purulent infection (eg, cholangitis).
4. Wasting fever (hectic). In the mornings, as with intermittent, normal or even low body temperature is observed, but daily temperature fluctuations reach 3-5 0 C and are often accompanied by debilitating sweats. Such an increase in body temperature is characteristic of active pulmonary tuberculosis and septic diseases.
5. Reverse or perverted fever differs in that the morning body temperature is higher than the evening one, although from time to time there is still the usual slight evening temperature increase. Reverse fever occurs with tuberculosis (more often), sepsis, brucellosis.
6. Irregular or irregular fever manifests itself by alternating different types of fever and is accompanied by varied and irregular daily fluctuations. Irregular fever occurs in rheumatism, endocarditis, sepsis, tuberculosis.
Fever form
1. Wave-like fever characterized by a gradual rise in temperature over a certain period of time (constant or remitting fever for several days) followed by a gradual decrease in temperature and a more or less long period of normal temperature, which gives the impression of a series of waves. The exact mechanism by which this unusual fever occurs is unknown. Often observed in brucellosis and lymphogranulomatosis.
2. Relapsing fever (recurrent) characterized by alternating periods of fever with periods of normal temperature. In the most typical form, it occurs with relapsing fever, malaria.
One-day or ephemeral fever: elevated body temperature lasts for several hours and does not recur. Occurs with mild infections, overheating in the sun, after blood transfusion, sometimes after intravenous administration medicines.
The daily repetition of attacks - chills, fever, drop in temperature - in malaria is called daily fever.
Three-day fever - recurrence of attacks of malaria every other day.
Four-day fever - recurrence of attacks of malaria after 2 fever-free days.
Five-day paroxysmal fever (synonyms: Werner-His disease, trench or trench fever, paroxysmal rickettsiosis) - acute infectious disease, caused by rickettsia, carried by lice, and proceeding in typical cases in a paroxysmal form with repeated four- to five-day attacks of fever, separated by several days of remission, or in a typhoid form with many days of continuous fever.
Symptoms accompanying a fever
Fever is characterized not only by an increase in body temperature. Fever is accompanied by increased heart rate and respiration; arterial pressure often goes down; patients complain of a feeling of heat, thirst, headache; the amount of urine excreted decreases. Fever promotes an increase in metabolism, and since, along with this, appetite is reduced, patients who are febrile for a long time often lose weight. Feverish patients note: myalgia, arthralgia, drowsiness. Most of them have chills and chilliness. With tremendous chills, severe fever, piloerection ("goosebumps") and trembling occur, the patient's teeth chatter. Activation of heat loss mechanisms leads to sweating. Mental status abnormalities, including delirium and seizures, are more common in very young, very old, or debilitated patients.
1. Tachycardia(cardiopalmus). The relationship between body temperature and pulse deserves great attention, because, other things being equal, it is fairly constant. Usually, with an increase in body temperature by 1 ° C, the heart rate increases by at least 8-12 beats per 1 minute. If, at a body temperature of 36 0 C, the pulse is, for example, 70 beats per minute, then a body temperature of 38 0 C will be accompanied by an increase in heart rate up to 90 beats per minute. The discrepancy between high body temperature and pulse rate in one direction or another is always subject to analysis, since in some diseases this is an important recognition sign (for example, fever in typhoid fever, on the contrary, is characterized by relative bradycardia).
2. Sweating. Sweating is one of the heat transfer mechanisms. Profuse sweating is observed with a decrease in temperature; in contrast, when the temperature rises, the skin is usually hot and dry. Sweating is not observed in all cases of fever; it is characteristic of purulent infection, infective endocarditis and some other diseases.
4. Herpes. Fever is often accompanied by the appearance of a herpetic rash, which is not surprising: 80-90% of the population is infected with the herpes virus, although clinical manifestations of the disease are observed in 1% of the population; Activation of the herpes virus occurs at the time of reduced immunity. Moreover, speaking of a fever, ordinary people often mean herpes by this word. In some types of fever, a herpetic rash is so common that its appearance is considered one of the diagnostic signs of the disease, for example, lobar pneumococcal pneumonia, meningococcal meningitis.
5. Febrile convulsionsOgi. Convulsions with fever occur in 5% of children aged 6 months to 5 years. The likelihood of developing a convulsive syndrome with fever depends not so much on the absolute level of the increase in body temperature, but on the rate of its rise. Typically, febrile convulsions do not last more than 15 minutes (average 2-5 minutes). In many cases, convulsions are observed at the onset of fever and usually resolve on their own.
You can associate convulsive syndrome with fever if:
the age of the child does not exceed 5 years;
there are no diseases that can cause seizures (for example, meningitis);
convulsions were not observed in the absence of fever.
First of all, in a child with febrile seizures, meningitis should be considered (lumbar puncture is indicated if the clinical picture is appropriate). Calcium levels are measured to rule out spasmophilia in infants. If convulsions lasted more than 15 minutes, it is advisable to perform electroencephalography to rule out epilepsy.
6. Change in urinalysis. With kidney disease, leukocytes, cylinders, bacteria can be detected in the urine.
Diagnostics
In the case of acute fever, it is desirable, on the one hand, to avoid unnecessary diagnostic tests and unnecessary therapy for diseases that can end in spontaneous recovery. On the other hand, it must be remembered that under the mask of a banal respiratory infection, a serious pathology (for example, diphtheria, endemic infections, zoonoses, etc.) can be hidden, which must be recognized as early as possible. If an increase in temperature is accompanied by characteristic complaints and / or objective symptoms, then this allows you to immediately navigate the diagnosis of the patient.
The clinical picture should be carefully evaluated. They study in detail the anamnesis, the patient's life history, his trips, heredity. Next, a detailed functional examination of the patient is carried out, repeating it. They perform laboratory tests, including a clinical blood test with the necessary detail (plasmocytes, toxic granularity, etc.), as well as a study of pathological fluid (pleural, articular). Other tests: ESR, urinalysis, determination of the functional activity of the liver, blood cultures for sterility, urine, sputum and feces (for microflora). Special Methods studies include X-ray, MRI, CT (to detect abscesses), radionuclide studies. If non-invasive research methods do not allow making a diagnosis, a biopsy of the organ tissue is performed, bone marrow puncture is advisable in patients with anemia.
But often, especially on the first day of illness, it is impossible to establish the cause of the fever. Then the basis for decision-making is the patient's state of health before fever and disease dynamics.
1. Acute fever in the background of full health
When a fever occurs against the background of complete health, especially in a young or middle-aged person, in most cases it is possible to assume an acute respiratory viral infection (ARVI) with spontaneous recovery within 5-10 days. When making a diagnosis of ARVI, it should be borne in mind that with an infectious fever, catarrhal symptoms of varying severity are always observed. In most cases, no tests (other than daily temperature measurements) are required. When re-examined after 2-3 days, the following situations are possible: improvement in well-being, decrease in temperature. The appearance of new signs, such as skin rashes, plaque in the throat, wheezing in the lungs, jaundice, etc., which will lead to a specific diagnosis and treatment. Deterioration / no change. In some patients, the temperature remains high enough or the general condition worsens. In these situations, repeated, more in-depth questioning and additional research are required to search for diseases with exogenous or endogenous pyrogens: infections (including focal), inflammatory or tumor processes.
2. Acute fever on a modified background
In the case of an increase in temperature against the background of an existing pathology or a serious condition of the patient, the possibility of self-healing is low. An examination is immediately prescribed (the diagnostic minimum includes general blood and urine tests, chest X-ray). Such patients are also subject to more regular, often daily monitoring, during which indications for hospitalization are determined. Main options: Patient with a chronic disease. Fever may be associated primarily with a simple exacerbation of the disease, if it is of an infectious and inflammatory nature, such as bronchitis, cholecystitis, pyelonephritis, rheumatism, etc. In these cases, a purposeful additional examination is indicated. Patients with reduced immunological reactivity. For example, those suffering from oncohematological diseases, HIV infection, or receiving glucocorticosteroids (prednisolone more than 20 mg / day) or immunosuppressants for any reason. The appearance of fever may be due to the development of an opportunistic infection. Patients who have recently undergone invasive diagnostic tests or therapeutic procedures. Fever may reflect the development of infectious complications after examination/treatment (abscess, thrombophlebitis, bacterial endocarditis). An increased risk of infection also exists in intravenous drug addicts.
3. Acute fever in patients over 60 years of age
Acute fever in the elderly and senile age is always a serious situation, because due to the decrease in functional reserves in such patients, acute disorders can quickly develop under the influence of fever, for example, delirium, heart and respiratory failure, dehydration. Therefore, such patients require immediate laboratory and instrumental examination and determination of indications for hospitalization. One more important circumstance should be taken into account: at this age, asymptomatic and atypical clinical manifestations are possible. In most cases, fever in the elderly has an infectious etiology. The main causes of infectious and inflammatory processes in the elderly: Acute pneumonia is the most common cause of fever in the elderly (50-70% of cases). Fever, even with extensive pneumonia, may be small, auscultatory signs of pneumonia may not be expressed, but will be in the foreground. general symptoms(weakness, shortness of breath). Therefore, with any obscure fever, an x-ray of the lungs is indicated - this is the law ( pneumonia is a friend of the elderly). When making a diagnosis, the presence of an intoxication syndrome (fever, weakness, sweating, cephalgia), impaired broncho-drainage function, auscultatory and radiological changes are taken into account. The range of differential diagnosis includes the possibility of pulmonary tuberculosis, which is often found in geriatric practice. Pyelonephritis is usually manifested by fever, dysuria, and back pain; in the general analysis of urine, bacteriuria and leukocyturia are detected; Ultrasound reveals changes in the pelvicalyceal system. The diagnosis is confirmed by bacteriological examination of urine. The occurrence of pyelonephritis is most likely in the presence of risk factors: female gender, bladder catheterization, urinary tract obstruction (urolithiasis, prostate adenoma). Acute cholecystitis can be suspected when there is a combination of fever with chills, pain in the right hypochondrium, jaundice, especially in patients with already known chronic gallbladder disease.
Other, less common causes of fever in the elderly and senile age include herpes zoster, erysipelas, meningoencephalitis, gout, polymyalgia rheumatica and, of course, SARS, especially during the epidemic period.
4. Prolonged fever of unknown origin
The conclusion “fever of unknown origin” is valid in cases where the increase in body temperature above 38 ° C lasts more than 2 weeks, and the cause of the fever remains unclear after routine studies. In the international classification of diseases of the 10th revision, fever of unknown origin has its own R50 code in the "Symptoms and signs" section, which is quite reasonable, since it is hardly advisable to raise a symptom to a nosological form. According to many clinicians, the ability to understand the causes of prolonged fever of unknown origin is the touchstone of the diagnostic abilities of a doctor. However, in some cases it is generally impossible to identify difficult-to-diagnose diseases. Among febrile patients who were initially diagnosed with "fever of unknown origin", according to various authors, from 5 to 21% of such patients account for the proportion of cases not fully deciphered. Diagnosis of fever of unknown origin should begin with an assessment of the social, epidemiological and clinical characteristics of the patient. To avoid mistakes, you need to get answers to 2 questions: What kind of person is this patient (social status, profession, psychological picture)? Why did the disease manifest itself right now (or why did it take such a form)?
1. A carefully taken history is of paramount importance. It is necessary to collect all available information about the patient: information about previous diseases (especially tuberculosis and heart valve defects), surgical interventions, taking any medications, working and living conditions (travel, personal hobbies, contacts with animals).
2. Conduct a thorough physical examination and perform routine investigations (CBC, urinalysis, biochemistry, Wassermann test, ECG, chest X-ray), including blood and urine cultures.
3. Think about the possible causes of fever of unknown origin in a particular patient and study the list of diseases that are manifested by prolonged fever (see list). According to various authors, the “big three” is at the heart of prolonged fever of unknown origin in 70%: 1. infections - 35%, 2. malignant tumors - 20%, 3. systemic diseases of the connective tissue - 15%. Another 15-20% is due to other diseases, and in about 10-15% of cases, the cause of fever of unknown origin remains unknown.
4. Form a diagnostic hypothesis. Based on the data obtained, it is necessary to try to find a "leading thread" and, in accordance with the accepted hypothesis, appoint certain additional studies. It must be remembered that for any diagnostic problem (including fever of unknown origin), first of all, you need to look for common and common, and not some rare and exotic diseases.
5. If you get confused, go back to the beginning. If the formed diagnostic hypothesis turns out to be untenable or new assumptions arise about the causes of fever of unknown origin, it is very important to re-question the patient and examine him, re-examine the medical records. Conduct additional laboratory tests (from the category of routine) and form a new diagnostic hypothesis.
5. Prolonged subfebrile condition
Subfebrile body temperature is understood as its fluctuations from 37 to 38 ° C. Prolonged subfebrile temperature occupies a special place in therapeutic practice. Patients in whom prolonged subfebrile condition is the dominant complaint are encountered quite often at the appointment. To find out the cause of low-grade fever, such patients are subjected to various studies, they are given a variety of diagnoses and prescribed (often unnecessary) treatment.
In 70-80% of cases, prolonged subfebrile condition occurs in young women with asthenia phenomena. This is due to the physiological characteristics of the female body, the ease of infection of the urogenital system, as well as the high frequency of psycho-vegetative disorders. It should be borne in mind that prolonged low-grade fever is much less likely to be a manifestation of any organic disease, in contrast to prolonged fever with a temperature above 38 ° C. In most cases, prolonged subfebrile temperature reflects a banal autonomic dysfunction. Conventionally, the causes of prolonged subfebrile condition can be divided into two large groups: infectious and non-infectious.
Infectious subfebrile condition. Subfebrile temperature always causes suspicion of an infectious disease. Tuberculosis. With unclear subfebrile condition, tuberculosis must first be excluded. In most cases, this is not easy to do. From the anamnesis are essential: the presence of direct and prolonged contact with a patient with any form of tuberculosis. The most significant is being in the same place with a patient with an open form of tuberculosis: an office, apartment, stairwell or entrance of the house where the patient with bacterial excretion lives, as well as a group of nearby houses united by a common courtyard. The presence in the anamnesis of previously transferred tuberculosis (regardless of localization) or the presence of residual changes in the lungs (presumably tuberculous etiology), previously detected during prophylactic fluorography. Any disease with ineffective treatment within the last three months. Complaints (symptoms) suspicious of tuberculosis include: the presence of a syndrome of general intoxication - prolonged subfebrile condition, general unmotivated weakness, fatigue, sweating, loss of appetite, weight loss. If pulmonary tuberculosis is suspected - chronic cough (lasting more than 3 weeks), hemoptysis, shortness of breath, chest pain. If extrapulmonary tuberculosis is suspected, complaints about a dysfunction of the affected organ, with no signs of recovery against the background of ongoing therapy. Focal infection. Many authors believe that prolonged subfebrile temperature may be due to the existence of chronic foci of infection. However, in most cases, chronic foci of infection (dental granuloma, sinusitis, tonsillitis, cholecystitis, prostatitis, adnexitis, etc.), as a rule, are not accompanied by fever and do not cause changes in the peripheral blood. It is possible to prove the causal role of the focus of chronic infection only when the sanitation of the focus (for example, tonsillectomy) leads to the rapid disappearance of the previously existing subfebrile condition. Subfebrile temperature is a constant sign of chronic toxoplasmosis in 90% of patients. In chronic brucellosis, subfebrile condition is also the predominant type of fever. Acute rheumatic fever (a systemic inflammatory disease of the connective tissue involving the heart and joints in the pathological process, caused by group A beta-hemolytic streptococcus and occurring in genetically predisposed people) often occurs only with subfebrile body temperature (especially with II degree of activity of the rheumatic process). Subfebrile condition may appear after an infectious disease ("temperature tail"), as a reflection of the syndrome of post-viral asthenia. In this case, the subfebrile temperature is benign, is not accompanied by changes in the analyzes and disappears on its own, usually within 2 months (sometimes the "temperature tail" can last up to 6 months). But in the case of typhoid fever, prolonged subfebrile condition that occurs after a decrease in high body temperature is a sign of incomplete recovery and is accompanied by persistent adynamia, non-decreasing hepato-splenomegaly and persistent aneosinophilia.
6 Traveler Fever
Most dangerous diseases: malaria (South Africa; Central, Southwest and Southeast Asia; Central and South America), typhoid fever, Japanese encephalitis (Japan, China, India, South and North Korea, Vietnam, Far East and Primorsky Krai of Russia), meningococcal infection (the incidence is common in all countries, especially high in some African countries (Chad, Upper Volta, Nigeria, Sudan), where it is 40-50 times higher than in Europe), melioidosis (Southeast Asia, Caribbean regions and Northern Australia), amoebic liver abscess (amebiasis prevalence - Central and South America, South Africa, Europe and North America, Caucasus and Central Asian republics of the former USSR), HIV infection.
Possible causes: cholangitis, infective endocarditis, acute pneumonia, legionnaires' disease, histoplasmosis (widely distributed in Africa and America, found in Europe and Asia, isolated cases are described in Russia), yellow fever (South America (Bolivia, Brazil, Colombia, Peru , Ecuador, etc.), Africa (Angola, Guinea, Guinea-Bissau, Zambia, Kenya, Nigeria, Senegal, Somalia, Sudan, Sierra Leone, Ethiopia, etc.), Lyme disease (tick-borne borreliosis), Dengue fever (central and South Asia (Azerbaijan, Armenia, Afghanistan, Bangladesh, Georgia, Iran, India, Kazakhstan, Pakistan, Turkmenistan, Tajikistan, Uzbekistan), Southeast Asia (Brunei, Indochina, Indonesia, Singapore, Thailand, Philippines), Oceania, Africa , Caribbean Sea (Bahamas, Guadeloupe, Haiti, Cuba, Jamaica) Not found in Russia (only imported cases), Rift Valley fever, Lassa fever (Africa (Nigeria, Sierra Leone, Liberia, Ivory Coast, Guinea, Mozambique , Senegal, etc.)), Ross River fever, Rocky Mountain spotted fever (USA, Canada, Mexico, Panama, Colombia, Brazil), sleeping sickness (African trypanosomiasis), schistosomiasis (Africa, South America, Southeast Asia), leishmaniasis (Central America (Guatemala, Honduras, Mexico, Nicaragua, Panama), South America, Central and South Asia (Azerbaijan, Armenia, Afghanistan, Bangladesh, Georgia, Iran, India, Kazakhstan, Pakistan, Turkmenistan, Tajikistan, Uzbekistan), South -Western Asia ( United Arab Emirates, Bahrain, Israel, Iraq, Jordan, Cyprus, Kuwait, Syria, Turkey, etc.), Africa (Kenya, Uganda, Chad, Somalia, Sudan, Ethiopia, etc.), Marseille fever (Countries of the Mediterranean and Caspian basins, some countries of Central and Southern Africa, South coast Crimea and Black Sea coast Caucasus), Pappatachi fever (Tropical and subtropical countries, the Caucasus and the Central Asian republics of the former USSR), Tsutsugamushi fever (Japan, East and Southeast Asia, Primorsky and Khabarovsk region Russia), tick-borne North Asian rickettsiosis (tick-borne typhus - Siberia and the Far East of Russia, some areas of Northern Kazakhstan, Mongolia, Armenia), relapsing fever (endemic tick - Central Africa, USA, Central Asia, the Caucasus and the Central Asian republics of the former USSR, severe acute respiratory syndrome ( South East Asia- Indonesia, Philippines, Singapore, Thailand, Vietnam, China and Canada).
Mandatory examinations in case of fever upon return from a foreign trip include:
General blood analysis
Examination of a thick drop and a smear of blood (malaria)
Blood cultures (infective endocarditis, typhoid fever, etc.)
Urinalysis and urine culture
Biochemical blood test (liver tests, etc.)
Wasserman reaction
Chest x-ray
Stool microscopy and stool culture.
7. hospital fever
Hospital (nosocomial) fever, which occurs during the patient's stay in the hospital, occurs in approximately 10-30% of patients, and one in three of them die. Hospital fever aggravates the course of the underlying disease and increases mortality by 4 times compared with patients suffering from the same pathology, not complicated by fever. The clinical condition of a particular patient dictates the scope of the initial examination and the principles of treatment of fever. The following main clinical conditions are possible, accompanied by nosocomial fever. Noninfectious fever: due to acute illness internal organs(acute myocardial infarction and Dressler's syndrome, acute pancreatitis, perforated stomach ulcer, mesenteric (mesenteric) ischemia and intestinal infarction, acute deep vein thrombophlebitis, thyrotoxic crisis, etc.); associated with medical interventions: hemodialysis, bronchoscopy, blood transfusion, drug fever, postoperative non-infectious fever. Infectious fever: pneumonia, urinary tract infection (urosepsis), sepsis due to catheterization, wound postoperative infection, sinusitis, endocarditis, pericarditis, fungal aneurysm (mycotic aneurysm), disseminated candidiasis, cholecystitis, intra-abdominal abscesses, bacterial intestinal translocation, meningitis, etc.
8. Fever simulation
False temperature increase can depend on the thermometer itself, when it does not meet the standard, which is extremely rare. Fever is more common.
Simulation is possible, both for the purpose of depicting a feverish state (for example, by rubbing the reservoir mercury thermometer or its preheating), and for the purpose of hiding the temperature (when the patient holds the thermometer so that it does not heat up). According to various publications, the percentage of simulation of a feverish state is insignificant and ranges from 2 to 6 percent of total patients with elevated body temperature.
Fever is suspected in the following cases:
- the skin to the touch has a normal temperature and there are no symptoms accompanying fever, such as tachycardia, redness of the skin;
- too high temperature is observed (from 41 0 C and above) or daily temperature fluctuations are atypical.
If fever is to be simulated, the following is recommended:
Compare the data obtained with the determination of body temperature by touch and with other manifestations of fever, in particular, with the pulse rate.
In the presence of a medical worker and with different thermometers, measure the temperature in both armpits and be sure to rectum.
Measure the temperature of freshly passed urine.
All measures should be explained to the patient by the need to clarify the nature of the temperature, without offending him with suspicion of a simulation, especially since it may not be confirmed.
General concept of fever
General characteristics of hyperthermic syndrome and types of fevers
Many diseases of infectious and non-infectious origin occur with an increase in body temperature. The feverish reaction of the body is not only a manifestation of the disease, but also one of the ways to stop it. The normal temperature when measured in the armpit is 36.4-36.8 ° C. During the day, body temperature changes. The difference between morning and evening temperatures in healthy people does not exceed 0.6 °C.
Hyperthermia - an increase in body temperature above 37 ° C - occurs when the balance between the processes of heat production and heat transfer is disturbed.
Fever is characterized not only by an increase in temperature, but also by changes in all organs and systems. Patients are concerned about headache, weakness, feeling of heat, dry mouth. With fever, metabolism increases, pulse and respiration become more frequent. With a sharp increase in body temperature, patients feel chills, a feeling of cold, trembling. At high body temperature, the skin becomes red, warm to the touch. A rapid drop in temperature is accompanied by profuse sweat.
The most common cause of fever is infection and tissue breakdown products. Fever is usually the body's response to an infection. Noninfectious fevers are rare. The degree of temperature increase can be different and largely depends on the state of the body.
Feverish reactions differ in duration, height and type of temperature curve. The duration of fever is acute (up to 2 weeks), subacute (up to 6 weeks) and chronic (more than 6 weeks).
Depending on the degree of temperature increase, subfebrile (37–38 ° C), febrile (38–39 ° C), high (39–41 ° C) and ultra-high (hyperthermic - above 41 ° C) are distinguished. The hyperthermic state itself can lead to lethal outcome. Depending on daily fluctuations in temperature, six main types of fever are distinguished (Fig. 12).
Persistent fever, in which the difference between morning and evening body temperature does not exceed 1 ° C. Such a fever is more common with pneumonia, typhoid fever.
Laxative (relapsing) fever is characterized by fluctuations of more than 1 ° C. It happens with tuberculosis, purulent diseases, pneumonia.
Intermittent fever is characterized by large temperature fluctuations with the correct alternation of febrile attacks and periods of normal temperature (2-3 days), typical of 3- and 4-day malaria.
Rice. 12. Types of fever: 1 - constant; 2 - laxative; 3 - intermittent; 4 - return; 5 - wavy; 6 - exhausting
Exhausting (hectic) fever is characterized by a sharp increase in body temperature (by 2-4 ° C) and its fall to normal and below. Observed in sepsis, tuberculosis.
The reverse type of fever (perverted) is characterized by a higher morning temperature than in the evening. Occurs in tuberculosis, sepsis.
Irregular fever is accompanied by varied and irregular diurnal fluctuations. It is observed in endocarditis, rheumatism, tuberculosis.
On the basis of a febrile reaction and symptoms of intoxication, one can judge the onset of the disease. So, with an acute onset, the temperature rises within 1-3 days and is accompanied by chills and symptoms of intoxication. With a gradual onset, body temperature rises slowly, over 4-7 days, the symptoms of intoxication are moderate.
Clinical characteristics of hyperthermic syndrome in infectious diseases
Fever in infectious diseases is protective. It is usually a reaction to an infection. Different infectious diseases may have different types of temperature curves, although it should be remembered that with early antibiotic therapy, temperature curves can change significantly.
Malaria
The correct alternation of febrile attacks (chills, fever, drop in temperature, accompanied by sweat) and periods of normal body temperature is characteristic of malaria. Attacks in this disease can be repeated two days on the third or three days on the fourth. The total duration of a malarial attack is 6-12 hours, with tropical malaria - up to a day or more. Then the body temperature drops sharply to normal, which is accompanied by profuse sweating. The patient feels weakness, drowsiness. His health is improving. The period of normal body temperature lasts 48–72 hours, and then again a typical malarial attack.
Typhoid fever
Fever is a constant and characteristic symptom of typhoid fever. Basically, this disease is characterized by an undulating course, in which temperature waves, as it were, roll over one another. In the middle of the last century, the German physician Wunderlich schematically described the temperature curve. It consists of a temperature rise phase (lasting about a week), a heat phase (up to 2 weeks) and a temperature drop phase (about 1 week). Currently, due to the early use of antibiotics, the temperature curve for typhoid fever has various options and is diverse. Most often, relapsing fever develops, and only in severe cases - a permanent type.
Typhus
Typically, the temperature rises within 2–3 days to 39–40 °C. The temperature rises both in the evening and in the morning. Patients have slight chills. From the 4th–5th day of illness, a constant type of fever is characteristic. Sometimes with early use of antibiotics, a relapsing type of fever is possible.
With typhus, "cuts" in the temperature curve can be observed. This usually happens on the 3-4th day of illness, when the body temperature drops by 1.5-2 ° C, and the next day, with the appearance of a rash on the skin, it rises again to high numbers. This is observed at the height of the disease.
On the 8th–10th day of illness, patients with typhus may also experience a "cut" in the temperature curve, similar to the first. But then after 3-4 days the temperature drops to normal. In uncomplicated typhus, the fever usually lasts 2-3 days.
Flu
The flu is characterized by an acute onset. Body temperature rises within a day or two to 39-40 ° C. In the first two days, the clinical picture of influenza is “obvious”: with symptoms of general intoxication and high body temperature. The fever usually lasts from 1 to 5 days, then the temperature drops critically and returns to normal. This reaction is usually accompanied by sweating.
adenovirus infection
With adenovirus infection, the temperature rises to 38-39 ° C for 2-3 days. The fever may be accompanied by chills and last for about a week.
The temperature curve is constant or remitting. The phenomena of general intoxication in adenovirus infection are usually mild.
Meningococcal infection
With meningococcal infection, body temperature can range from subfebrile to very high (up to 42 ° C). The temperature curve can be of constant, intermittent and remitting type. Against the background of antibiotic therapy, the temperature decreases by the 2-3rd day, in some patients subfebrile temperature persists for another 1-2 days.
Meningococcemia (meningococcal sepsis) begins acutely and proceeds rapidly. characteristic feature is a hemorrhagic rash in the form of asterisks of irregular shape. The elements of the rash in the same patient can be of different sizes - from small punctures to extensive hemorrhages. The rash appears 5-15 hours after the onset of the disease. Fever in meningococcemia is often intermittent. Pronounced symptoms of intoxication are characteristic: the temperature rises to 40–41 ° C, severe chills, headache, hemorrhagic rash, tachycardia, shortness of breath, cyanosis appear. Then the blood pressure drops sharply. Body temperature drops to normal or subnormal numbers. Motor excitation increases, convulsions appear. And in the absence of appropriate treatment, death occurs.
Meningitis can be not only meningococcal etiology. Meningitis, like encephalitis (inflammation of the brain), develops as a complication of any past infection. So, the most harmless at first glance viral infections, such as influenza, chicken pox, rubella, can be complicated by severe encephalitis. Usually there is a high body temperature, a sharp deterioration in the general condition, there are cerebral disorders, headache, dizziness, nausea, vomiting, impaired consciousness, general anxiety.
Depending on the damage to a particular part of the brain, various symptoms can be detected - disorders of the cranial nerves, paralysis.
Infectious mononucleosis
Infectious mononucleosis often begins acutely, rarely gradually. The rise in temperature is usually gradual. The fever may be of a constant type or with great fluctuations. The feverish period depends on the severity of the course of the disease. In mild forms, it is short (3-4 days), in severe cases - up to 20 days or more. The temperature curve can be different - constant or remitting type. The fever can also be subfebrile. The phenomena of hyperthermia (40-41 ° C) are rare. Characterized by temperature fluctuations during the day with a range of 1–2 °C and its lytic decrease.
Polio
With poliomyelitis - acute viral disease central nervous system - there is also an increase in temperature. Various parts of the brain and spinal cord are affected. The disease occurs predominantly in children under 5 years of age. Early symptoms of the disease are chills, gastrointestinal disorders (diarrhea, vomiting, constipation), body temperature rises to 38–39 ° C or more. In this disease, a double-humped temperature curve is often observed: the first rise lasts 1–4 days, then the temperature decreases and remains within the normal range for 2–4 days, then it rises again. There are cases when the body temperature rises within a few hours and goes unnoticed, or the disease proceeds as a general infection without neurological symptoms.
Leptospirosis
Leptospirosis is one of the acute febrile illnesses. This is a disease of humans and animals, characterized by intoxication, undulating fever, hemorrhagic syndrome, damage to the kidneys, liver, and muscles. The disease begins acutely.
Body temperature during the day rises to high numbers (39–40 ° C) with chills. The temperature stays high for 6-9 days. A remitting type of temperature curve with fluctuations of 1.5–2.5 °C is characteristic. Then the body temperature returns to normal. In most patients, repeated waves are noted, when after 1–2 (less often 3–7) days of normal body temperature, it again rises to 38–39 ° C for 2–3 days.
Brucellosis
Fever is the most common clinical manifestation of brucellosis. The disease usually begins gradually, rarely acutely. Fever in the same patient may be different. Sometimes the disease is accompanied by a wavy temperature curve of a remitting type, typical for brucellosis, when fluctuations between morning and evening temperatures are more than 1 ° C, intermittent - a decrease in temperature from high to normal or constant - fluctuations between morning and evening temperatures do not exceed 1 ° C. Feverish waves are accompanied by profuse sweating. The number of waves of fever, their duration and intensity are different. The intervals between waves are from 3–5 days to several weeks and months. Fever may be high, long-term subfebrile, and may be normal (Fig. 13).
Rice. 13. Types of fever according to the degree of temperature rise: 1 - subfebrile (37–38 ° C); 2 - moderately elevated (38–39 °C); 3 - high (39–40 °C); 4 - excessively high (above 40 °C); 5 - hyperpyretic (above 41-42 ° C)
The disease often occurs with prolonged subfebrile condition. Characteristic is the change of a long febrile period by a fever-free interval, also of varying duration.
Despite the high temperature, the condition of the patients remains satisfactory. With brucellosis, damage to various organs and systems is noted (first of all, the musculoskeletal, urogenital, nervous systems suffer, the liver and spleen increase).
Toxoplasmosis
ornithosis
Ornithosis is a disease resulting from human infection from sick birds. The disease is accompanied by fever and atypical pneumonia.
Body temperature from the first days rises to high numbers. The feverish period lasts 9-20 days. The temperature curve can be constant or remitting. It decreases in most cases lytically. The height, duration of fever, the nature of the temperature curve depend on the severity and clinical form of the disease. With a mild course, the body temperature rises to 39 ° C and lasts 3–6 days, decreasing within 2–3 days. With moderate severity, the temperature rises above 39 ° C and remains at high numbers for 20–25 days. An increase in temperature is accompanied by chills, a decrease in profuse sweating. Ornithosis is characterized by fever, symptoms of intoxication, frequent lung damage, enlargement of the liver and spleen. The disease can be complicated by meningitis.
Tuberculosis
Tuberculosis occupies a special place among infectious diseases that occur with an increase in body temperature. Tuberculosis is a very serious disease. His clinic is diverse. Fever in patients for a long time can proceed without identified organ lesions. Most often, body temperature is kept at subfebrile figures. The temperature curve is intermittent, usually not accompanied by chills. Sometimes fever is the only sign of illness. The tuberculous process can affect not only the lungs, but also other organs and systems (lymph nodes, bone, genitourinary systems). Debilitated patients may develop tuberculous meningitis. The disease begins gradually. Symptoms of intoxication, lethargy, drowsiness, photophobia gradually increase, body temperature is kept at subfebrile figures. In the future, the fever becomes constant, distinct meningeal signs, headache, drowsiness are found.
Sepsis
Sepsis is a severe general infectious disease that occurs as a result of insufficient local and general immunity of the body in the presence of a focus of inflammation. It develops mainly in premature infants, weakened by other diseases, survivors of trauma. It is diagnosed by a septic focus in the body and the entrance gate of infection, as well as symptoms of general intoxication. Body temperature often remains at subfebrile figures, hyperthermia is periodically possible. The temperature curve can be hectic in nature. Fever is accompanied by chills, a decrease in temperature - a sharp sweating. The liver and spleen are enlarged. Rashes on the skin are not uncommon, more often hemorrhagic.
Helminthiases
Clinical characteristics of hyperthermic syndrome in somatic diseases
Bronchopulmonary diseases
An increase in body temperature can be observed in various diseases of the lungs, heart, and other organs. So, inflammation of the bronchi (acute bronchitis) can occur in acute infectious diseases (flu, measles, whooping cough, etc.) and when the body is cooled. Body temperature in acute focal bronchitis can be subfebrile or normal, and in severe cases it can rise to 38-39 ° C. Weakness, sweating, coughing are also disturbing.
The development of focal pneumonia (pneumonia) is associated with the transition of the inflammatory process from the bronchi to the lung tissue. They can be of bacterial, viral, fungal origin. The most characteristic symptoms of focal pneumonia are cough, fever and shortness of breath. Fever in patients with bronchopneumonia is of varying duration. The temperature curve is often of a relieving type (daily temperature fluctuations of 1 ° C, with a morning minimum above 38 ° C) or of an incorrect type. Often the temperature is subfebrile, and in the elderly and senile age it may be absent altogether.
Croupous pneumonia is more often observed with hypothermia. Lobar pneumonia is characterized by a certain cyclical flow. The disease begins acutely, with a tremendous chill, fever up to 39–40 °C. The chill usually lasts up to 1-3 hours. The condition is very serious. Shortness of breath, cyanosis are noted. In the stage of the height of the disease, the condition of patients worsens even more. Symptoms of intoxication are expressed, breathing is frequent, shallow, tachycardia up to 100/200 beats per minute. Against the background of severe intoxication, vascular collapse may develop, which is characterized by a drop in blood pressure, tachycardia, shortness of breath. Body temperature also drops sharply. The nervous system suffers (sleep is disturbed, there may be hallucinations, delirium). In lobar pneumonia, if antibiotic treatment is not started, the fever can last for 9-11 days and be permanent. The drop in temperature can occur critically (within 12–24 hours) or gradually, over 2–3 days. In the stage of resolution of fever usually does not happen. Body temperature returns to normal.
Rheumatism
Fever can accompany a disease such as rheumatism. It has an infectious-allergic nature. In this disease, connective tissue is damaged, predominantly the cardiovascular system, joints, central nervous system and other organs. The disease develops 1–2 weeks after a streptococcal infection (tonsillitis, scarlet fever, pharyngitis). Body temperature usually rises to subfebrile numbers, weakness, sweating appear. Less often, the disease begins acutely, the temperature rises to 38–39 ° C. The temperature curve is remittent in nature, accompanied by weakness, sweating. A few days later, pain in the joints appears. Rheumatism is characterized by damage to the heart muscle with the development of myocarditis. The patient is concerned about shortness of breath, pain in the heart, palpitations. There may be an increase in body temperature to subfebrile numbers. The feverish period depends on the severity of the disease. Myocarditis can also develop with other infections - scarlet fever, diphtheria, rickettsiosis, viral infections. Allergic myocarditis may occur, for example, with the use of various drugs.
Septic endocarditis
Against the background of an acute severe septic condition, the development of septic endocarditis is possible - an inflammatory lesion of the endocardium with damage to the heart valves. The condition of such patients is very serious. Symptoms of intoxication are expressed. Disturbed by weakness, malaise, sweating. Initially, body temperature rises to subfebrile numbers. Against the background of subfebrile temperature, irregular temperature rises to 39 ° C and above ("temperature candles") occur, chilling and profuse sweating are typical, lesions of the heart and other organs and systems are noted. Diagnosis of primary bacterial endocarditis presents particular difficulties, since at the beginning of the disease there is no lesion of the valvular apparatus, and the only manifestation of the disease is a fever of the wrong type, accompanied by chills, followed by profuse sweating and a decrease in temperature. Sometimes the rise in temperature can be observed during the day or at night. Bacterial endocarditis can develop in patients with artificial heart valves.
In some cases, there are fevers due to the development of a septic process in patients with catheters in the subclavian veins.
Diseases of the biliary system
A feverish state can occur in patients with damage to the biliary system, liver (cholangitis, liver abscess, gallbladder empyema). Fever in these diseases may be the leading symptom, especially in senile and elderly patients. The pain of such patients is usually not disturbed, there is no jaundice. The examination reveals an enlarged liver, its slight soreness.
kidney disease
An increase in temperature is noted in patients with kidney disease. This is especially true for acute pyelonephritis, which is characterized by a severe general condition, symptoms of intoxication, high fever of the wrong type, chills, dull pain in the lumbar region. With the spread of inflammation to the bladder and urethra, painful urge to urinate and pain during urination occur. A urological purulent infection (abscesses and carbuncles of the kidneys, paranephritis, nephritis) can be a source of prolonged fever. Characteristic changes in the urine in such cases may be absent or mild.
Systemic connective tissue diseases
The third place in the frequency of febrile conditions is occupied by systemic diseases of the connective tissue (collagenosis). This group includes systemic lupus erythematosus, scleroderma, nodular arteritis, dermatomyositis, rheumatoid arthritis.
Systemic lupus erythematosus is characterized by a steady progression of the process, sometimes quite long remissions. In the acute period there is always a fever of the wrong type, sometimes taking on a hectic character with chills and profuse sweat. Dystrophy, damage to the skin, joints, various organs and systems are characteristic.
It should be noted that diffuse connective tissue diseases and systemic vasculitis are relatively rarely manifested by an isolated febrile reaction. Usually they are manifested by a characteristic lesion of the skin, joints, internal organs.
Basically, fevers can occur with various vasculitis, often their localized forms (temporal arteritis, damage to large branches of the aortic arch). In the initial period of such diseases, fever appears, which is accompanied by pain in the muscles, joints, weight loss, then localized headaches appear, a thickening and thickening of the temporal artery is found. Vasculitis is more common in the elderly.
Clinical characteristics of hyperthermic syndrome in neuroendocrine pathology
An increase in body temperature is observed in various endocrine diseases. First of all, this group includes such a serious disease as diffuse toxic goiter (hyperthyroidism). The development of this disease is associated with excessive production of thyroid hormones. Numerous hormonal, metabolic, autoimmune disorders arising in the patient's body lead to damage to all organs and systems, dysfunction of other endocrine glands and various types of metabolism. First of all, the nervous, cardiovascular, digestive systems are affected. Patients experience general weakness, fatigue, palpitations, sweating, trembling of the hands, protrusion of the eyeballs, weight loss, and an increase in the thyroid gland.
The disorder of thermoregulation is manifested by an almost constant feeling of heat, intolerance to heat, thermal procedures, subfebrile body temperature. An increase in temperature to high numbers (up to 40 ° C and above) is characteristic of a complication of diffuse toxic goiter - a thyrotoxic crisis that occurs in patients with a severe form of the disease. Sharply exacerbated all the symptoms of thyrotoxicosis. There is a pronounced excitation, reaching psychosis, the pulse quickens to 150-200 beats per minute. The skin of the face is hyperemic, hot, moist, the extremities are cyanotic. Muscle weakness, trembling of the limbs develop, paralysis, paresis are expressed.
Acute purulent thyroiditis is a purulent inflammation of the thyroid gland. It can be caused by various bacteria - staphylococcus, streptococcus, pneumococcus, Escherichia coli. It occurs as a complication of purulent infection, pneumonia, scarlet fever, abscesses. The clinical picture is characterized by an acute onset, an increase in body temperature up to 39-40 ° C, chills, tachycardia, severe pain in the neck, radiating to the lower jaw, ears, aggravated by swallowing, moving the head. The skin over the enlarged and sharply painful thyroid gland is hyperemic. The duration of the disease is 1.5–2 months.
Polyneuritis - multiple lesions of peripheral nerves. Depending on the causes of the disease, infectious, allergic, toxic and other polyneuritis are distinguished. Polyneuritis is characterized by a violation of the motor and sensory functions of peripheral nerves with a primary lesion of the limbs. Infectious polyneuritis usually begins acutely, like an acute febrile process, with fever up to 38-39 ° C, pain in the extremities. Body temperature lasts for several days, then normalizes. At the forefront in the clinical picture are weakness and damage to the muscles of the arms and legs, impaired pain sensitivity.
In allergic polyneuritis, which develops after the introduction of an anti-rabies vaccine (used to prevent rabies), an increase in body temperature may also be noted. Within 3-6 days after administration, high body temperature, indomitable vomiting, headache, and impaired consciousness can be observed.
There is a constitutionally determined hypothalamopathy ("habitual fever"). This fever has a hereditary predisposition, it is more common in women. young age. Against the background of vegetovascular dystonia and constant subfebrile condition, there is an increase in body temperature to 38–38.5 °C. The rise in temperature is associated with physical exertion or emotional stress.
In the presence of a prolonged fever, artificial fever should be borne in mind. Some patients artificially cause an increase in body temperature in order to simulate any disease. Most often, this kind of disease occurs in young and middle-aged people, mostly females. They constantly find various diseases in themselves, are treated for a long time with various drugs. The impression that they have a serious illness is reinforced by the fact that these patients often lie in hospitals, where they are given various diagnoses and undergo therapy. When consulting these patients with a psychotherapist, hysteroid traits are revealed, which makes it possible to suspect a falsification of fever in them. The condition of such patients is usually satisfactory, feeling good. It is necessary to take the temperature in the presence of a doctor. Such patients need to be carefully examined.
The diagnosis of "artificial fever" can be suspected only after observing the patient, examining him and excluding other causes and diseases that cause an increase in body temperature.
Clinical characteristics of hyperthermic syndrome in neoplastic diseases
The leading place among febrile conditions is occupied by tumor diseases. An increase in temperature can occur with any malignant tumors. Most often, fever is observed with hypernephroma, tumors of the liver, stomach, malignant lymphomas, leukemia.
In malignant tumors, especially in small hypernephroid cancer and in lymphoproliferative diseases, severe fever may be noted. In such patients, fever (more often in the morning) is associated with the collapse of the tumor or the addition of a secondary infection.
A feature of fever in malignant diseases is the wrong type of fever, often with a maximum rise in the morning, the lack of effect from antibiotic therapy.
Often, fever is the only symptom of a malignant disease. Feverish conditions are often found in malignant tumors of the liver, stomach, intestines, lungs, prostate gland. There are cases when fever for a long time was the only symptom of malignant lymphoma with localization in the retroperitoneal lymph nodes.
The main causes of fever in cancer patients are considered to be the addition of infectious complications, tumor growth and the effect of tumor tissue on the body.
Clinical characteristics of hyperthermic syndrome when taking drugs
Among patients with prolonged fever, drug fever occurs in 5-7% of cases. It can occur on any medication, more often on the 7-9th day of treatment. Diagnosis is facilitated by the absence of an infectious or somatic disease, the appearance of a papular rash on the skin, which coincides in time with the medication. This fever is characterized by one feature: the symptoms of the underlying disease disappear during therapy, and the body temperature rises. After discontinuation of the drug, body temperature usually returns to normal after 2-3 days.
Clinical characteristics of hyperthermic syndrome in trauma and surgical diseases
Fever can be observed in various acute surgical diseases (appendicitis, peritonitis, osteomyelitis, etc.) and is associated with the penetration of microbes and their toxins into the body. A significant increase in temperature in the postoperative period may be due to the reaction of the body to the surgical injury. When muscles and tissues are injured, the temperature may increase as a result of the breakdown of muscle proteins and the formation of autoantibodies. Mechanical irritation of the centers of thermoregulation (fracture of the base of the skull) is often accompanied by an increase in temperature. With intracranial hemorrhages (in newborns), postencephalitic lesions of the brain, hyperthermia is also noted, mainly as a result of a central violation of thermoregulation.
Acute appendicitis is characterized by a sudden onset of pain, the intensity of which progresses as inflammatory changes develop in the appendix. There are also weakness, malaise, nausea, and there may be a delay in stool. Body temperature is usually elevated to 37.2-37.6 ° C, sometimes accompanied by chills. With phlegmonous appendicitis, pain in the right iliac region is constant, intense, the general condition worsens, body temperature rises to 38–38.5 ° C.
With suppuration of the appendicular infiltrate, a periappendicular abscess is formed. The condition of the patients is deteriorating. Body temperature becomes high, hectic. Sudden changes in temperature are accompanied by chills. The pain in the abdomen gets worse. A formidable complication of acute appendicitis is diffuse purulent peritonitis. Abdominal pains are diffuse. The condition of the patients is severe. There is significant tachycardia, and the pulse rate does not correspond to body temperature.
Brain injuries can be open or closed. Closed injuries include concussion, contusion and concussion with compression. The most common concussion is the clinical manifestations which are loss of consciousness, repeated vomiting and amnesia (loss of memory of events that preceded the disorder of consciousness). In the coming days after a concussion, there may be an increase in body temperature to subfebrile figures. Its duration can be different and depends on the severity of the condition. Headache, dizziness, weakness, malaise, sweating are also observed.
With sun and heat stroke, general overheating of the body is not necessary. Violation of thermoregulation occurs due to exposure to direct sunlight on an uncovered head or naked body. Disturbed by weakness, dizziness, headache, nausea, sometimes vomiting and diarrhea may occur. In severe cases, excitement, delirium, convulsions, loss of consciousness are possible. High temperature, as a rule, does not happen.
Fever treatment
Treatment of fever with traditional methods
With hyperthermic syndrome, treatment is carried out in two directions: correction of the vital functions of the body and directly combating hyperthermia.
To reduce body temperature, both physical methods of cooling and medication are used.
Physical cooling methods
Physical means include methods that provide cooling of the body: it is recommended to remove clothes, wipe the skin with water at room temperature, 20–40% alcohol solution. On the wrists, a bandage moistened with cold water can be applied to the head. They also use gastric lavage through a tube with cold water (temperature 4-5 ° C), put cleansing enemas, also with cool water. In the case of infusion therapy, all solutions are administered intravenously cooled to 4 ° C. The patient can be blown with a fan to reduce body temperature.
These activities allow you to reduce body temperature by 1-2 ° C within 15-20 minutes. Body temperature should not be lowered below 37.5 ° C, since after that it continues to decrease on its own to normal numbers.
Medications
As medications apply analgin, acetylsalicylic acid, brufen. It is most effective to use the drug intramuscularly. So, a 50% solution of analgin, 2.0 ml is used (for children - at a dose of 0.1 ml per year of life) in combination with antihistamines: 1% diphenhydramine solution, 2.5% pipolfen solution or 2 % suprastin solution.
In a more severe condition, Relanium is used to reduce the excitability of the central nervous system.
A single dose of the mixture for children is 0.1-0.15 ml / kg of body weight intramuscularly.
To maintain the function of the adrenal glands and to reduce blood pressure, corticosteroids are used - hydrocortisone (for children, 3-5 mg per 1 kg of body weight) or prednisolone (1-2 mg per 1 kg of body weight).
In the presence of respiratory disorders and heart failure, therapy should be aimed at eliminating these syndromes.
With an increase in body temperature to high numbers, children may develop a convulsive syndrome, for the relief of which Relanium is used (children under 1 year old at a dose of 0.05–0.1 ml; 1–5 years old - 0.15–0.5 ml 0, 5% solution, intramuscularly).
First aid for heat or sunstroke
It is necessary to immediately stop exposure to factors that led to sun or heat stroke. It is necessary to transfer the victim to a cool place, remove clothes, lay down, raise his head. The body and head are cooled by applying compresses with cold water or pouring cold water over them. The victim is given a sniff of ammonia, inside - soothing and heart drops (Zelenin drops, valerian, Corvalol). The patient is given a plentiful cool drink. When respiratory and cardiac activity stops, it is necessary to immediately release the upper respiratory tract from vomit and begin artificial respiration and heart massage until the first respiratory movements and cardiac activity appear (determined by pulse). The patient is urgently admitted to the hospital.
Treatment of fever with non-traditional methods
To reduce body temperature, traditional medicine recommends using infusions of various herbs. Of the medicinal plants, the following are most often used.
Linden heart-shaped (small-leaved) - lime blossom has a diaphoretic, antipyretic and bactericidal effect. 1 st. l. brew finely chopped flowers in a glass of boiling water, leave for 20 minutes, strain and drink like tea, 1 glass each.
Raspberry ordinary: 2 tbsp. l. brew dry berries in a glass of boiling water, leave for 15–20 minutes, strain, take 2–3 cups of hot infusion for 1–2 hours.
Swamp cranberries: in scientific medicine, cranberries have long been used to prepare acidic drinks prescribed for febrile patients.
Blackberry: an infusion and decoction of blackberry leaves, prepared at the rate of 10 g of leaves per 200 g of water, are consumed hot orally with honey as a diaphoretic in febrile patients.
Common pear: pear broth quenches thirst well in febrile patients, has an antiseptic effect.
Sweet orange: has long been used to treat various diseases. Patients with fever were recommended to take daily (2-3 times a day) powder from the thick peel of an orange, and orange fruits and juice quench their thirst well.
Cherry ordinary: cherry fruits, like cherry juice, well quench thirst in febrile patients.
Strawberries: Fresh berries and strawberry juice are good for fever.
For the same purpose, fruits and juice of lemon, red currant are used.
Fresh cucumber and juice from it is used for fever as an antipyretic and anti-inflammatory agent.
Peppermint: in traditional medicine mint is used internally as a diuretic, diaphoretic, anti-cold remedy.
Cultural grapes: the juice of unripe grapes is used in folk medicine as an antipyretic, as well as for sore throats.
Figs (fig tree): a decoction of figs, jam and a coffee surrogate prepared from dried figs have a diaphoretic and antipyretic effect. Decoction: 2 tbsp. l. dried berries in 1 glass of milk or water.
Rosehip (cinnamon rose): mainly used as a multivitamin remedy in the treatment of various diseases, with exhaustion of the body, as a general tonic.
Highlander bird (knotweed): prescribed as an antipyretic and anti-inflammatory agent, in particular for malaria, rheumatism.
Oats: in folk medicine, decoctions, teas, tinctures are prepared from oat straw, which are used as a diaphoretic, diuretic, antipyretic (to prepare a decoction, take 30–40 g of chopped straw per 1 liter of water, insist 2 hours).
Stinging nettle: nettle roots, together with garlic, insist on vodka for 6 days and rub the patient with this infusion and give inside 3 tablespoons a day for fever and joint pain.
Greater celandine: Inside, a decoction of celandine leaves is given for fever.
Willow: in folk medicine, willow bark is used in the form of a decoction, mainly for a feverish condition.
According to the degree of increase, the temperature is distinguished: subfebrile - 37-38 ° C, febrile - 38-39 ° C, hyperpyretic - above 39 ° C.
With regard to the development of fever in the temperature curve, three periods are distinguished:
A) the initial stage or period of temperature increase. With some diseases, this period is very short and is measured in hours, usually accompanied by chills, with others it stretches for a more or less long period, for several days;
B) the stage of the peak of fever. The top of the temperature curve lasts from a few hours to many days and even weeks;
C) the stage of temperature decrease. In some diseases, the temperature drops quickly within a few hours - a critical drop in temperature or a crisis, in others - gradually over several days - a lytic fall or lysis.
The nature temperature fluctuations stand out the following types fever:
1) constant fever is characterized by the fact that during the day the difference between morning and evening temperatures does not exceed 1 ° C, while a high temperature is noted;
2) laxative fever gives daily fluctuations in temperature within 2 ° C, and the morning minimum is above 37 ° C. With laxative fever, the rise in temperature is accompanied by chills, the decrease in temperature is accompanied by sweating;
3) intermittent fever is characterized by a sudden rise in temperature to 39 ° C and above, and after a few hours the temperature will drop to normal numbers. The rise in temperature is repeated every 1-2 or 3 days. This type of fever is characteristic of malaria;
4) hepatic fever is characterized by an increase in temperature by 2-4 ° C in the evening and its fall to normal and lower in the morning. Such a drop in temperature is accompanied by a sharp weakness with profuse sweating. Seen in sepsis severe forms tuberculosis;
5) the reverse type of fever is distinguished by the fact that the morning temperature is higher than the evening one. Occurs in pulmonary tuberculosis;
6) abnormal fever is accompanied by various and irregular daily fluctuations. Occurs in rheumatism, influenza, etc.;
7) relapsing fever is characterized by alternating periods of fever with fever-free periods. The rise in temperature to 40 ° C or more is replaced by its fall after a few days to normal, which lasts for several days, and then the temperature curve repeats. This type of fever is characteristic of relapsing fever;
8) wave-like fever is characterized by a gradual increase in temperature over several days and its gradual decrease to normal. Then comes a new increase followed by a decrease in temperature. This temperature occurs with lymphogranulomatosis, brucellosis.
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