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Post by Nanneerose Thu Jun 19, 2014 9:20 am

Fever Fever_300x_m2019741
Fever is usually a sign that your body is fighting an infection, but there can be other causes.


Fever is a body temperature that is greater than normal. It usually occurs when the body is fighting an infection. It's generally seen as a symptom of an underlying disease, rather than an illness itself.
Normally, a person's body temperature ranges between 36.5 and 37.4°C, but our actual temperature varies depending on where it is measured and time of day. The body's metabolism works best in this range and it's usually kept in check thanks to the body's 'thermostat' – an area at the base of the brain, known as the hypothalamus.
However, when we are infected with a bacteria, a virus or another germ, the body releases chemicals known as pyrogens that stimulate the hypothalamus. This causes physiological changes in our body which result in a fever or 'pyrexia'. Definitions of fever vary, but generally a temperature above 37.8-38°C is usually considered abnormal.
This rise in temperature is beneficial as it makes the body a less favourable host for viruses and bacteria, (as they are temperature sensitive). It also helps simulate the immune system, making it more effective at fighting these pathogens. For this reason, treatment of fever is not always necessary or beneficial.
There are other occasions where fever may arise, aside from an infection, although most are relatively rare. They include:

  • after severe sunburn

  • after an immunisation

  • drug reactions

  • inflammatory conditions such as rheumatoid arthritis

  • following major trauma or surgery

  • in certain cancers.


Sometimes no obvious cause can be found for a fever, a medical condition called 'pyrexia of unknown origin'. Patients are often admitted to hospital for extensive investigations and the cause of the fever is then identified in about half.


Symptoms
A fever may be classified as mild (or 'low grade') if it's between 37.8°C and 38.5°C; or high (or 'high-grade') above 38.5°C.
A fever can be short lasting (acute) or ongoing (chronic) or it can be intermittent (as is often the case in malaria for example).
Elderly people tend to get a lower fever than a younger person does in the same circumstances. Newborn infants, especially those born prematurely, may have a drop in temperature when they have an infection
A fever in itself is usually not dangerous, unless it becomes very high. Internal body temperatures in excess of 41°C, for instance, can cause damage to the body's tissues and organs.
In children, a high fever – especially if it has risen very quickly – can cause fits; called febrile convulsions. These are not usually harmful, but can be frightening for parents to witness.(See below)
The symptoms of fever vary but they commonly include:

  • feeling unwell

  • shivering or shaking (usually occurs when you have a rising fever)

  • sweating (this usually occurs when the fever has broken)

  • flushed face

  • headache and muscle aches

  • dehydration.


Tips for taking a temperature
Digital thermometers have replaced glass mercury thermometers as the instruments of choice for measuring temperature.
Temperature strips and temperature-sensitive pacifiers are available for use with children but are not recommended as they are often inaccurate.
Temperatures can be taken from the mouth, the armpit, and (rarely in children) the rectum. The armpit temperature tends to be the lowest, so is the least accurate.
You can also buy thermometers which take the temperature inside the ear. These are probably most suitable for older infants and young children, who might not be able to hold a digital thermometer under their tongue for long enough to take a reading.



Diagnosis
Fever itself isn't a disease but a symptom of an underlying condition. So when doctors examine a patient who has a fever, they are looking for the disease that is causing it. Your doctor will usually take a history and do a physical examination. Tests may be ordered to try to find the source of the infection.
These may include tests of urine, blood, faeces, sputum or tissue samples. From these samples, pathologists will try to identify the cause of the fever – usually a bacteria or virus – and to test for which antibiotics to use if bacteria are to blame. Further tests may include X-rays, CT or MRI scans, and ultrasound.


Treatment
If it is a bacterial infection, the doctor may prescribe a course of antibiotics. Fevers caused by viruses shouldn't be treated with antibiotics, since these drugs have no effect against viruses.
If another cause is found, then that should be treated appropriately. For instance, certain drugs or an interaction between two medicines can cause a fever, and your doctor can advise you on switching medicines to prevent this problem.
In many cases however, no specific treatment is needed and the person gets better by themselves with rest and plenty of fluids.
Simple over-the-counter fever-reducing medications, known as antipyretics, such as aspirin or paracetamol for adults, or in the case of children, paracetamol or ibuprofen will help bring down the fever, but they only provide relief from symptoms; they do not treat the underlying infection or other cause.
These medicines do not necessarily always need to be given to children with fever. They are effective in treating the irritability and discomfort associated with a fever, but they do not prevent febrile convulsions.
Aspirin shouldn't be given to infants or children under the age of 12 years as it may cause a rare but serious disorder known as Reye's syndrome.
Some other simple measures that can make the patient with a fever more comfortable include:

  • Drinking plenty of clear fluids to replace fluids lost by sweating, vomiting or diarrhoea – either water, or an oral rehydration solution which contains electrolytes.

  • Changing clothing and bed linen frequently.

  • Tepid baths (but don't use cold water, as this can increase core body temperature by cooling the skin and causing shivering).

  • Keeping clothes and blankets to a minimum.

  • Avoiding hot water bottles or electric blankets (which may raise body temperature further).

  • Ventilating the room.




When to see a doctor
Body temperature isn't always a reliable indicator of illness in the elderly, and the same goes for babies and young children.
For children, rather than just relying on fever to gauge the severity of your their illness, ask yourself whether they appear to be distressed or in pain, if they are playing or moving around normally in the bed, whether they are alert and interested in their surroundings and whether they are wetting the usual number of nappies.
Most fevers in children result from viral illnesses that get better without treatment. Immunising your child on time protects them from a variety of more serious infections.
Consider seeking medical attention if your child has a fever and they:

  • are under six months of age

  • have a fever of 40°C or more

  • won't eat or drink

  • have a headache, earache or stiff neck

  • have a rash or don't like bright lights

  • are passing less urine than normal

  • are very drowsy, sleepy, confused or cant be woken

  • have a seizure (convulsion) - see below

  • vomit or has persistent diarrhoea

  • cry continually and won't be comforted

  • have difficulty breathing, including breathing more rapidly

  • are in pain.


In some children (about one in 30) a high fever can cause febrile convulsions or fever fits at one time or another. A child may experience sudden convulsions and or loss of consciousness. Their muscles may stiffen and jerk and they may go red or blue in the face. This may last for several minutes.
Though distressing for parents, these convulsions do not cause brain damage and almost never cause any lasting effects at all.
There's nothing you can do to stop a convulsion. You should try and stay calm, put your child on a soft surface, lying on their back or side, and watch what happens so you can describe it later. Time how long the convulsion lasts. If the convulsions last more than five minutes, your child does not wake up when the convulsion stops or the child looks very sick when the convulsion stops, call an ambulance. Otherwise make an appointment with your family doctor.
Adults with a fever should see a doctor if:

  • the fever persists after three days, despite simple home-based measures

  • the fever is high (over 40°C)

  • they are shivering and shaking involuntarily

  • they have a severe headache (especially if not responding to painkillers) or become drowsy or confused

  • they have recently travelled overseas.




Reviewed by Dr David Burgner, paediatric infectious diseases consultant and medical researcher, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne. With thanks to the Royal Australasian College of Physicians for assistance.
Nanneerose
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