Fever causes. Fever disease: what is it, treatment, symptoms, signs, causes

An increase in body temperature above normal is called fever. Normal body temperature in the armpit ranges from 36,0-36,9 degrees, and in the morning it can be a third or half a degree lower than in the evening. in the rectum and oral cavity the temperature is usually half a degree or a degree higher than in the armpit, but no more 37,5 degrees.

Fever may occur for different reasons. The most common causes of its occurrence are infectious diseases. Microorganisms, their waste products and toxins affect the thermoregulatory center located in the brain, resulting in an increase in body temperature.

Fever is of several types. So, according to the degree of temperature rise, fever is:
subfebrile - not exceeding 37,5 degrees,
febrile.

When diagnosing daily temperature fluctuations are taken into account. But today the situation is such that the picture of diseases is often erased due to the intake of antipyretic drugs, and in some cases the self-use of antibiotics. Therefore, the doctor has to use other diagnostic criteria.

Manifestations of fever are known to everyone: headache, muscle aches, weakness, pain in the eyes, chills. Chills are nothing more than a physiological way to increase body temperature. During muscle contractions, heat production increases, resulting in an increase in body temperature.

For infectious diseases body temperature does not rise by chance. The physiological significance of fever is very great. Firstly, most of the bacteria at high temperatures lose their ability to reproduce or die altogether. In addition, with an increase in temperature in the body, the activity of protective mechanisms designed to fight infection increases. Therefore, if the fever is benign and there are no other symptoms, medication is not needed, plenty of drink and rest is enough.

However, fever can also have negative consequences. In addition to causing discomfort to a person, it also causes increased fluid loss and excessive energy expenditure. This can be dangerous for patients with heart and vascular disease, as well as those with other chronic diseases. Fever is extremely dangerous for children who have an increased tendency to convulsions.

When to lower the temperature?

How to lower the temperature?

Helping a child with a fever

In the fight against fever, medical and physical methods of dealing with fever are used.

If the child has a pronounced fever (the body and limbs are dry, hot), the following physical methods of dealing with fever are used:
wiping with vinegar solution ( 9% (strictly!) Vinegar is diluted with water in a ratio of 1:1). When wiping, do not touch the nipples, face, pimples, genitals, diaper rash, wounds. Wiping can be carried out repeatedly until the temperature drops to 37-37,5 degrees;
vinegar wraps. If there are no injuries and inflammations on the skin of the child, during the procedure, cover the nipples and genitals with napkins and a dry diaper. The diaper must be soaked in vinegar solution (mixed with water, as when rubbing) and wrap the child in it (with one edge of the diaper cover his stomach, chest, legs, arms while lifting up; then press the child’s hands to the body and wrap the other edge of the diaper ). To limit the inhalation of vinegar fumes, put a roller rolled up from a dry diaper on the child's neck. If necessary, having previously measured the temperature, the wrapping can be repeated later. 20-30 minutes;
on the area of ​​large vessels (armpits, groin, subclavian region), neck, forehead, apply cold cold water or ice pack wrapped in a diaper, or wet compresses);
drink at room temperature.

If chills are present, feet and hands are cold, it is forbidden to use rubdowns and cold: the child, on the contrary, needs to be additionally covered, it is allowed to use a heating pad filled with hot water and wrapped in a diaper (the water temperature is not higher than 60 degrees), apply it to the child's feet, give a warm drink.

If the temperature rises to 38 degrees and the child feels normal, it is not recommended to use antipyretics. The child is given a plentiful drink: warm water, sour compotes, fruit drinks, sharp emotions and physical activity should be limited.

The exception is cases when there is a pronounced malaise, weakness, chills in a child, the temperature rises rapidly, especially closer to the night (you need to measure it every half hour), the presence of aching joints and muscles, as well as past convulsive syndrome. In such a situation, you can give the child antipyretic drugs from the paracetamol group ( cefecon, efferalgan, kalpol, panadol etc.). A single dose should not exceed 10 mg per 1 kg of the child's weight.

If the temperature rises from 38 before 38,5-38,8 degrees, it is necessary to give the child antipyretics: ibuprofen (nurofen) based on 5 mg per kilogram of body weight or paracetamol(or analogues) based on 10 mg/kg. Simultaneous use of a combination of single doses is allowed paracetamol And ibuprofen or the finished product "Ibuklin for children" (if separate use is ineffective or there is a pronounced inflammatory process).

When the temperature rises to 39 degrees, the dose of antipyretic drugs should be as follows: paracetamol - 15 mg/kg, ibuprofen - 10 mg/kg (allowable single dose 15 mg/kg). Allowed to enter analgin: 0.1 percent solution from the calculation 0,15 ml/kg plus papaverine (or [i] no-shpa) 2 percent - 0.1 ml/kg plus tavegil (suprastin) 1 percent - 0.1 ml/kg as an injection or as an enema (with the addition of a small amount of warm water).

In addition, you can give the child a means of "nise for children" ( nimesulide) based on 5 mg / kg per day, divided into two or three doses - the antipyretic and anti-inflammatory effects of this drug are higher than those of ibuprofen or paracetamol, however, it is also more toxic.

To reduce and remove toxic products from the body, which are formed during high and prolonged fever, the child is additionally given "enterodesis" (1 sachet for 100 ml of water two to three times a day).

When is an ambulance needed?

Fever- the reaction of the body to the effects of pathogenic stimuli (infection, decay products of microbes, any tissues) and is expressed in an increase in body temperature; at its core, it is an adaptive reaction that increases the body's natural resistance to infectious diseases, but at excessively high temperatures it can be harmful (in children - convulsions).

Q fever is an acute infectious disease characterized by damage to the reticuloendothelial system, intoxication, fever, and interstitial pneumonia.

Relapsing fevers (typhoids) are a group of acute infectious diseases caused by human pathogenic treponemas of the genus Borrelia; are manifested by a series of febrile attacks with headache, muscle and joint pain, diarrhea, vomiting, cough, pain in the eyes, enlargement of the spleen. Attacks last 5-6 days and are separated by temperature-free intervals of approximately the same duration.

Dengue hemorrhagic fever is an endemic tropical and subtropical infection that occurs in the form of a systemic fever with joint pain or hemorrhagic syndrome.

Hemorrhagic Crimean-Congo fever is an acute infectious disease that occurs with high fever, characterized by a two-wave temperature curve, severe intoxication, headache and muscle pain, bleeding, hemorrhagic enanthema and petechial skin rash.

Hemorrhagic fever of Laos is an infectious disease from the group of hemorrhagic fevers; characterized by high contagiousness, gradual development, severe intoxication, fever, widespread myositis, hemorrhagic syndrome, diffuse liver damage.

hemorrhagic fever with renal syndrome- an acute infectious disease that occurs in the form of chronic progressive nephritis with the development kidney failure and hemorrhagic syndrome. Etiology. The causative agents are viruses of the Hantavirus genus of the Bunyaviridae family.

Yellow fever is an acute infectious disease characterized by hemorrhagic syndrome, damage to the cardiovascular system, liver and kidneys.

Marseille fever is an acute infectious disease characterized by fever, rash and joint pain.

Fever of unknown origin - an increase in body temperature above 38.3 ° C at least 4 times within 14 days due to an undiagnosed disease.

Trench fever is an acute infectious disease that typically occurs in a paroxysmal form with repeated four- to five-day attacks of fever, separated by several days of remission, or in a typhoid form with many days of continuous fever. Etiology. The causative agent is the rickettsia Rochalimaea quintana.

Acute rheumatic fever is a disease characterized by a systemic inflammatory lesion connective tissue autoimmune nature involving the heart and joints, initiated by group A B-hemolytic streptococcus. In the absence of antibiotic prophylaxis, relapses often occur. The term rheumatism, which is widely used in practice, is currently used to refer to pathological condition combining acute rheumatic fever and rheumatic heart disease.

Rat bite fever is the common name for two infectious diseases from the group of bacterial zoonoses: sodbka and streptobacillary fever.

Pappatachi fever is an acute infectious disease that occurs with short-term high fever, headaches and muscle pain, photophobia and injection of scleral vessels.

Rocky Mountain spotted fever is an acute infectious disease; characterized by polymorphic fever, often papular-hemorrhagic rash throughout the body, enanthema of the mucous membranes and various complications, especially skin necrosis in the inguinal region.

Streptobacillary fever is an acute infectious disease characterized by repeated attacks of fever, inflammatory-necrotic changes at the bite site, regional lymphadenitis, polyarthritis, rashes, mainly on the joints and extensor surfaces.

Tsutsugamushi fever is an acute rickettsiosis that occurs with severe fever, damage to the nervous and cardiovascular systems, the presence of primary affect, lymphadenopathy and maculopapular rash.

Fever Treatment

Bed rest, careful patient care, a dairy-vegetarian diet. Pathogenetic means of therapy are corticosteroid drugs. To reduce toxicosis, intravenous solutions of sodium chloride or glucose (5%) are administered up to 1 liter. In acute renal failure, peritoneal dialysis is performed.

A more detailed course of treatment is compiled by a doctor.

Fever - this is a protective and adaptive mechanism of the 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 normal temperature body, measured in the armpit, should be 36.0-36.9, then with 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 instance, hectic fever develops with strong 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. signs this disease were also 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 be disturbed by vomiting, in the initial period there is a noticeable reddening 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 result, hemorrhagic kidney fever leads to kidney damage and liver failure. There is bleeding gums, nosebleeds, a person may lose consciousness. Viral diseases associated with 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 improper treatment can lead to death. Therefore, prevention of infection is important: immediately after a tick bite, you need to contact a specialist. Far East hemorrhagic fever is a serious disease that requires urgent treatment.

Prolonged fever of unknown origin can be diagnosed if heat body (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. Very 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 of the 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 a mosquito bite. The onset of yellow fever is acute: body temperature rises to 40 degrees, there is a severe 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.)

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 instance, 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 reaction of the body to the appearance of milk in the breast of a nursing mother, you should not wait until this condition passes 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. Nevertheless, local funds can reduce the symptoms of the disease. How to treat a fever on the lip, you should ask your doctor.

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 in non-communicable diseases due to the reaction of the body either to endotoxins that enter the blood when its own microflora dies, or to endogenous pyrogens released when leukocytes and other normal and pathologically altered tissues are destroyed in the first place during septic inflammation, as well as when autoimmune and metabolic disorders.

Development mechanism

Thermoregulation in the human body 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 exogenous 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 the diencephalon (body temperature rises with encephalitis, hemorrhage into the ventricles of the brain). An increase in body temperature can temporarily occur when the balance between the processes of heat production and heat transfer is disturbed in the normal functional state of the thermoregulation 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:

1. 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 the normal level (with 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 a 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:

1. Fever is, as it were, a significant manifestation of the disease or its combination with such non-specific symptoms as weakness, sweating, irritability 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 the temperature in the presence of medical workers 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.) . The results of laboratory studies 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 of the pathological process, one should resort to more informative laboratory, functional-morphological and instrumental research methods.

The scheme for the initial examination of a patient with fever includes such generally accepted methods of laboratory and instrumental diagnostics as general analysis blood, urine, x-ray chest, ECG and Echo CG. With their low information content and depending on clinical manifestations diseases use more complex methods of 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 there are no obvious signs of an acute abdomen, bacterial sepsis or endocarditis, then for the period of the examination it is advisable to refrain from using antibacterial and other drugs that tend to cause a pyrogenic reaction.

Differential Diagnosis

The variety of nosological forms that manifest hyperthermia for a long time 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 connective tissue diseases, which account for 90% of all cases of fever of unknown origin.

Fever in diseases caused by infection

The most common cause of fever for which patients consult a general practitioner are:

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

classic infectious diseases with severe acute specific fever.

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

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

Endocarditis. In the practice of the therapist, a special place as a cause of fever of unknown origin is currently occupied by infective endocarditis, in which fever (chills) often far outstrips the physical manifestations of heart disease (murmurs, expansion of the boundaries of the heart, thromboembolism, etc.). In the risk group for infective endocarditis are drug addicts (drug injections) and people who have been parenterally administered drugs for a long time. 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 the 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. Most often, tuberculosis affects the lungs, and the X-ray method is one of the most informative. Reliable bacteriological method research. Mycobacterium tuberculosis can be isolated not only from sputum, but also from urine, gastric juice, cerebrospinal fluid, peritoneal and pleural effusion.

What is a fever?

Fever is an increase in body temperature above 37 °C Celsius. Most often, fever becomes one of the symptoms of infectious diseases of various origins and is accompanied by hyperemia of the skin, thirst, and confusion.

Causes of fever

An increase in temperature may be associated with intoxication of the body against the background or with an exacerbation of some chronic diseases such as kidney disease. Symptoms of fever may accompany, acute abdominal diseases, some types oncological diseases, for example .

Fever symptoms

The feverish state is accompanied by hyperemia (blood overflow) of the skin, headache, a feeling of aching bones, euphoria. In addition, the patient is disturbed by trembling, chills, increased sweating, thirst. The patient's breathing becomes frequent, his appetite disappears, confusion may occur, delirium begins. In pediatric practice, children have increased irritability, crying, and feeding problems.

In the case of an exacerbation of chronic diseases, symptoms related to the characteristics of the course of recurrent pathology can be added to the above manifestations of fever. Calling a doctor at home is necessary in case of an increase in body temperature in a child of the first three months of life above 37.5 ° C or in the case when the elevated temperature persists for two days.

Fever may be accompanied by convulsions, which also requires immediate consultation with a specialist. Besides, health care necessary for fever that occurs with stiff neck, abdominal pain and skin rash, especially if it is dark red or takes the form of large blisters.

For an adult, medical assistance is necessary if the fever is accompanied by swelling, pain in the joints, and skin rashes. Also, an examination by a specialist with an increase in temperature is necessary for pregnant women and patients who are tormented by a cough with yellowish or greenish sputum, acute headache, pain in the ears, throat or abdomen, dry mouth,. A visit to the doctor is also necessary for patients with confused consciousness, rash, increased irritability.

Fever Treatment

Treatment of fever at home is primarily aimed at replenishing the water-salt balance, preserving the vitality of the body, and controlling body temperature. The patient needs bed rest and light food, he should drink more fluids, do not dress warmly, do not take a bath and measure body temperature 4-6 times a day. If the temperature rises above 38 ° C Celsius, the patient is prescribed.

To normalize body temperature, as a rule, paracetamol is used in age dosages, ibuprofen or nimesulide.

As part of a medical examination, the cause of the increase in the patient's body temperature is established and appropriate treatment is prescribed. In some cases, the patient may need hospitalization or an additional examination on an outpatient basis.

Expert editor: Mochalov Pavel Alexandrovich| MD general practitioner

Education: Moscow Medical Institute. I. M. Sechenov, specialty - "Medicine" in 1991, in 1993 "Occupational diseases", in 1996 "Therapy".