Fever:-
A body temperature greater than 37.7°C is defined as fever. Fever may be continuous, intermittent or remittent.
Investigations
A meticulous history of chronology of symptoms, any associated focal symptom(s), exposure to infectious agents and occupational history may be useful. A thorough physical examination repeated on a regular basis may provide potentially diagnostic clues.
- If there are no clinical clues, the tests include a complete haemogram with ESR, smear for malaria parasite, blood culture, Widal test and urine analysis including urine culture.
- If the febrile illness is prolonged to more than 2 weeks, an X-ray chest is indicated even in the absence of respiratory symptoms. Any abnormal fluid collection should be sampled.
Treatment
Routine use of antipyretics in low-grade fever is not justified. This may mask important clinical indications. However, in acute febrile illnesses suggestive of viral or bacterial cause, fever should be treated.
Non pharmacological treatment
Hydrotherapy and rest
Pharmacological treatment
Non-specific
- paracetamol 500-1000 mg 6-8 hourly. Or Tab. ibuprofen 400-600 mg 8 hourly.
Specific
- Antibiotics/antimalarials depending upon the cause suggested by clinical and laboratory evaluation.
Outcome
In most cases of fever, patient may either recover spontaneously or a diagnosis is reached after repeated clinical evaluation and investigations. If no diagnosis is reached in up to 3 weeks, patient is said to be having fever of unknown origin (FUO) and should be managed accordingly.
Patient education
- Self medication should be avoided.
- Antibiotics should be taken only on advice of a physician.
- Avoid covering the patient having high fever with blanket etc.
- Plenty of fluids should be taken. Stay in cool environment. Cold sponging of face and limbs should be done repeatedly.
References:-
- Alterations in Body Temperature. In: Harrison’s Principles of Internal Medicine. Kasper DL, Braunwald E Fauci AS et al (eds), 16th Edition, 2005, McGraw Hill Company Inc., New York, pp 104-25
- Physiological Changes in Infected Patients. In: Oxford Textbook of Medicine. Warrell DA, Cox TM, Firth JD, Benz EJ Jr (eds), 4th Edition, 2003. Oxford University Press, 1289-92