Last month I listened to a Patriot Nurse Youtube on the 5
critical first aid skills we all need to have.
And the last thing she covered was fever
management.
I wasn’t entirely sure I’d
written on that topic, and a quick check of the blog revealed the omission.
I thought it important to discuss and had
previously noted the wisdom of acquiring a glass, non-digital,
thermometer.
We older folks all used
them as kids, but most of our children have only used digital
thermometers.
I don’t think mine have
ever seen me shake down a glass thermometer.
They certainly have no clue how long to hold them under the tongue.
So that’s what that article was for.
In researching that article, I came across a few pages in Where There Is No Doctor on the
different fever patterns. And I have
included info on the distinct fever patterns found with some of the illnesses
that have been covered on the blog.
However, I was pretty sure I hadn’t seen any mention of these patterns in
any of my other off-grid medical texts.
Sure enough, nobody else addressed it. And why is it important?
Thought you’d never ask.
As you recall from the previous fever article, most fevers
are associated with respiratory infections.
However, there are several serious infections that are accompanied by a
fever with a specific pattern, some of which resemble respiratory
infections (at least in the beginning), and which are not respiratory
infections. Sneaky little buggers.
If we are recording the temperature at least a few times per
day, even plotting it on a graph, we may see a pattern develop. In a world with limited physician and/or
laboratory access, these distinct fever patterns may reveal it’s not a
respiratory illness at all. Rather, the
infection is something more sinister.
Full articles have been posted on many of these illnesses
(links below). Here we are briefly describing the symptoms
and the fever pattern.
- Acute fever (less than 7 days long)
-
Malaria
-
Viral upper
respiratory tract infections
-
Sub-acute fever (less than 14 days
long)
-
Typhoid
-
Intra-abdominal
abscess
-
Chronic fever (more than 14 days long)
-
Tuberculosis
-
HIV
-
Cancer
-
Connective tissue
disease
-
Any cause of
acute fever if untreated
Normal
and Febrile Body Temperature Ranges
(Rectal
Temperature)
|
Body Temperature
|
Fahrenheit (°F)
|
Celsius (°C)
|
Normal
|
98.6-100.4°
|
37-38°
|
Mild fever
|
100.5-102.2°
|
38.1-39°
|
Moderate fever
|
102.3-104°
|
39.1-40°
|
High fever
|
104.1-106°
|
40.1-41.1°
|
Hyperpyrexia
|
>106°
|
>41.1°
|
Does the height of the body temperature indicate severity of
the illness?
Researchers indicate that the height of the temperature may
aid diagnosis. Studies correlate high fevers
in infants to serious bacterial infection, noting that hyperpyrexia (extremely high fever) is rare in
infants less than 3 months of age, and that one-third of infants in this group
who presented with a temperature over 40°C also had a serious bacterial
infection.
Researchers also found that 20% children with hyperpyrexia also
had a serious bacterial infection and recommended antibiotic therapy in the
absence of a confirmed viral illness.
In general, however, the height of the fever only
occasionally correlates with the severity of the illness.
Hyperpyrexia and severe illness
- Shigellosis
-
Dengue
-
Acute
falciparum malaria
The overall clinical state of the patient (check those vital
signs!) is usually a better indicator of serious illness than the height of the
fever.
Five major fever patterns
A continuous fever
does not fluctuate more than 1.5°F (1°C) during a 24-hour period and never
touches normal. This is seen with the
following illnesses:
- Pneumonia,
lobar or gram-negative
-
Typhoid
-
Acute bacterial
meningitis
-
Urinary tract
infection
A fever with a slow,
stepwise temperature increase and high plateau suggests typhoid fever. This is only infrequently observed because
most patients self-medicate with antibiotics and fever-reducing medications
before seeing a doctor. If this fever
occurs with relative bradycardia, it points to the following possible
illnesses:
- Untreated typhoid
-
Leishmaniasis
-
Brucellosis
-
Legionnaire’s
disease
-
Psittacosis
-
Yellow fever
An intermittent fever
pattern, where the fever occurs for several hours each day, is observed with
the following illnesses:
- Malaria
(periodicity of fever varies from every 24 to 72 hours, depending on the
species)
-
Tuberculosis
-
Schistosomiasis
-
Pyogenic infections
(pus-producing infections, most commonly due to Streptococcus and
Staphylococcus bacteria)
-
Lymphomas
(low fever lasts 3-10 days followed by afebrile period of 3-10 days)
-
Septicemia
-
Leptospirosis
-
Borrelia infections,
including Lyme disease
-
Kala-azar,
visceral leishmaniasis
Remittent fever
includes daily temperature fluctuations of more than 2°C (about 3.5°F), but
which never touch normal.
Illnesses include:
- Rickettsiae infections
(most commonly tick-borne, but fleas and lice are also vectors)
-
Brucellosis
-
Infective endocarditis
Relapsing fevers are
recurring fevers separated by periods of low- or no fever. These occur with
- Malaria
-
Lymphoma
-
Borrelia
-
Cyclic neutropenia
-
Rat-bite
fever
Night-sweat
fevers are seen with
-
Tuberculosis
-
Brucellosis
-
Liver or
lung abscess
-
Sub-acute
infective endocarditis
-
Lymphomas
FEVER PATTERN DESCRIPTIONS FOR SPECIFIC DISEASES
- Brucellosis. Fever
and sweating most frequently occur at night, with the fever disappearing for a
few days and then returning. This may
continue for months or years.
-
Childbirth fever. A
slight fever begins one or more days after giving birth, and then the fever
increases later.
-
Hepatitis. Mild
fever, which decreases when the eyes turn yellow.
-
Malaria. Fever comes
and goes for a few days, accompanied by shivering and chills as the body
temperature rises and sweats as it falls.
Then the patient is feverish for a few hours every 2-3 days, feeling
more or less well at other times.
-
Pneumonia.
Temperature rises quickly and remains high with a bacterial infection,
gradually decreasing with a viral infection.
-
Rheumatic fever. Sudden
fever with a sore throat is followed by another fever 10-15 days later.
-
Tick-borne relapsing fever.
Fever for 3 days, following by a 7-day break, and then another 3 days of
fever and a 7-day break, and it keeps going.
-
Typhoid. The
temperature rises a little more each day.
-
Typhus. Similar to typhoid.
So why are these fever patterns important? What is their significance?
After all, as noted above, many of these fever patterns aren’t
seen in clinical practice. Today.
And that is because people often start self-medicating before seeing a
doctor. That, of course, messes with the
pattern. Tomorrow, the story may be
different.
And as you use these patterns to help identify what’s troubling
a family member, keep in mind that elderly, severely malnourished, and
immunocompromised people sometimes don’t develop a fever at all. Also, concurrent infection with another
illness may alter fever patterns.
But when a pattern can be identified, it may offer useful
clues for diagnosing diseases, including ruling out other diseases. And this will be particularly important when
we find ourselves with few resources.
Links to related posts:
Brucellosis
Childbirth fever
Hepatitis
Malaria
Pneumonia
Tick-borne
relapsing fever
Typhoid
Typhus
Glass thermometers