Fever

Overview of Fever

• Generally, Fever itself is an illness.
• Furthermore, But it is an important sign of something going wrong in the body.
• It is the part of body’s response to disease.
• Fever may be beneficial to body and on many occasions, additionally it plays an important role in helping the body fight the diseases, particularly the infections. [1]

Epidemiology of Fever

Causes

• Infection: Certain substances (pyrogens) released either from bacteria or parasites affect the heat­ regulating system in hypothalamus, resulting in the production of excess heat and fever.
• Hyperthyroidism: Increased basal metabolic rate during hyperthyroidism causes fever
• Brain lesions: When lesion involves temperature regulating centers, fever occurs.
• Diabetes insipidus: In this condition, fever occurs without any apparent cause. [1]
• Pyrexia of unknown origin (in other words; PUO): This term is used when cause of fever cannot be ascertained. [3]

Classification of Fever

Fever is classified into three categories i.e.:

• Low-grade: When the body temperature rises to 38°C to 39°C, (100.4°F to 102.2°F)
• Moderate-grade: When the temperature rises to 39°C to 40°C (102.2°F to 104°F)
• High-grade: When the temperature rises above 40°C to 42°C (104°F to 107.6°F) [1]

Risk Factors of Fever

The risk factors for fever are diverse and can be broadly categorized as follows:

Host factors:

• Age: Young children and the elders are more susceptible to infections due to immature or weakened immune systems.
• Immunocompromised status: Individuals with HIV/AIDS, cancer, or those on immunosuppressive medications are at higher risk of infections.
• Underlying medical conditions: Chronic diseases like diabetes, heart disease, or lung disease can increase susceptibility to infections and fever.
• Nutritional status: Malnutrition weakens the immune system and increases the risk of infections.
• Genetic predisposition: Certain genetic factors may increase susceptibility to certain infections.

Environmental factors:

• Poor sanitation and hygiene: Lack of access to clean water and sanitation facilities increases the risk of infections.
• Overcrowding: Close contact with infected individuals in crowded settings facilitates the spread of infections.
• Travel to endemic areas: Traveling to regions where certain diseases are prevalent increases the risk of exposure.
• Occupational exposure: Healthcare workers, farmers, and veterinarians are at higher risk due to exposure to infectious agents.
• Climate change: Changing weather patterns can affect the distribution of disease vectors and increase the risk of certain infections.

Iatrogenic factors:

• Medical procedures: Invasive procedures like surgery, catheterization, or endoscopy can introduce infections.
• Medications: Certain medications, like immunosuppressants or antibiotics, can increase the risk of infections.
• Blood transfusions: Blood transfusions can transmit infections like HIV or hepatitis.[9]

Pathogenesis of Fever

Pathophysiology of Fever

• Pyrogens increase the production of interleukin-1 (IL-1) in phagocytic cells.
• Moreover; IL-1 acts on the anterior hypothalamus to increase the production of prostaglandins.
• Prostaglandins increase the set-point temperature, additionally setting in motion the heat-generating mechanisms that increase body temperature also produce fever. [2]

Clinical Features of Fever

The clinical features of fever can vary depending on the underlying cause, the severity of the fever, and individual patient factors. However, some common manifestations include:

Elevated body temperature:

• This is the defining feature of fever, typically defined as a core body temperature exceeding 38.0°C (100.4°F) when measured orally.

Constitutional symptoms:

• These are non-specific symptoms that accompany many illnesses, including:

• • Malaise: A general feeling of discomfort, uneasiness, or illness.
  • Fatigue: Feeling tired, weak, or lacking energy.
  • Chills: A sensation of cold with shivering, often occurring at the onset of fever.
  • Headache: Pain or discomfort in the head.
  • Myalgia: Muscle aches and pains.
  • Arthralgia: Joint aches and pains.

Other signs and symptoms:

• Sweating: The body’s attempt to cool down.
• Tachycardia: Increased heart rate.
• Tachypnea: Increased respiratory rate.
• Flushed skin: Redness or warmth of the skin.
• Anorexia: Loss of appetite.
• Dehydration: Dry mouth, decreased urine output, and thirst due to increased fluid loss from sweating.
• Irritability and confusion: Particularly in children and the elders.

In addition to these general features, there may be specific signs and symptoms depending on the cause of the fever. For example, a patient with a respiratory infection may also have a cough, sore throat, and difficulty breathing, while someone with a gastrointestinal infection may experience abdominal pain, nausea, vomiting, and diarrhea. [9]

Sign & Symptoms of Fever

Signs and symptoms depend upon the cause:

• Headache
• Sweating
• Shivering
• Muscle pain
• Dehydration
• Loss of appetite
• General weakness

Hyperpyrexia may result in:

• Confusion
• Hallucinations
• Irritability
• Convulsions [1]

Clinical / Physical Examination

Often overlooked portions of the physical i.e.;

• Complete skin examination
• Dental examination
• Evaluation of the joints (especially the hips)
• Rectal also perirectal evaluation
• Pelvic examination

Each may provide critical clues that lead to the correct diagnosis.[4]

Diagnosis of Fever

The diagnosis of fever involves a multi-faceted approach that encompasses:

History taking:

• Detailed history of present illness: Onset, duration, pattern (continuous, intermittent, remittent), severity of fever, associated symptoms, and any recent travel or exposure to ill individuals.
• Past medical history: Underlying medical conditions, recent surgeries or hospitalizations, medications, allergies, and vaccination history.
• Family history: Any family members with similar illnesses or known genetic predispositions.
• Social history: Occupation, living conditions, recent travel, and any high-risk behaviors.

Physical examination:

• Vital signs: Measurement of body temperature (oral, rectal, axillary, or tympanic), heart rate, respiratory rate, and blood pressure.
• General appearance: Assessment of the patient’s overall condition, including level of consciousness, hydration status, and signs of distress.
• Systematic examination: Thorough examination of all organ systems to look for signs of infection or inflammation (e.g., enlarged lymph nodes, skin rash, abdominal tenderness, etc.).

Laboratory investigations:

• Complete blood count (CBC): To assess for signs of infection (e.g., elevated white blood cell count) or other blood disorders.
• Blood cultures: To identify any bacteria or fungi in the bloodstream.
• Serological tests: To detect antibodies against specific pathogens (e.g., dengue, malaria, typhoid).
• Urine analysis and culture: To identify urinary tract infections.
• Other tests: Depending on the suspected cause, additional tests may be ordered, such as chest X-ray, lumbar puncture, stool culture, or imaging studies.

Imaging studies:

• Chest X-ray: To evaluate for pneumonia or other lung infections.
• Ultrasound: To assess for abdominal or pelvic abscesses.
• CT scan or MRI: To identify deeper infections or inflammatory processes. [9]

Differential diagnosis

• Infectious causes: Bacterial, viral, fungal, or parasitic infections.
• Inflammatory/autoimmune conditions: Rheumatoid arthritis, lupus, inflammatory bowel disease.
• Malignancies: Lymphoma, leukemia, solid tumors.
• Drug-induced fever: Certain medications can cause fever as a side effect.
• Miscellaneous: Heat stroke, thyroid storm, etc. [9]

Complications of Fever 

The complications of fever can be categorized as follows:

Direct effects of elevated temperature:

• Febrile seizures: Most common in young children (6 months to 5 years), characterized by convulsions triggered by a rapid rise in body temperature.
• Heat stroke: A life-threatening condition characterized by extremely high body temperature (>40°C/104°F), altered mental status, and multi-organ dysfunction.
• Dehydration: Increased fluid loss due to sweating and decreased oral intake.
• Electrolyte imbalances: Dehydration can lead to imbalances in sodium, potassium, and other electrolytes, affecting nerve and muscle function.

Complications related to the underlying cause:

• Organ damage: Severe infections can lead to damage of organs such as the lungs (pneumonia), heart (endocarditis), kidneys (pyelonephritis), or brain (meningitis, encephalitis).
• Sepsis: A life-threatening condition characterized by a dysregulated immune response to infection, leading to organ dysfunction and potentially shock.
• Disease-specific complications: Certain infections can have unique complications, such as rheumatic fever following streptococcal pharyngitis or neurological sequelae after encephalitis.

Complications of treatment:

• Drug-induced side effects: Antipyretics (fever-reducing medications) can cause allergic reactions, liver damage, or kidney problems.
• Hospital-acquired infections: Patients hospitalized for fever may be at risk of acquiring additional infections due to exposure to other pathogens. [9]

Investigation

• CBC
• Electrolytes with blood urea nitrogen (in other words; BUN) and creatinine.
• Prothrombin time (PT) and Partial thromboplastin time (PTT).
• Liver tests- e.g. Bilirubin, Alkaline phosphatase, Transaminase levels
• Amylase levels
• Urinalysis
• Urine pregnancy test.
• Cultures- For example; Blood Urine Sputum Stool. [4]

Treatment:

General measures

• Fluids
• Discontinuing medications

Antipyretic therapy

• Acetaminophen
• Ibuprofen
• Evaporative cooling [4]

Prevention of Fever 

The prevention of fever focuses on reducing exposure to infectious agents and maintaining a healthy immune system. While not all fevers can be prevented, the following strategies can significantly reduce the risk:

Vaccination:

• Routine immunization: Ensure that you and your family are up-to-date on recommended vaccinations, such as those for influenza, pneumococcal disease, meningitis, and COVID-19.
• Travel vaccines: If you are traveling to regions where certain diseases are endemic, get vaccinated against them before departure (e.g., yellow fever, typhoid fever, hepatitis A).

Hygiene:

• Handwashing: Wash your hands frequently with soap and water for at least 20 seconds, especially before eating, after using the toilet, and after being in public places.
• Respiratory hygiene: Cover your mouth and nose when coughing or sneezing, using a tissue or your elbow, and dispose of used tissues properly.
• Food safety: Cook food thoroughly, wash fruits and vegetables before eating, and avoid consuming raw or undercooked meat or eggs.
• Water safety: Drink safe water, preferably boiled or treated, and avoid consuming untreated water from unknown sources.

Other preventive measures:

• Insect protection: Use insect repellents, wear long-sleeved clothing and pants, and use bed nets in areas where mosquito-borne diseases are prevalent.
• Safe sex practices: Use condoms to prevent sexually transmitted infections.
• Avoid close contact with sick individuals: If you are sick, stay home to prevent spreading the illness to others.
• Healthy lifestyle: Maintain a healthy diet, exercise regularly, get enough sleep, and manage stress to boost your immune system. [10]

Homeopathic Treatment

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Fever:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicines:

Aconite:

• This remedy typifies a synochal asthenic fever, and corresponds to hyperemia congestion also chill preceding inflammatory fever.
• Frequent chilliness is common in fevers calling for Aconite.
• There is redness of the face, great heat also oftentimes an outward pressing headache.
• A slight degree of delirium does not contra-indicate Aconite
• Besides this; If it is brought on by exposure to dry cold winds or chilling of the body after overheat, especially when warm and sweaty it is well indicated.
• All in all; The attack of fever often terminates with a critical sweat.

Gelsemium:

• This remedy suits dull,foolish, apathetic conditions.
• The patient is dizzy and drowsy, the chill is partial; there is a full flowing pulse with an element of weakness in it.
• It corresponds especially to remittent types of fever and to fevers brought on by warm, relaxing weather.
• The fever is accompanied by languor, muscular weakness and a desire for absolute rest and is unaccompanied by thirst.

Sulphur:

• An excellent fever remedy, it comes in after Aconite when the skin is dry also hot also there is no sweat.
• The fever seems to burn the patient up, the tongue is dry and red also the patient at first is sleepless and restless, but soon becomes drowsy.
• There are no blood changes.
• It is a chronic Aconite or a passive Aconite holding same relation to the veins that Aconite does to the arteries.

Belladonna:

• This remedy is marked by erethism, violent delirium, headache, throbbing carotids and cerebral symptoms.
• Eyes red and glistering; the skin is hot and burning; In detail the heat seems to steam out from the body; it may be followed by a profuse sweat which brings no relief.
• General dry heat with chills, little or no thirst, in fact, the patient may have a dread of water, cool extremities and throbbing headache.
• The fever is worse especially at night.

Bryonia:

• Suits especially a quite form of fever; true, the patient may be restless and toss about, but is always made worse thereby.
• There is intense headache, dull, stupefying with a sensation as if the head would burst at the temples; sharp pains over the eyes, faintness on rising up, dry mouth also a tongue coated white in the middle.
• Cold, chilly sensations predominate in fevers calling for Bryonia, and there is much thirst for large drinks of water at rather infrequent intervals.
• The fever of Bryonia is unmarked by the violence, acuteness and general storm of Aconite or the decomposition and great debility of the acids.
• It is neither synochal nor so markedly asthenic in character, it is between the two and is dependent upon local affections, state of stomach, liver, chest, etc.

Rhus Toxicodendron:

• A form of catarrhal fever, so-called, which is met with frequently calls for Rhus more than for any other remedy.
• It commences with weakness of the whole body with desire to lie down, soreness or bruised sensations in the limbs, aching of limbs and bones, great pain in back, restlessness, worse while lying still, sickness at the stomach, loss of appetite, repugnance for food, great thirst, dry tongue and mouth.
• It is useful on that borderland where febrile cases merge into a typhoid condition.

Mercurius:

• Here the fever is characterized by weariness, prostration also trembling.
• It is slow, lingering fever, generally a gastric or a bilious, remittent fever
• It is characterized by the following combination of symptoms which no other drug has: Profuse salivation, dry throat and great thirst for cold water. [5]

Ferrum Phos:

• Hyperaemia of the brain.
• High fever, quick pulse and increased temperature, sometimes with little thirst.
• During teething when convulsions threaten. [6]

Diet & Regimen of Fever

• The diet should be more of fluid given at frequent intervals during the first few days.
• Plenty of water.
• Readily digestible bland food
• The food can be soft or normal consistency.
• Protein intake must also be increased
• High quality proteins such as milk (especially low fat), egg, and moong dhal mashed dal porridge.
• Include dry fruits and nuts also decrease sugar intake.
• Make sure to take proper rest.
• Take a sponge bath with room temperature – cool water to bring the fever down also make them feel comfortable. [7]

Terminology

References use for Article 

1. K Sembulingam – Essentials of Medical Physiology, 6th Edition
2. BRS_Physiology_6th_Edition
3. Textbook of Medical Physiology (PDF Drive)
4. https://oxfordmedicine.com/view/10.1093/med/9780190862800.001.0001/med-9780190862800-chapter-48
5. Practical Homeopathic Therapeutic by Dewey W.A.
6. Homeopathic Therapeutic by Lilienthal
7.  https://naturallyyours.in/blogs/blog/ nutritional-management-in-fever
8. Savita Kumari, et al. (2021). Aetiology of pyrexia of unknown origin in north India.
9. PubMed.https://pubmed.ncbi.nlm.nih.gov/32807027/
10. Harrison’s Principles of Internal Medicine, 21st Edition, by Dennis L. Kasper, Anthony S. Fauci, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, Joseph Loscalzo (2022) Published by McGraw Hill Education
11. Control of Communicable Diseases Manual, 21st Edition, Edited by David L. Heymann (2018) Published by American Public Health Association

There are several ways to search for information about fever:

 Online Search Engines:

• Use search engines like Google, Bing, or DuckDuckGo.
• Enter keywords like "fever," "causes of fever," "treatment of fever," or specific questions you have.
• You can also search for specific types of fever, such as "viral fever," "bacterial fever," or "fever of unknown origin."

Medical Websites and Resources:

• Reputable websites like WebMD, Mayo Clinic, or Medical News Today offer comprehensive information about fever, its causes, symptoms, and treatment options.
• Government health agencies like the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) provide reliable information on fever and its management.

Medical Books and Journals:

• Libraries and online databases like PubMed offer access to medical textbooks and journals that provide in-depth information on fever.
• Look for books or articles that focus on the specific type of fever you are interested in.

Consult a Healthcare Professional:

• If you or someone you know is experiencing fever, the best way to get accurate information and personalized advice is to consult a doctor or healthcare provider.
• They can assess the situation, diagnose the cause of the fever, and recommend appropriate treatment options.