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Fever  is a frequent medical sign that describes an increase in internal body temperature to levels above normal. Fever is most accurately characterized as a temporary elevation in the body's thermoregulatory set-point, usually by about 1–2 °C (1.8-3.6 °F).

Fever is caused by an elevation in the thermoregulatory set-point, causing typical body temperature (generally and problematically considered to be 37 °C ±1 °C, or approximately 99 ±2 °F; see below for specifics) to rise, and effector mechanisms are enacted as a result. A feverish individual has a general feeling of cold despite an increased body temperature, and increases in heart rate, muscle tone and shivering, all of which are caused by the body's attempts to counteract the newly-perceived hypothermia and reach the new thermoregulatory set-point.

Fever differs from hyperthermia in that hyperthermia is an increase in body temperature over the body's thermoregulatory set-point, due to excessive heat production or insufficient thermoregulation, or both.

A fever is considered one of the body's immune mechanisms to attempt a neutralization of a perceived threat inside the body, be it bacterial or viral. Carl Wunderlich discovered that fever is not a disease, but the body's response to a disease.

Measurement and normal variation

When a patient has or is suspected of having a fever, that person's body temperature is measured using a thermometer.

At a first glance, fever is present if:

• Temperature in the anus (rectum/rectal) or in the ear (otic) is at or over 38.0 °C (100.4 °F)
• Temperature in the mouth (oral) is at or over 37.5 °C (99.5 °F)
• Temperature under the arm (axillary) is at or over 37.2 °C (99.0 °F)

The common oral measurement of normal human body temperatureis 36.8±0.7 °C (98.2±1.3 °F). This means that any oral temperature between 36.1 and 37.5 °C (96.9 and 99.5 °F) is likely to be normal.

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However, there are many variations in normal body temperature, and this needs to be considered when measuring for fever. The values given are for an otherwise healthy, non-fasting adult, dressed comfortably, indoors, in a room that is kept at a normal room temperature (22.7 to 24.4 °C or 73 to 76 °F), during the morning, but not shortly after arising from sleep. Furthermore, for oral temperatures, the subject must not have eaten, drunk, or smoked anything in at least the previous fifteen to twenty minutes.

Body temperature normally fluctuates over the day, with the lowest levels around 4 a.m. and the highest around 6 p.m. (assuming the subject follows the prevalent pattern, i.e, sleeping at nighttime and staying awake during daytime). Therefore, an oral temperature of 37.2 °C (99.0 °F) would strictly be a fever in the morning, but not in the afternoon. An oral body temperature reading up to 37.5 °C (99.5 °F) in the early/late afternoon or early/late evening also wouldn't be a fever. Normal body temperature may differ as much as 1 °F (0.6 °C) between individuals or from day to day. In women, temperature differs at various points in the menstrual cycle, and this can be used as part of fertility awareness (although temperature is only one of the variables). Temperature is increased after eating, and psychological factors also influence body temperature.

There are different locations where temperature can be measured, and these differ in temperature variability. Tympanic membrane thermometers measure radiant heat energy from the tympanic membrane (infrared). These may be very convenient, but may also show more variability.

Children develop higher temperatures with activities like playing, but this is not fever because their set-point is normal. Elderly patients may have a decreased ability to generate body heat during a fever, so even a low-grade fever can have serious underlying causes in geriatrics.

Fever is usually accompanied by sickness behavior which consists of lethargy, depression,anorexia, sleepiness, hyperalgesia, and the inability to concentrate.

Types

 














According to one common rule of thumb, fever is generally classified for convenience as an anal (core) temperature of:

Fever classification

Grade	°C	°F
low grade	38–39	100.4–102.2
moderate	39–40	102.2–104.0
high-grade	40–41.1	104.0–106.0
hyperpyrexia	>41.1	>106.0

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The last is a medical emergency because it approaches the upper limit compatible with human life. If the temperature is taken by another route (mouth, ear, armpit), then the reading needs to be converted to the equivalent core body temperature.

Most of the time, fever types can not be used to find the underlying cause. However, there are specific fever patterns that may occasionally hint the diagnosis:

• Pel-Ebstein fever: A specific kind of fever associated with Hodgkin's lymphoma, being high for one week and low for the next week and so on. However, there is some debate as to whether this pattern truly exists.
• Continuous fever: Temperature remains above normal throughout the day and does not fluctuate more than 1 °C in 24 hours, e.g. lobar pneumonia, typhoid, urinary tract infection, brucellosis, ortyphus. Typhoid fever may show a specific fever pattern, with a slow stepwise increase and a high plateau.
• Intermittent fever: Elevated temperature is present only for some hours of the day and becomes normal for remaining hours, e.g. malaria, kala-azar, pyaemia, or septicemia. In malaria, there may be a fever with a periodicity of 24 hours (quotidian), 48 hours (tertian fever), or 72 hours (quartan fever, indicating Plasmodium malariae). These patterns may be less clear in travelers.
• Remittent fever: Temperature remains above normal throughout the day and fluctuates more than 1 °C in 24 hours, e.g. infective endocarditis.

A neutropenic fever, also called febrile neutropenia, is a fever in the absence of normal immune system function. Because of the lack of infection-fighting neutrophils, a bacterial infection can spread rapidly and this fever is therefore usually considered a medical emergency. This kind of fever is more commonly seen in people receiving immune-suppressing chemotherapy than in apparently healthy people.

Febricula is a mild fever of short duration, of indefinite origin, and without any distinctive pathology.

Causes

Fever is a common symptom of many medical conditions:

• Infectious disease, e.g. influenza, common cold, HIV, malaria, infectious mononucleosis, orgastroenteritis
• Various skin inflammations, e.g. boils, pimples, acne, or abscess
• Immunological diseases, e.g. lupus erythematosus, sarcoidosis, inflammatory bowel diseases
• Tissue destruction, which can occur in hemolysis, surgery, infarction, crush syndrome,rhabdomyolysis, cerebral hemorrhage, etc.
• Drug fever
  • directly caused by the drug, e.g. lamictal, progesterone, or chemotherapeutics causingtumor necrosis
  • as an adverse reaction to drugs, e.g. antibiotics or sulfa drugs.
  • after drug discontinuation, e.g. heroin or fentanyl withdrawal
• Reaction to incompatible blood products
• Cancers, most commonly renal cancer and leukemia and lymphomas
• Metabolic disorders, e.g. gout or porphyria
• Thrombo-embolic processes, e.g. pulmonary embolism or deep venous thrombosis

Persistent fever which cannot be explained after repeated routine clinical inquiries, is called fever of unknown origin.

Usefulness of fever

There are arguments for and against the usefulness of fever, and the issue is controversial.There are studies using warm-blooded vertebrates and humans in vivo, with some suggesting that they recover more rapidly from infections or critical illness due to fever. A Finnish study suggested reduced mortality in bacterial infections when fever was present.

Theoretically, fever can aid in host defense. There are certainly some important immunological reactions that are sped up by temperature, and some pathogens with strict temperature preferences could be hindered. Fevers may be useful to some extent since they allow the body to reach high temperatures, causing an unbearable environment for some pathogens. White blood cells also rapidly proliferate due to the suitable environment and can also help fight off the harmful pathogens and microbes that invaded the body.

Research has demonstrated that fever has several important functions in the healing process:

• increased mobility of leukocytes
• enhanced leukocytes phagocytosis
• endotoxin effects decreased
• increased proliferation of T Cells
• enhanced activity of interferon

Treatment

Fever should not necessarily be treated. Fever is an important signal that there's something wrong in the body, and it can be used to govern medical treatment and gauge its effectiveness. Moreover, not all fevers are of infectious origin.

Even when treatment is not indicated, however, febrile patients are generally advised to keep themselves adequately hydrated, as the dehydration produced by a mild fever can be more dangerous than the fever itself. Water is generally used for this purpose because it is a universal solvent, but there is always a small risk of hyponatremia if the patient drinks too much water. For this reason, some patients drink sports drinks or electrolyte-replacing products designed specifically for this purpose.

Most people take medication against fever because the symptoms cause discomfort. Fever increases heart rate and metabolism, thus potentially putting an additional strain on elderly patients, patients with heart disease, etc. This may even cause delirium. Therefore, potential benefits must be weighed against risks in these patients. In any case, fever must be brought under control in instances when fever escalates to hyperpyrexia and tissue damage is imminent.

Treatment of fever is normally done by lowering the set-point, but facilitating heat loss may also be effective. The former is accomplished with antipyretics such as ibuprofen or paracetamol (USacetominophen). Aspirin can also be given to adults, but can cause Reye's Syndrome in children. Heat removal is generally by wet cloth or pads, usually applied to the forehead, but also through bathing the body in tepid water. This is particularly important for babies, where drugs should be avoided. However, using water that is too cold can induce vasoconstriction, and reduce effective heat loss.

Heat loss may also be accomplished by heat conduction, convection, radiation, or evaporation(sweating, perspiration), or a combination of these.

How does blood flow through the body


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