Fever disease. Fever is a high body temperature. Causes and treatment of fever

Fever is a protective and adaptive mechanism human body, which develops as a reaction to the influence of pathogenic stimuli. Sometimes fever also manifests itself in non-infectious ailments. This is how the body reacts to the action of endotoxins, endogenous pyrogens, which are released when they are destroyed, a septic inflammatory process occurs, and metabolic disorders and autoimmune processes are also observed.

How does fever manifest itself?

The processes of thermoregulation in the human body determines the center of thermoregulation, which is located in a person. These processes can be disrupted exogenous or endogenous factors. Sometimes the temperature rises in case of violation of the processes of heat production and heat transfer and in the normal state of the thermoregulation center.

The main manifestation of fever is elevated body temperature. If the normal body temperature, measured in the armpit, should be 36.0-36.9, then with a fever, these figures increase. With a fever, a person experiences chills, headache, weakness, severe aching muscles.

Classification of fevers is practiced depending on various factors. Taking into account the cause of the development of this condition, it is determined infectious and non-infectious fever.

Taking into account the level of increase in body temperature, the patient differs subfebrile fever (body temperature 37-37.9 °С), febrile fever (body temperature 38-38.9 °С), pyretic or high fever(Body temperature 39-40.9 °С) and hyperpyretic or excessive fever (body temperature 41 °С and more).

Depending on the duration of this state varies acute , subacute and chronic fever.

According to the assessment of body temperature and the time when they appear, it is determined constant , laxative , intermittent , returnable , undulating , wrong , perverted , hectic fever. All types of fever have features of the course. For example, hectic fever develops when there are large fluctuations in body temperature. These types of fever are manifested in the development of certain diseases.

A number of diseases associated with fever and associated symptoms are identified.

Types of fevers

Crimean hemorrhagic fever is a viral disease that develops as a result of exposure to a pathogen transmitted by ticks. Crimean fever was first diagnosed in the Crimea. Symptoms of this disease were found in 1944. His trigger is RNA virus, which enters the body through the skin when a person is bitten by a tick.

Symptoms of hemorrhagic fever are acute: body temperature rises sharply, intoxication is noted, as well as hemorrhagic syndrome (high bleeding). The patient may experience vomiting, initial period there is noticeable redness of the face. After 2-6 days, hemorrhagic syndrome is observed, which is characterized by the appearance hemorrhagic rash on the shoulders, legs, hands.

If hemorrhagic fever with renal syndrome develops, then the acute onset of fever is combined with symptoms of intoxication and severe kidney damage. As a consequence, hemorrhagic renal fever leads to kidney damage and liver failure. There is bleeding gums, nosebleeds, a person may lose consciousness. Viral diseases, Related hemorrhagic syndrome, are also dangerous because a person can develop bleeding in the stomach and intestines. The development of complications ( sepsis , pulmonary edema , pneumonia ) and wrong treatment may lead to death. Therefore, prevention of infection is important: immediately after a tick bite, you need to contact a specialist. Hemorrhagic Far East fever - serious illness requiring urgent treatment.

Prolonged fever of unknown origin can be diagnosed if a high body temperature (above 38 degrees) keeps the patient for more than two weeks, and the reasons for this phenomenon remain unidentified. At the same time, a comprehensive examination was carried out and all diagnostic standards were taken into account. Highly important point is a differential diagnosis of fever of unknown origin, since sometimes this diagnosis can be made erroneously. According to some experts, this type of fever is based on infection, the development of a malignant tumor, and systemic diseases. connective tissue. Approximately at 20% cases, the cause of this type of fever, both in children and adults, remains unclear. Treatment of the disease is prescribed depending on the intensity of the fever.

yellow fever a person becomes infected from animals and people, the carriers of the pathogen are mosquitoes. The first symptoms of yellow fever appear about 3-6 days after mosquito bite. The onset of yellow fever is acute: body temperature rises to 40 degrees, a strong headache and pain in the joints, back, legs. There is also a hemorrhagic component: the patient's face becomes very red and swollen. Already on the second day, a person suffers from severe vomiting, nausea and thirst. Around the fifth day, a period of remission begins, when the person begins to feel better. But this improvement lasts only a few hours. Further, the person becomes worse, as thrombohemorrhagic syndrome develops. Possible bleeding, hematemesis. The disease is fraught with the development of serious complications - sepsis , pneumonia , myocarditis . Treatment of this disease consists of symptomatic therapy and prevention of further progression of the disease. Vaccination is the main preventive measure. Vaccination against yellow fever is mandatory if a person travels to areas where there is an endemic situation for this disease. Over 45 endemic countries identified in Latin America and Africa where you need to get vaccinated when you leave ( Colombia, Peru, Brazil, Ecuador, Kenya and etc.)

West Nile fever is infectious. Transmission of the pathogen occurs with mosquito bites. The disease can occur both sporadically and manifest as serious outbreaks. In Russia, such an outbreak was recorded in 1962-64, later outbreaks were observed in the CIS countries. Therefore, the prevention of West Nile fever is very important both in Africa and in Europe. The disease in humans begins acutely, with chills and a sharp rise in body temperature. The state of fever can last up to two weeks in a person. Symptoms of Nile fever are expressed by sweating, painful intoxication for the patient. A person is plagued by vomiting, headache, drowsiness, etc. If the diagnosis was carried out on time, and symptomatic treatment relieves the patient's condition, then the Nile fever is successfully cured.

mouse fever Humans become infected through contact with rodents. Mice and rats do not get sick themselves, but only carry this dangerous disease. The virus is shed through the feces and urine of animals. The first symptoms of mouse fever in children and adults at the initial stage of the development of the disease are similar to acute form ORZ . Before the first signs of mouse fever appear in adults and children, it takes from 7 to 46 days from the moment of infection. What symptoms of mouse fever occur in men and women in adulthood, most often you can find out already on the 25th day. Initially, the symptoms in adults are renal and hemorrhagic manifestations, and in children the disease manifests itself gradually: body temperature rises, nausea, vomiting, migraine worries, vision deteriorates.

Infection leads to grave consequences: the patient's kidneys are affected, serious intoxication of the body occurs, thrombohemorrhagic syndrome is noted. If the first symptoms appear, and the treatment was not taken in time, then kidney damage can eventually lead to death.

Mouse fever in children in the initial period is often mistaken for another disease, since its symptoms in the initial period can be mistaken for a severe cold or other infectious disease. Sometimes, even during the diagnosis process, the doctor may suspect that other types of fevers are developing. Prolonged fever, pale skin, and other features common to some types of fever sometimes make the diagnosis difficult.

Treatment takes place in bed rest. Complex therapy includes taking antipyretic, antiviral painkillers. The appointment of infusion therapy, glucocorticoids, hemodialysis is also practiced.

Acute rheumatic fever in children indicates that rheumatic pathology is already developing in the body. Acute rheumatoid fever is a very dangerous disease, as it primarily affects the cardiovascular system.

Classification of the disease is carried out according to the course of the disease: acute rheumatic fever and recurrent rheumatic fever are distinguished. The cause of the disease is exposure to beta-hemolytic streptococcus. This microorganism infects connective tissues, this is facilitated by some additional factors. Acute rheumatic fever is caused by hypothermia, malnutrition, malfunctions of the immune system, etc.

Symptoms of the disease are general intoxication, fever, joint pain, pale skin, irritability. After establishing the correct diagnosis, it is necessary to immediately begin treatment, since timely complex therapy determines the success of treatment. Prevention of the disease consists in preventing infection with streptococcal infection.

hay fever in children older than five years and adults develops due to an allergic reaction of the body to plant pollen. Symptoms hay fever is, first of all, allergic rhinitis and allergic conjunctivitis . Many people also have some other signs - fatigue, problems with appetite. Men are more likely to suffer from the disease, as well as those who have already experienced certain allergic reactions. Treating hay fever is often a long and complicated process, especially if the goal is to be rid of the disease for good. The main treatment for hay fever is antihistamines. Also used vasoconstrictors, glucocorticosteroids. There is also treatment folk remedies. However, often people suffer from this ailment for many years, since with the help of treatment it is only possible to reduce the symptoms.

Symptoms of Dengue Fever , which is also called dengue fever, are manifested due to infection of the body with an infection carried by one of the types of mosquitoes. Tropical fever symptoms are severe muscle pain, high performance body temperature, diarrhea, cough, runny nose, conjunctivitis. The disease is curable, but tropical hemorrhagic fever, which affects young people and children, causes acute bleeding and therefore very dangerous. The consequences of this disease can be fatal. Treatment is carried out immediately after an accurate diagnosis. Prevention consists in a mandatory consultation with a specialist before traveling to countries such as Thailand and others. Vaccination is carried out against other types of fever; this moment not practiced.

Ebola and Marburg have a lot in common, as their pathogens are similar. These diseases are very dangerous, contagious and in most cases end lethal outcome. Symptoms Ebola and Marburg immediately manifest acutely, the person is worried chills, a strong rise in temperature, general intoxication of the body. Symptoms appear after a few days gastrointestinal lesions, consciousness is disturbed. Ebola hemorrhagic fever, like Marburg hemorrhagic fever, can be fatal between days 4 and 27 after infection. Treatment consists in maintaining vital functions, symptomatic therapy is also practiced. Marburg fever ends in death in more than 80% of cases.

Lassa hemorrhagic fever characterized by the development hemorrhagic syndrome, myocarditis, pneumonia, kidney damage. Lethality rate in this case very tall.

Familial Mediterranean Fever , which is also called periodic illness manifested in humans by recurring cases of fever, inflammation lungs, bodies abdominal cavity , joints. This disease is more common in indigenous people Caucasus, mediterranean. The disease is diagnosed in childhood. It is impossible to completely cure it, so symptomatic treatment is practiced.

Marseille fever also characteristic of the inhabitants of the above regions. The disease is characterized high body temperature, rash, pain in the limbs and headache,regional lymphadenitis, work changes of cardio-vascular system. Treatment is carried out using tetracycline antibiotics .

Rocky Mountain Spotted Fever appears intoxication, rash, defeat of cardio-vascular system, vessels and CNS. The disease is common in Northern and South America. Carriers of the disease are rodents, some domestic animals. Treatment involves taking drugs of the tetracycline or levomycetin group.

In addition to the types of fever described, there are a number of other types of fevers that are dangerous to human life.

Fever is treated with bed rest . It is important to establish the nature of the increase in temperature and make the correct diagnosis. For fever caused by colds, should be used antipyretic if the temperature rises above 38 degrees. Children are recommended to give funds based on to reduce the temperature.

After establishing the diagnosis, the doctor prescribes the treatment of the disease that has been diagnosed. It is important not to delay contacting a specialist for conditions that cause anxiety. For example, white fever in children, inadequate heat transfer is manifested, so there is a danger of serious overheating of the body. In this case, the doctor should be contacted immediately to establish the causes of this condition and prescribe treatment. You need to consult a doctor if your child has post-immunization fever , that is, the temperature rise after vaccination.

If a woman shows milk fever , that is, the body's reaction to the appearance of milk in the breast of a nursing mother, you should not wait until it state will pass by itself. This is fraught with complications, so the chest must be examined by a doctor.

Fever on the lips (as rashes are called among the people) periodically appears in people who are infected with the herpes virus. How to cure herpes completely, doctors still do not know. Nonetheless, local funds can reduce the symptoms of the disease. How to treat a fever on the lip, you should ask your doctor.

Reasons for the rise in temperature

Fever symptoms

Redness of the skin of the face;
-, aching bones, unmotivated good mood (euphoria);
- shivering, chills, intense sweating;
- feeling of thirst;
- rapid breathing;
- poor appetite;
- confusion, delirium (delirium), especially in the elderly;
- Children may also have irritability, crying, feeding problems.

Sometimes an increase in body temperature may be accompanied by other symptoms associated with an exacerbation of chronic diseases.

A doctor should be called if in children under 3 months the temperature has risen above 37.5, if the temperature is elevated for more than 24 hours.

In children aged 6 months to 6 years, high temperatures are sometimes observed. If your child has such convulsions, make sure that he does not get hurt, remove all dangerous objects near him and make sure that he breathes freely.
If in children fever is accompanied by convulsions, stiff neck, rash, if it is noted at elevated temperature, then you should immediately seek medical help.

If the temperature is accompanied by swelling and pain in the joints; as well as a rash, especially a dark red color or in the form of large blisters, you should immediately consult a doctor. If you experience concomitant symptoms: cough with yellowish or greenish sputum, severe headache, ear pain, confusion, severe irritability, dry mouth, abdominal pain, rash, intense thirst, severe , painful urination and vomiting, you should also call a doctor. With an increase in body temperature in a pregnant woman, you should also consult a doctor.

What can you do

Try to rest, it's best to observe bed rest, in no case do not wrap up and do not dress too warmly, drink more fluids. Be sure to eat, but light and well-digestible food is better. Take your temperature every 4-6 hours. Take an antipyretic medicine if you have a headache or a temperature above 38 degrees.
If the child has a temperature above 38 degrees, use paracetamol (special children's forms). Follow the instructions and calculate the required dose depending on the weight and age of the child. Do not give (aspirin) to children as found that it can lead to Reye's syndrome (hepatocerebral syndrome), a serious condition that can lead to coma and even death.

What can a doctor do

The doctor must determine the cause of the elevated body temperature and prescribe appropriate therapy. If necessary, prescribe an additional examination, and if a serious illness is suspected, refer to hospitalization.

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 temperatures healthy people does not exceed 1 0 С); motor activity(rest and sleep help to reduce temperature. A slight increase in body temperature is also observed immediately after eating. Significant physical stress can cause a temperature rise of 1 degree); phases of the menstrual cycleamong women with normal temperature cycle the morning vaginal temperature curve has a characteristic two-phase 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 another follicular phase. The absence of a decrease in temperature may indicate fertilization. Characteristically, the morning temperature, measured in armpit, in the mouth or rectum, produces 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.

The reasons

The causes of fever are many and varied:

1. Diseases that directly damage the centers of thermoregulation of the brain (tumors, intracerebral hemorrhages or thrombosis, heatstroke).

3. Mechanical injury (disintegration).

4. Neoplasms (Hodgkin's disease, lymphomas, leukemia, kidney carcinomas, hepatomas).

5. Acute disorders metabolism (thyroid crisis, adrenal crisis).

6. Granulomatous diseases (sarcoidosis, Crohn's disease).

7. immune disorders(diseases of the connective tissue, drug allergy, serum sickness).

8. Acute vascular disorders (thrombosis, lung infarcts, myocardium, brain).

9. Violation of hematopoiesis (acute hemolysis).

10. Under the influence of medications (malignant neuroleptic syndrome).

Mechanisms of emergence and development (pathogenesis)

The temperature of the human body is the balance between the formation of heat in the body (as a product of all metabolic processes in the body) and heat transfer 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. Under the conditions causing an increase temperature, the hypothalamus instructs the sympathetic nervous system to vasodilate blood vessels 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. For some neoplastic diseases- lymphoma, monocytic leukemia, kidney cancer (hypernephroma) - autonomous production of endogenous pyrogen occurs 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 body temperature for more high level, and on the other hand, they affect the vasomotor center, causing narrowing 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 ( cardiopsychoneurosis, neurosis), 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 cerebral circulation, tumors, 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 increase in body temperature 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 rise 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 emaciated faces 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. sudden, quick ending fever with a drop in temperature to normal during the 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 gave a very great importance 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 of the disease.

Type of fever

1. Persistent or persistent fever. Constantly elevated body temperature is observed and during the day the difference between morning and evening temperature does not exceed 1 0 C. It is believed that such an increase in body temperature is characteristic of lobar pneumonia, typhoid fever, viral infections(for example, the flu).

2. Laxative fever (relapsing). There is a constantly elevated body temperature, but daily temperature fluctuations exceed 1 0 C. A similar increase in body temperature occurs with tuberculosis, purulent diseases(for example, with pelvic abscess, empyema of the gallbladder, wound infection), as well as with malignant neoplasms.

Incidentally, the fever sharp fluctuations 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 morning, as in intermittent, there is a normal or even low temperature body, 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 rise. Reverse fever occurs with tuberculosis (more often), sepsis, brucellosis.

6. Irregular or irregular fever manifested by alternation various types 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. It occurs in its most typical form in 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-Gies disease, trench or trench fever, paroxysmal rickettsiosis) is an acute infectious disease caused by rickettsia, carried by lice, and occurring in typical cases in a paroxysmal form with repeated four-, five-day attacks of fever, separated by several days in remission, or in the 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. Deviations in mental status, including delirium and convulsions, are more common in very young, very old or debilitated patients.

1. Tachycardia(cardiopalmus). The relationship between body temperature and pulse deserves great attention, since, 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 convulsionsaboutgi. 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.

bind convulsive syndrome with fever is possible 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 guise of a banal respiratory infection a serious pathology may be hidden (for example, diphtheria, endemic infections, zoonoses, etc.), 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. Perform laboratory research, including a clinical blood test with the necessary detail (plasmocytes, toxic granularity, etc.), as well as the 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 on the background 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, there are always catarrhal symptoms varying degrees of expression. 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 emergence of new features, such as skin rashes, raids in the throat, wheezing in the lungs, jaundice, etc., which will lead to a definite 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 scheduled immediately 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. Basic options: Patient with 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 development infectious complications after examination/treatment (abscess, thrombophlebitis, bacterial endocarditis). There is also an increased risk of infection in drug addicts intravenous administration drugs.

3. Acute fever in patients over 60 years of age

Acute fever in old and senile age is always serious situation, since due to a decrease in functional reserves in such patients, under the influence of fever, they can quickly develop acute disorders e.g. delirium, cardiac and respiratory failure, dehydration. Therefore, such patients require immediate laboratory and instrumental examination and determination of indications for hospitalization. Another important circumstance should be taken into account: at this age, asymptomatic and atypical clinical manifestations. 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, and general symptoms (weakness, shortness of breath) will be in the foreground. 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, consider the presence of intoxication syndrome(fever, weakness, sweating, cephalgia), broncho-drainage function disorders, auscultatory and radiological changes. In a circle differential diagnosis include the possibility of pulmonary tuberculosis, which is not uncommon 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 with bacteriological examination urine. The occurrence of pyelonephritis is most likely in the presence of risk factors: female sex, catheterization Bladder, obstruction urinary tract (urolithiasis disease, 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.

To others less common reasons fevers 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. AT international classification 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 build a symptom into 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 portrait)? 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 valvular heart disease), surgical interventions, taking any medicines, 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 possible reasons fever of unknown origin in a particular patient and study the list of diseases manifested by prolonged fever (see list). How do they think different authors, at the heart of prolonged fever of unknown origin in 70% is the "big three": 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 medical documentation. 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. long subfebrile temperature ranks in therapeutic practice special place. 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 explained physiological features female body, ease of infection of the urogenital system, as well as a 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 the patient open form tuberculosis: 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 general intoxication- prolonged low-grade fever, 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 chronic foci infections. 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. Prove the causal role of the focus chronic infection it is possible only in the case when the sanitation of the focus (for example, tonsillectomy) leads to the rapid disappearance of the previously existing subfebrile condition. Permanent feature chronic toxoplasmosis 90% of patients have subfebrile temperature. In chronic brucellosis, subfebrile condition is also the predominant type of fever. Acute rheumatic fever (systemic inflammatory disease connective tissue with involvement in the pathological process of the heart and joints, 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

The 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, the Far East and the Primorsky Territory 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, the Caribbean 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 (Bahamas, Guadeloupe, Haiti, Cuba, Jamaica) Not found in Russia (only imported cases), Rift Valley fever, Lassa fever (Africa (Nigeria, Sierra Leone, Liberia, Bereg Ivory, 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), Southwest 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 South Africa, the southern coast of Crimea and Black Sea coast Caucasus), Pappatachi fever (Tropical and subtropical countries, the Caucasus and Central Asian republics of the former USSR), Tsutsugamushi fever (Japan, East and Southeast Asia, Primorsky and Khabarovsk Territories of Russia), North Asian tick-borne rickettsiosis (tick-borne typhus - Siberia and the Far East Russia, some areas of Northern Kazakhstan, Mongolia, Armenia), relapsing typhus (endemic tick-borne - Central Africa, USA, Central Asia, the Caucasus and the Central Asian republics of the former USSR, severe acute respiratory syndrome (Southeast Asia - Indonesia, the Philippines, Singapore, Thailand, Vietnam, China and Canada).

Mandatory examinations in case of fever upon return from a foreign trip include:

General analysis blood

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 acute illnesses internal organs(acute myocardial infarction and Dressler's syndrome, acute pancreatitis, perforated stomach ulcer, mesenteric (mesenteric) ischemia and intestinal infarction, acute thrombophlebitis deep veins, 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, aneurysm of fungal origin (mycotic aneurysm), disseminated candidiasis, cholecystitis, intra-abdominal abscesses, bacterial translocation of the intestine, 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 febrile state simulation is insignificant and ranges from 2 to 6 percent of the total number of 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 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.

Fever- elevated body temperature, which occurs as a protective and adaptive reaction in infectious and many other diseases, or as a manifestation of thermoregulation disorders in the pathology of the nervous or endocrine system. It is accompanied by a violation of some functions of the body, is additional load on the respiratory and circulatory systems.

With fever the basal metabolism is increased, the breakdown of proteins increases (in connection with which the excretion of nitrogen in the urine increases), the frequency of respiration and heart rate increases; possible clouding of consciousness. However, the violations of functions and metabolism observed during fever are often determined not by the fever itself, but by the underlying disease.

Depending on the cause distinguish between infectious and non-infectious fever. The latter is observed in case of poisoning with various poisons (plant, animal, industrial, etc.), with idiosyncrasy, allergic reactions(for example, with parenteral protein administration) and diseases (bronchial asthma), malignant tumors, aseptic inflammation, necrosis and autolysis. As a manifestation of disorders in the regulation of body temperature, non-infectious fever is noted in diseases of the brain, thyrotoxicosis, and ovarian dysfunction.

The mechanism of occurrence of infectious and non-infectious fever is similar. It consists in irritation of the nerve centers of thermoregulation by substances (the so-called pyrogens) of an exogenous nature (decomposition products of microbes, toxins) or formed in the body (immune complexes, pyrogens produced in leukocytes). There are three stages of febrile reaction. The first stage - an increase in temperature - is the result of an increase in heat production with a decrease in heat transfer, which is due to a reflex spasm of skin vessels. Paleness of the skin and chills are often noted. Then heat transfer begins to increase due to vasodilation, and in the second stage of fever, when the temperature is kept at elevated level(height of fever), both heat production and heat transfer are increased. The pallor of the skin is replaced by hyperemia (redness), the skin temperature rises, the patient has a feeling of heat. The third stage of fever - a decrease in temperature - occurs due to a further increase in heat transfer, incl. at the expense profuse sweating and significant additional vasodilation, which can lead to collapse. Such a course is often observed during a sharp, so-called critical, decrease in temperature, or a crisis. If the decrease in temperature occurs gradually over many hours or several days (lytic decrease, or lysis), then the threat of collapse, as a rule, is absent.

For some diseases(e.g. malaria) fever is cyclical: the three stages of fever are repeated at intervals when the temperature remains normal. According to the degree of increase in body temperature, subfebrile (from 37 ° to 38 °), moderate (from 38 ° to 39 °), high (from 39 ° to 41 °) and excessive, or hyperpyretic, fever (over 41 °) are distinguished.

In typical cases, in acute infectious diseases, the most favorable form is moderate fever with daily temperature fluctuations within 1 °.

Hyperpyrexia is dangerous with a deep impairment of vital activity, and the absence of fever indicates a decrease in the reactivity of the body.

How to treat a fever?

You can take paracetamol and aspirin in moderate doses, indicated in the annotations to these drugs, for no longer than 3 days in a row, drinking plenty of water.

Be careful with aspirin! It increases the risk of hemorrhages and bleeding in influenza.

If the temperature is high, then make an exception for medicinal plantshelping to reduce the temperature. Additionally, non-pharmacological procedures can be carried out:

1. You can bring down the temperature by rubbing the body with vodka or vinegar, half diluted with water. Undress for the duration of the procedure, and do not dress immediately after it. Rubbing should be done frequently, as water dries quickly on a hot body.

2. Don't dress too lightly and at the same time don't wrap yourself up. In the first case, chills occur, and in the second, overheating. Wrapping up a feverish patient is like wrapping a blanket around a red-hot house.

3. Open a window in the room or use an air conditioner, a fan. The cool air helps eliminate heat escaping from your body.

4. High temperature makes you thirsty. The fact that you sweat and breathe rapidly contributes to the loss of fluid that needs to be replenished. Drink raspberry tea to reduce fever lime blossom and honey, cranberry or lingonberry juice. Diaphoretic tea recipes are given below.

5. You can put a compress of vinegar water on your head. In this case, the heat will be transferred much easier.

6. Good antipyretic. Mix the juice of 1 onion with the juice of 1 apple and 1 tablespoon of honey. Take 3 times a day.

In most healthy people, body temperature usually stays around 37°C, and to be very precise, the ideal body temperature is considered to be 36.6°C, and it remains at the same level day after day until microbes disturb this stable pattern. . Microorganisms, beware! The body's defense system begins to raise the body temperature in an attempt to restore order and destroy disease-causing microbes.

Temperature rise is important

In the center of the brain is the hypothalamus, which acts like a thermostat on the body. Therefore, when the hypothalamus receives a message that microbes have illegally entered the territory it controls, it begins to set internal temperature body is taller than usual. Heat helps fight bacteria, making the body less comfortable for them to exist. With a cold, some viruses do not multiply at elevated body temperature, so even a slight increase in temperature can actually help get rid of the virus faster.

a fever indicates that the body has entered fight mode to get rid of a virus or infection. Almost any infection can cause a fever - this is chickenpox, sore throat, flu, and even the common cold - they all often cause an increase in body temperature.

Sometimes a fever appears along with other symptoms, such as chills, loss of appetite, a general feeling of tiredness or weakness, and a headache, since a simple increase in body temperature is not enough to quickly deal with germs.

Is it worth fighting a fever?

There are several ways to measure body temperature, including holding a thermometer under the armpit, in the mouth, in the ear, and in the rectum. The rectal method is the most accurate, but it is too messy, although children get the most benefit from this method. Measuring the temperature in the mouth is another fairly accurate way to measure temperature,

and underarm and in-ear measurements provide the least accurate readings. And one more thing - leave these mercury thermometers for medical museums and make your life a little easier.

We take glasses and check the numbers on the screen: with a fever, the temperature is usually two or three, and sometimes four degrees above normal body temperature. In general, fevers below 38.9°C are not treated even with over-the-counter medications. Drugs such as ibuprofen and acetaminophen can help relieve symptoms that accompany a fever but do not treat the underlying condition. And since the drug blocks the signals that the hypothalamus sends, the microbes survive and the disease will last longer.

If the fever is higher than 38.9°C or lasts longer than three days, you may need to health care. For children, pregnant women and people with a weakened immune system fever is the greatest danger, so it is very important for them to take action at the very beginning of the disease.

As for everyone else, it's worth knowing that when the body gets hot, it's easy to get dehydrated, so you should drink plenty of fluids to prevent this. Here is the good news: after the cause of the fever disappears, the hypothalamus restores order, returning the body temperature to normal.