Fever, raised temperature
Our body's normal temperature is between 36°C and 37°C, between 37°C and 38°C it is considered a raised temperature and above 38°C fever.
Our body's normal temperature is between 36°C and 37°C. A raised temperature is considered to be between 37°C and 38°C and a fever above 38°C. The temperature should be brought down only above 38°C. Fever may be accompanied by chills and, mostly in small children, febrile seizures. This symptom is one of the body’s protective mechanisms against attacking pathogens.
Fever is caused most often by infectious diseases, be it either bacterial or viral. The most common viral infections are infections of the respiratory tract (i.e., the common cold, sore throat, flu, and, in more critical cases, pneumonia). Infectious diarrhea is frequent as is gastroentiritis. Fever also accompanies childhood diseases (chicken pox and measles), that are now preventable with vaccines.
When fever is accompanied by headaches, nausea and a stiff neck, meningitis or encephalitis should always be considered and, when it is accompanied by jaundice, hepatitis or cholangitis. Infectious mononucleosis may cause high fever and frightening laboratory results and may be accompanied by an intense feeling of malaise and hepatitis. While it is, generally, a benign infection and recovery usually does not require medical intervention, serious complications do arise at times. Thus, the patient should be closely monitored.
Localized bacterial infections such as skin abscesses, gallbladder inflammation, urinary tract infection, middle ear or sinus infection have serious symptoms (i.e., abdominal cramps, lower back pain, frequent urination, etc.), along with high fever. In cases of severe bacterial infections, the pathogens may break into the circulatory system. This may lead to infection of the blood stream and sepsis, a life-threatening condition, as well as to endocarditis that, in cases of prolongued fever, should be ruled out with a heart ultrasound.
Diseases may also appear following a trip to the tropics (i.e., malaria - the cause of fever recurring every two to three days). Autoimmune diseases may also be the source of fever (as a consequence of its pathological workings, the immune system produces antibodies that attack our own system causing inflammation in certain organs).
Although rarely, malignant tumors may be accompanied by fever. Sun stroke can be one of the physical causes of fever. Brain damage and, though quite seldom, psychological factors may also be the source of a fever.
Feverish children under one year of age should definitely be taken to a doctor as should older children with a high temperature (above 39°C) as well as those who do not respond to medication. In the event of febrile seizures, emergency measures are needed - an ambulance must be called.
Adults should undergo a thorough physical examination in the case of long-lasting fever (2-5 days) or a high temperature (39°C) and when there is a rash, jaundice, chronic headaches, cough, stiffness of the neck, chest complaints or other serious symptoms.
After the thorough physical examination and questioning, laboratory tests follow with blood work that include important inflammatory values (CRP, in serious cases, PCT-pocalcitonine). In viral infection cases special virus serology tests are done.
In cases of bacterial infections, various samples (urine, stool, blood, saliva and throat) are taken for culture. These are special antibody tests for autoimmune disease cases.
Diagnostic imaging, (chest or nose and paranasal sinus x-rays, abdominal ultrasound and heart ultrasound) are of great help. Endoscopic examination and a biopsy may also be necessary.
Should the basic examinations and tests fail to find the cause of the chronic fever or raised temperature, then we are talking of a fever of unknown origin (FUO) which will require special tests, searching for a source (including various medical specialty examinations), and, if needed, inhospital examinations and tests.
The feverish patient must rest, lying down and, to ward off dehydration, drink a lot of fluids such as water, fruit juice and tea and eat light food, such as boullion or consommé and canned fruit. The temperature should be brought down actively only above 38°C. This may be accomplished with wet compresses: placing wet towels or cold packs on the forehead, wrists and ankles or by rolling the entire body in a wet sheet. If a cooling bath is used, the bath water should be cooled gradually. The water should not be too cold at the start. Antifebrile medication in the proper dosage or suppositories may also be used. Since there are several over-the-counter medications containing paracetamol (Rubophen, NeoCitran) it is important not to take a variety of them, one after the other, for fear of improper dosage.
Overdosage of paracetamol derivatives may have serious consequences, even fatal liver damage. Prescription medications, such as Algopyrin, may result in abnormal blood test results, especially significant, a lower white blood cell count. Antiinflammatories, such as Cataflam or Ibuprofen may, in addition to liver damage, also cause stomach complaints, even, bleeding.
Similarly, medications containing salicylic acid derivatives, such as Aspirin may also cause stomach complaints. All antifebrile medications can cause allergy symptoms.
Who to turn to
As detailed above infants (under one year with chronic or very high temperatures or, serious accompanying symptoms) should be taken to a family practitioner, pediatrician or internist, or even an infectologist to help with medication, prescribe antibiotics in cases of bacterial infection and, if necessary, refer you for further examinations. In serious, life threatening cases (febrile seizures, choking, etc.) an ambulance should be called.
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