Chronic fever. Why does fever occur? thrombophlebitis and fever

it general reaction organism in many diseases, which is based on a violation of the thermal balance, and therefore increases. Fever is accompanied by a violation of a number of body functions, including metabolism.

The mechanism of fever is based on the reaction of the centers (see) located in the hypothalamus. This reaction occurs in response to the action of various stimuli of exogenous and endogenous nature, which are called pyrogens. However, pyrogenic agents do not cause fever if the thermoregulatory centers are destroyed or depressed (by anesthesia, bromides, in certain neuropsychiatric diseases, etc.). The degree of temperature increase is usually proportional to the dose of pyrogenic agents ( chemical substances or bacterial toxins), but above 40.5-41 ° temperature human body, as a rule, does not rise, and a further increase in the dose of pyrogens causes an atypical reaction, characterized by a hypothermic phase. With the most severe toxic forms and stages of some acute infectious diseases febrile reaction does not occur. Mildly expressed, it also happens in children and patients of elderly and senile age.

Fever is an adaptive mechanism that activates defensive forces organism.

Depending on the cause of occurrence, infectious and non-infectious fevers are distinguished, but they are similar. Pyrogenic factors in infectious fever are microbial, products of metabolism and decay of microbes.

Pyrogens, entering the body, cause the formation, mainly in granular leukocytes, of secondary pyrogens - specific protein bodies, which in turn support a feverish reaction.

Fever of non-infectious etiology can be caused by plant, animal or industrial poisons: arsenic, etc., occur when allergic reactions- with idiosyncrasy (see), bronchial asthma, parenteral protein administration, etc., physical influences, emotional upheavals, aseptic inflammations, necrosis and autolysis, as well as in diseases of the brain, in particular the hypothalamus, in which there is a violation of thermoregulation.

Fever, especially in severe cases, is accompanied by dysfunction of various internal organs and systems in the first place nervous system, which is manifested by a headache, a feeling of heaviness in the head, confusion or loss of consciousness. Other systems of the body also suffer, there is an increase in cardiac activity and respiration, a decrease in diuresis, etc. Metabolism during fever is also disturbed, basal metabolism can be increased, protein breakdown increases, and therefore nitrogen excretion in the urine increases. However, it should be borne in mind that a number of functional and metabolic disorders may depend not on fever as such, but on the development of the underlying disease.

A feverish reaction in its development goes through three stages: an increase in temperature, its standing and a decrease. The duration of each stage is determined by many factors, in particular, the dose of pyrogen, the duration of its action, the disorders that have arisen in the body under the influence of a pathogenic agent, etc. Often, fever is cyclical (for example, with malaria), when after the three stages described for some time the body temperature remains normal (apyrexia), and then rises again. Such cycles during the course of the disease can occur repeatedly.

The temperature rise stage is the result of an increase in heat production under the influence of pyrogens and a decrease in heat transfer caused by reflex spasm. skin vessels. For this reason, especially when sharp narrowing blood vessels, patients experience a feeling of cold - chills. Vasospasm also explains the pallor with fever. muscle tremor with fever, it is accompanied by an increase in metabolism and heat production in the muscles. The same mechanism causes drawing pains in muscles in a number of infectious diseases.

With the continuation of fever, the processes of heat production and heat transfer balance each other for some time, but then the second stage of fever occurs - standing temperature. This stage is characterized by increased heat transfer (compared to heat transfer healthy body, heat production is also increased at this stage) - vasodilation, as a result of which pallor is replaced by hyperemia, skin temperature rises, and a feeling of heat appears.

With the termination of the effect of pyrogen on the body or its suppression therapeutic agents heat production decreases before heat transfer and an increased level of the latter characterizes the third stage of fever - a decrease in temperature. In these cases, it sharply increases, the vessels expand significantly, which can lead to collapse (see). However, these phenomena are observed only with a sharp, so-called critical, decrease in temperature. Often this decrease in temperature occurs in the form of lysis, that is, a gradual decrease over several days. With lysis, the listed signs are less pronounced and the threat of collapse becomes much less.

There are subfebrile fever (up to 38°), moderate (up to 39°), high (up to 41°) and hyperpyretic (over 41°). In typical cases, in acute infectious diseases, the most favorable form is moderate fever, while its absence or hyperpyrexia indicate a reduced (see) or severity of the disease. With a typical development of a febrile reaction, the evening body temperature (at 17-20 hours) exceeds the morning (at 4-6 hours) within 1 °.

At various diseases febrile reactions can proceed in different ways, which is reflected in various forms temperature curves. In the clinic, the following types of fevers are usually distinguished.
1. Constant, characteristic, for example, for lobar pneumonia, when the normal daily rhythm of temperature is maintained with fluctuations not higher than 1 °, but it is set at a higher level.

2. Remitting, or laxative, observed with purulent diseases(exudative, lung abscess etc.) with a temperature amplitude within a day of up to 2° and more.

3. Intermittent, or intermittent, when periods normal temperature alternate with periods of elevated temperature, and during the latter there may be either a sharp increase and decrease in temperature, as in malaria, relapsing fever(relapsing fever), or its gradual increase with the same gradual decrease as in (undulating fever).

4. Perverse, in which the morning temperature is higher than the evening temperature, which is sometimes observed in tuberculosis, protracted forms, and some other diseases.

5. Hectic, or exhausting, with temperature drops up to 3-4 °, occurring 2-3 times a day (with especially severe forms tuberculosis, sepsis, etc.).

6. Wrong, quite common in many infectious diseases (flu, dysentery), when no regularity is found in temperature fluctuations.

Different types of fevers during illness may alternate or pass one into another.

In the treatment of fever, antipyretics are sometimes prescribed that act on the thermoregulatory centers ( acetylsalicylic acid, and etc.); however, the main treatment should be causal, i.e. aimed at eliminating the underlying disease and the disorders caused by it metabolic processes and functions. At the same time, in some cases, an increase in body temperature, activating energy metabolism, excitability and other processes in the body, contributes to the implementation of adaptive reactions, thereby creating favorable conditions to fight disease; therefore, in such cases, the use of antipyretics should be limited.

Under fever of unknown origin(LNG) are understood clinical cases characterized by a persistent (more than 3 weeks) increase in body temperature above 38 ° C, which is the main or even the only symptom, while the causes of the disease remain unclear, despite intensive examination (by conventional and additional laboratory methods). Fever of unknown origin may be due to infectious and inflammatory processes, oncological diseases, metabolic diseases, hereditary pathology, systemic diseases connective tissue. The diagnostic task is to identify the cause of the increase in body temperature and establish accurate diagnosis. For this purpose, an extended and comprehensive examination of the patient is carried out.

ICD-10

R50 Fever of unknown origin

General information

Under fever of unknown origin(LNG) refers to clinical cases characterized by a persistent (more than 3 weeks) increase in body temperature above 38 ° C, which is the main or even the only symptom, while the causes of the disease remain unclear, despite intensive examination (by conventional and additional laboratory methods).

Thermoregulation of the body is carried out reflexively and is an indicator general condition health. The occurrence of fever (> 37.2°C with axillary measurement and > 37.8 °C with oral and rectal measurements) is associated with a response, protective and adaptive reaction of the body to the disease. Fever is one of the most early symptoms many (not only infectious) diseases, when there are no other clinical manifestations illness. This causes difficulties in diagnosing given state. Establishing the causes of fever of unknown origin requires a more extensive diagnostic examination. Start of treatment, including trial, before establishing true reasons LNG is prescribed strictly individually and is determined by a specific clinical case.

Causes and mechanism of fever development

Fever lasting less than 1 week usually accompanies various infections. Fever lasting more than 1 week is most likely due to some serious illness. In 90% of cases, fever is caused various infections, malignant neoplasms and systemic lesions connective tissue. Unexplained fever may be caused by atypical form common illness In some cases, the reason for the increase in temperature remains unclear.

The mechanism for increasing body temperature in diseases accompanied by fever is as follows: exogenous pyrogens (of bacterial and non-bacterial nature) affect the thermoregulatory center in the hypothalamus through endogenous (leukocyte, secondary) pyrogen, a low molecular weight protein produced in the body. Endogenous pyrogen affects the thermosensitive neurons of the hypothalamus, leading to sharp increase heat production in the muscles, which is manifested by chills and a decrease in heat transfer due to vasoconstriction of the skin. It has also been experimentally proven that various tumors(lymphoproliferative tumors, tumors of the liver, kidneys) can themselves produce endogenous pyrogen. Violations of thermoregulation can sometimes be observed with damage to the central nervous system: hemorrhages, hypothalamic syndrome, organic lesions brain.

Classification of fever of unknown origin

There are several variants of the course of fever of unknown origin:

classic (previously known and new diseases (Lyme disease, chronic fatigue syndrome);
nosocomial (fever appears in patients admitted to the hospital and receiving intensive care, 2 or more days after hospitalization);
neutropenic (the number of neutrophils in candidiasis, herpes).
HIV-associated (HIV infection in combination with toxoplasmosis, cytomegalovirus, histoplasmosis, mycobacteriosis, cryptococcosis).

According to the level of increase, body temperature is distinguished:

subfebrile (from 37 to 37.9 ° C),
febrile (from 38 to 38.9 ° C),
pyretic (high, from 39 to 40.9 ° C),
hyperpyretic (excessive, from 41 ° C and above).

The duration of the fever can be:

acute - up to 15 days,
subacute - 16-45 days,
chronic - more than 45 days.

According to the nature of changes in the temperature curve over time, fevers are distinguished:

constant - for several days there is a high (~ 39 ° C) body temperature with daily fluctuations within 1 ° C (typhus, lobar pneumonia, etc.);
laxative - during the day the temperature ranges from 1 to 2 ° C, but does not reach normal indicators(for purulent diseases);
intermittent - with alternating periods (1-3 days) of normal and very high body temperature (malaria);
hectic - there are significant (more than 3 ° C) daily or at intervals of several hours temperature changes from sharp drops(septic conditions);
return - a period of temperature increase (up to 39-40 ° C) is replaced by a period of subfebrile or normal temperature (relapsing fever);
wavy - manifested in a gradual (day by day) increase and a similar gradual decrease in temperature (lymphogranulomatosis, brucellosis);
incorrect - there are no patterns of daily temperature fluctuations (rheumatism, pneumonia, influenza, oncological diseases);
perverted - morning readings temperatures above evening (tuberculosis, viral infections, sepsis).

Symptoms of a fever of unknown origin

The main (sometimes the only) clinical symptom of a fever of unknown origin is a rise in body temperature. For a long time, fever may be asymptomatic or accompanied by chills, excessive sweating, heart pain, suffocation.

Diagnosis of fever of unknown origin

Must be followed exactly the following criteria in the diagnosis of fever of unknown origin:

the patient's body temperature is 38°C or higher;
fever (or periodic rises in temperature) are observed for 3 weeks or more;
the diagnosis was not determined after examinations by conventional methods.

Fever patients are difficult to diagnose. Diagnosis of the causes of fever includes:

general analysis blood and urine, coagulogram;
biochemical analysis blood (sugar, ALT, AST, CRP, sialic acids, total protein and protein fractions);
aspirin test;
three-hour thermometry;
Mantoux reaction;
radiography of the lungs (detection of tuberculosis, sarcoidosis, lymphoma, lymphogranulomatosis);
Echocardiography (excluding myxoma, endocarditis);
Ultrasound of the abdominal cavity and kidneys;
consultation with a gynecologist, neurologist, ENT doctor.

To identify the true causes of fever, along with generally accepted laboratory tests apply additional research. For this purpose, the following are assigned:

microbiological examination of urine, blood, swab from the nasopharynx (allows you to identify the causative agent of infection), a blood test for intrauterine infections;
isolation of a viral culture from the secrets of the body, its DNA, viral antibody titers (allows you to diagnose cytomegalovirus, toxoplasmosis, herpes, Epstein-Barr virus);
detection of antibodies to HIV (enzyme-linked immunosorbent complex method, Western blot test);
examination under a microscope of a thick blood smear (to exclude malaria);
blood test for antinuclear factor, LE cells (to exclude systemic lupus erythematosus);
puncture bone marrow(to exclude leukemia, lymphoma);
computed tomography of organs abdominal cavity(exclusion of tumor processes in the kidneys and pelvis);
skeletal scintigraphy (detection of metastases) and densitometry (determination of the density bone tissue) with osteomyelitis, malignant tumors;
examination of the gastrointestinal tract radiodiagnosis, endoscopy and biopsy inflammatory processes, tumors in the intestines);
carrying out serological reactions, including reactions of indirect hemagglutination with intestinal group(with salmonellosis, brucellosis, Lyme disease, typhoid);
collection of data on allergic reactions to medications(if a drug disease is suspected);
study of family history in terms of the presence hereditary diseases(for example, familial Mediterranean fever).

To make a correct diagnosis of fever, anamnesis and laboratory tests can be repeated, which at the first stage could be erroneous or incorrectly assessed.

Treatment of fever of unknown origin

In the event that the patient's condition with fever is stable, in most cases treatment should be withheld. Trial treatment for a febrile patient is sometimes discussed (tuberculostatic drugs for suspected TB, heparin for suspected deep vein thrombophlebitis, pulmonary embolism; antibiotics fixed in the bone tissue, if osteomyelitis is suspected). The appointment of glucocorticoid hormones as a trial treatment is justified when the effect of their use can help in the diagnosis (if subacute thyroiditis is suspected, Still's disease, polymyalgia rheumatica).

It is extremely important in the treatment of patients with fever to have information about the possible previous use of drugs. The reaction to medication in 3-5% of cases may be manifested by an increase in body temperature, and be the only or main clinical symptom hypersensitivity to medicines. Drug fever may not appear immediately, but after a certain period of time after taking the drug, and is no different from fevers of other origins. If drug fever is suspected, withdrawal is required this drug and patient monitoring. If the fever disappears within a few days, the cause is considered to be clarified, and if the elevated body temperature persists (within 1 week after discontinuation of the medication), the medicinal nature of the fever is not confirmed.

Exist various groups drugs that can cause drug fever:

antimicrobials (most antibiotics: penicillins, tetracyclines, cephalosporins, nitrofurans, etc., sulfonamides);
anti-inflammatory drugs (ibuprofen, acetylsalicylic acid);
medicines used in diseases of the gastrointestinal tract (cimetidine, metoclopramide, laxatives, which include phenolphthalein);
cardiovascular drugs (heparin, alpha-methyldopa, hydralazine, quinidine, captopril, procainamide, hydrochlorothiazide);
drugs acting on the central nervous system (phenobarbital, carbamazepine, haloperidol, chlorpromazine thioridazine);
cytotoxic drugs (bleomycin, procarbazine, asparaginase);
other drugs (antihistamines, iodine, allopurinol, levamisole, amphotericin B).

Fever- one of the oldest protective and adaptive mechanisms of the body, arising in response to the action of pathogenic stimuli, mainly microbes with pyrogenic properties. Fever can also occur not infectious diseases in connection with the reaction of the body either to endotoxins entering the blood when its own microflora dies, or to endogenous pyrogens released during the destruction of primarily leukocytes, other normal and pathologically altered tissues during septic inflammation, as well as autoimmune and metabolic disorders.

Development mechanism

Thermoregulation in human body It is provided by a thermoregulatory center located in the hypothalamus through a complex system of control over the processes of heat production and heat transfer. The balance between these two processes, which provide physiological fluctuations in human body temperature, can be disturbed by various exo- or endogenous factors(infection, intoxication, tumor, etc.). At the same time, pyrogens formed during inflammation primarily affect activated leukocytes that synthesize IL-1 (as well as IL-6, TNF and other biologically active substances). active substances), stimulating the formation of PGE 2, under the influence of which the activity of the thermoregulation center changes.

Heat production is influenced by the endocrine system (in particular, body temperature rises with hyperthyroidism) and diencephalon(body temperature rises with encephalitis, hemorrhage in the ventricles of the brain). An increase in body temperature can temporarily occur when there is an imbalance between the processes of heat production and heat transfer under normal functional state thermoregulatory center of the hypothalamus.

A number of fever classifications .

Depending on the cause of occurrence, infectious and non-infectious fever are distinguished.

According to the degree of increase in body temperature: subfebrile (37-37.9 ° C), febrile (38-38.9 ° C), pyretic or high (39-40.9 ° C) and hyperpyretic or excessive (41 ° C and above ).

According to the duration of fever: acute - up to 15 days, subacute - 16-45 days, chronic - over 45 days.

Change in body temperature over time distinguish the following types of fever:

Constant- body temperature is usually high (about 39 ° C), lasts for several days with daily fluctuations within 1 ° C (with lobar pneumonia, typhus, etc.).
laxative- with daily fluctuations from 1 to 2 ° C, but not reaching normal level(for purulent diseases).
intermittent- alternation in 1-3 days of a normal and hyperthermic state (characteristic of malaria).
hectic- significant (over 3 °C) daily or at intervals of several hours temperature fluctuations with sharp drop and rise (in septic conditions).
returnable- with periods of temperature increase up to 39-40 °C and periods of normal or subfebrile temperature(with relapsing fever).
wavy- with a gradual increase from day to day and the same gradual decrease (with Hodgkin's disease, brucellosis, etc.).
wrong fever- without a definite pattern in the daily fluctuation (with rheumatism, pneumonia, influenza, oncological diseases).
perverted fever- morning temperature is higher than evening temperature (with tuberculosis, viral diseases, sepsis).

In combination with other symptoms of the disease, the following forms of fever are distinguished:

Fever - as if a significant manifestation of the disease or its combination with such nonspecific symptoms, as weakness, sweating, increased excitability in the absence of inflammatory acute phase shifts in the blood and local signs of the disease. In such cases, it is necessary to make sure that there is no simulation of fever, for which it is necessary, observing tact, to measure in the presence of medical workers temperature simultaneously in both axillary fossae and even in the rectum.
Fever is combined with nonspecific, sometimes very pronounced acute phase reactions (increased ESR, fibrinogen content, changes in the structure of globulin fractions, etc.) in the absence of local pathology detected clinically and even with instrumental examination (fluoroscopy, endoscopy, ultrasound, ECG, etc.) . results laboratory research exclude data in favor of any acute specific infection. In a word, the patient, as it were, “burns out” for an unknown reason.
Fever is combined both with severe nonspecific acute phase reactions and with organ changes of unknown nature (abdominal pain, hepatomegaly, arthralgia, etc.). Options for combining organ changes can be very different, while not always associated with a single mechanism of development. In these cases, to establish the nature pathological process should resort to more informative laboratory, functional-morphological and instrumental methods research.

To the scheme primary examination a patient with a fever includes such generally accepted methods of laboratory and instrumental diagnostics as a complete blood count, urine, x-ray examination chest, ECG and Echo CG. With their low information content and depending on the clinical manifestations of the disease, more complex methods are used. laboratory diagnostics(microbiological, serological, endoscopic with biopsy, CT, arteriography, etc.). By the way, in the structure of fever of unknown origin, 5-7% falls on the so-called medicinal fever. Therefore, if not obvious signs acute abdomen, bacterial sepsis or endocarditis, then for the period of examination it is advisable to refrain from the use of antibacterial and other drugs that tend to cause a pyrogenic reaction.

Differential Diagnosis

The variety of nosological forms that are manifested for a long time by hyperthermia make it difficult to formulate reliable principles. differential diagnosis. Taking into account the prevalence of diseases with severe fever, it is recommended to focus the differential diagnostic search primarily on three groups of diseases: infections, neoplasms and diffuse diseases connective tissue, which account for 90% of all cases of fever of unknown origin.

Fever in diseases caused by infection

Most common cause fever for which patients seek medical attention general practice, are:

infectious and inflammatory diseases of internal organs (heart, lungs, kidneys, liver, intestines, etc.);

classic infectious diseases with severe acute specific fever.

Infectious and inflammatory diseases of the internal organs. With a fever varying degrees all infectious and inflammatory diseases of internal organs and nonspecific purulent-septic processes occur ( subphrenic abscess, abscesses of the liver and kidneys, cholangitis, etc.).

This section discusses those that are most frequently encountered in medical practice a doctor and for a long time can only be manifested by a fever of unknown origin.

Endocarditis. In the practice of a therapist special place as the cause of fever of unknown origin is currently occupied by infective endocarditis, in which fever (chills) is often far ahead of the physical manifestations of heart disease (murmurs, expansion of the boundaries of the heart, thromboembolism, etc.). At risk infective endocarditis there are drug addicts (drug injections) and persons who long time drugs are administered parenterally. In this case, the right side of the heart is usually affected. According to a number of researchers, it is difficult to identify the causative agent of the disease: bacteremia, often intermittent, in almost 90% of patients requires 6 blood cultures. It should be borne in mind that in patients with a defect in immune status Fungi can be the cause of endocarditis.

Treatment - antibacterial drugs after determining the sensitivity of the pathogen to them.

Tuberculosis. Fever is often the only manifestation of tuberculosis lymph nodes, liver, kidneys, adrenal glands, pericardium, peritoneum, mesentery, mediastinum. Currently, tuberculosis is often combined with congenital and acquired immunodeficiency. Tuberculosis most commonly affects the lungs and X-ray method is one of the informative ones. Reliable bacteriological research method. Mycobacterium tuberculosis can be isolated not only from sputum, but also from urine, gastric juice, cerebrospinal fluid, from peritoneal and pleural effusions.

Fever is a protective and adaptive mechanism of the body that occurs in response to the action of pathogenic stimuli. During this process, an increase in body temperature is observed.

Fever can occur against the background of infectious or non-infectious diseases.

Causes

Fever may be due to heat stroke, dehydration, injury, and also as an allergic reaction to medication.

Symptoms

Symptoms of fever are caused by the action of pyrogen substances that enter the body from outside or are formed inside it. Exogenous pyrogens include microorganisms, their toxins and waste products. The main source of endogenous pyrogens are cells of the immune system and granulocytes (a subgroup of white blood cells).

In addition to an increase in body temperature during fever, there may be:

Redness of the skin of the face;
Headache;
Trembling, ;
Aches in the bones;
Intensive sweating;
Thirst, poor appetite;
Rapid breathing;
Manifestations of unreasonable euphoria or confusion;
In children, fever may be accompanied by irritability, crying, and feeding problems.

Other dangerous symptoms fevers: rash, cramps, abdominal pain, pain and swelling in the joints.

Features of the symptoms of fever depend on the type and the cause that caused it.

Diagnostics

To diagnose fever, methods of measuring the temperature of a person's body are used (in armpit, in oral cavity, in the rectum). The temperature curve is diagnostically significant - a graph of rises and falls in temperature during the day. Temperature fluctuations can vary significantly depending on the cause.

To diagnose the disease that caused the fever, a detailed history is collected and a thorough examination is carried out (general and biochemical blood tests, urinalysis, fecal analysis, radiography, ultrasound, ECG and others). necessary research). Dynamic observation is carried out for the appearance of new symptoms accompanying the fever.

Types of disease

Depending on the degree of temperature rise, the following types of fever are distinguished:

Subfibrality (37-37.9°С)
Moderate (38-39.9 °С)
High (40-40.9 °С)
Hyperpyretic (from 41°С)

According to the nature of temperature fluctuations, fever is divided into the following types:
Constant fever. Heat for a long time. Temperature difference in the morning and in the evening - no more than 1°С.

Laxative fever (relapsing). High temperature, morning minimum above 37°C. Daily temperature fluctuations are more than 1-2°C.

Wasting fever (hectic). Large daily fluctuations in temperature (3-4 ° C), which alternate with its decrease to the norm and below. Accompanied by profuse sweating.
Intermittent fever (intermittent). Short-term temperature rises up to high performance alternate with periods of normal temperature
The reverse type of fever - the morning temperature is higher than the evening.
Abnormal fever (atypical) - varied and irregular daily fluctuations.

The forms of fever are distinguished:

Undulating fever (undulating). Periodic increases in temperature, and then a decrease to normal levels for a long time.
Relapsing fever is a severe rapid alternation of periods of high temperature with fever-free periods.

Patient's actions

An increase in body temperature requires a visit to a doctor to find out the cause.

If a child has a fever accompanied by convulsions, remove all objects near him that could hurt him, make sure he breathes freely, and call a doctor.

An increase in temperature in a pregnant woman, as well as symptoms accompanying fever: swelling and pain in the joints, rash, severe headache, ear pain, cough with yellowish or greenish sputum, confusion, dry mouth, abdominal pain, vomiting, intense thirst, strong pain in throat, painful urination.

Treatment

Home treatment aims to replenish water-salt balance, maintenance vitality organism, control over body temperature.

At temperatures above 38 ° C, antipyretic drugs are prescribed. It is forbidden to use aspirin to reduce body temperature in children, it is recommended to use in age dosages, or .

Treatment is prescribed depending on the results of the medical examination and the cause of the fever.

Complications

High body temperature or prolonged symptoms of fever can cause seizures, dehydration, and hallucinations.
Fever caused by severe infections can lead to death. Fever is also life-threatening in people with weak immune system, cancer patients, the elderly, newborns, people with autoimmune diseases.

Prevention

Prevention of fever is the prevention of diseases and conditions that it accompanies.

Fever - fever body, arising 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 administration of protein) 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 nerve centers thermoregulation by substances (the so-called pyrogens) of an exogenous nature (decay 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 deep violation 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 large quantity 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.