High body temperature is a violation of thermoregulation, in which the temperature rises above 37 ° C. The symptom is accompanied by headaches, aching muscles, severe weakness, and malaise. Fever often occurs with infectious diseases, but fever may also have a non-infectious origin - endocrine and autoimmune diseases, tumors. Extensive laboratory tests and imaging techniques are performed to determine the cause of hyperthermia. Antipyretics and physical cooling methods usually help bring down the temperature quickly.
general characteristics
Temperature indicators change in absolutely healthy people throughout the day, in the morning the values \u200b\u200bare a couple of tenths of a degree lower than in the evening. An increase in indicators of more than 37 ° C when measured in the armpit indicates a pathology of thermoregulation. Body temperature often rises gradually. First, prodromal symptoms appear - headache, body aches, general malaise, and later - a subjective feeling of cold, muscle tremors. With an increase in indicators above 38 ° C, chills are replaced by a strong sensation of heat, the skin is hot to the touch, a bright red blush on the cheeks.
The general condition of patients worsens, they refuse to eat. Lips dry and cracked, severe dryness in the mouth worries. The period of persistently elevated temperature lasts from several days to a month or more, depending on the cause of the fever. Normalization of thermoregulation processes can be abrupt - with severe weakness, profuse sweats and hypotension, or gradual, when the general condition remains satisfactory. The rise in temperature in a child occurs faster, up to 39-40 ° C in a few hours.
Fever is always combined with other symptoms that correspond to the underlying pathology. Most often, abdominal pain and dyspeptic disorders, signs of SARS are observed. At a temperature of 37 ° C and above in an adult, which lasts for more than 2 days, you should consult a doctor. When a child has a fever, medical care is required already on the first day of fever, since the mechanisms of thermoregulation are not developed in childhood, the fever is more severe.
Classification
According to the etiological factor, fever is infectious - caused by bacteria, viruses and fungi, or non-infectious - with damage to internal organs, tumors, allergic reactions. By duration, high body temperature is classified into ephemeral (up to 3 days), acute (from 3 days to 2 weeks), subacute (2-6 weeks) and chronic (lasting more than 1.5 months). In clinical practice, the classification of fever is more often used, taking into account the level of pathologically elevated temperature, according to which there is:
- Subfebrile body temperature . Temperature values are in the range of 37-38 degrees, accompanied by weakness, weakness, decreased ability to work. Often occurs in chronic sluggish inflammatory processes in the body - some infections with a latent period, endocrine diseases.
- Febrile body temperature . Numerical indicators from 38 ° to 39 ° C. Its appearance indicates an active inflammatory process that triggers the internal causes of fever: the mechanisms of the immune system, massive production of endogenous pyrogens. It is observed in many infectious and somatic pathologies.
- High (pyretic) body temperature . Severe violation of thermoregulation with a fever of 39-41 ° C. There is a sharp deterioration in the condition, severe dehydration, bouts of nausea and vomiting. It is a pediatric emergency because children sometimes develop seizures.
- Hyperpyretic body temperature . An extremely serious condition, when the temperature exceeds 41 degrees. It indicates a complete disruption of the mechanisms of central thermoregulation. In addition to the usual signs of fever, there are disturbances of consciousness with delusions and hallucinations. The condition requires emergency care.
Doctors measure fever by looking at fluctuations in readings over the course of the day—called a temperature curve. A constant temperature is characterized by fluctuations within 1 degree, with a laxative fever, the indicators change by 1-2 ° C, but do not reach normal temperature. In the hectic form, which is caused by purulent and septic processes, temperature fluctuations are 3-5 ° C during the day. Rarer types of temperature curve include intermittent, recurrent and wavy.
An increase in temperature of more than 37 degrees on the skin or more than 37.8 ° C when determining indicators in the rectum is observed with a slight production of cytokines and pyrogens that affect the thermoregulatory center in the hypothalamus. The condition is accompanied by general malaise, but performance is often preserved. Subfebrile body temperature is caused by such reasons as:
- Emotional reactions : prolonged stress, neurosis and neurosis-like states, hysteria.
- Hormonal changes in women : first trimester of pregnancy, menopause.
- Respiratory diseases : colds, SARS, simple bronchitis and interstitial pneumonia.
- Focal inflammation : chronic tonsillitis, sinusitis.
- Chronic bacterial infections : tuberculosis, brucellosis, Lyme disease.
- Viral processes : acute hepatitis, herpes simplex and herpes zoster, cytomegalovirus.
- Childhood infections : measles, rubella.
- Temperature "tail" of infectious diseases .
- Helminthiases : giardiasis, amoebiasis, opisthorchiasis.
- Intestinal pathologies : ulcerative colitis, Crohn's disease, Whipple's disease.
- Autoimmune processes : systemic lupus erythematosus, scleroderma and dermatomyositis, rheumatoid arthritis.
- Endocrine pathology : the initial stage of thyrotoxicosis, Addison's disease.
- Tumors : lymphogranulomatosis, acute and chronic leukemia.
- HIV infection .
- Iatrogenic factors : postoperative period, reaction to blood transfusion or vaccination.
- Complications of pharmacotherapy : taking antibiotics, psychotropic drugs, atropine.
- Rare causes : chronic sepsis, allergic reactions.
Causes of febrile body temperature
If the body temperature is constantly elevated to 38 degrees or more, this indicates an acute course of the disease. Patients report severe headaches and muscle pain, weakness, drowsiness. At the same time, appetite is reduced, and the feeling of thirst increases due to massive loss of water through sweat and breath. Common reasons for the development of febrile temperature:
- Acute respiratory pathologies : influenza, adenovirus and rhinovirus infections, SARS.
- Infectious diseases : typhoid and typhus, malaria, meningococcal meningitis.
- Intestinal infections : salmonellosis, dysentery, escherichiosis, etc.
- ENT diseases : sinusitis (sinusitis, frontal sinusitis), tonsillitis, otitis.
- The defeat of the lower respiratory tract : purulent bronchitis and bronchiolitis, exudative pleurisy, focal and croupous pneumonia.
- Purulent foci : external (boils, carbuncles, suppuration of wounds) and internal (abscesses of the liver, intestines, pleural empyema).
- Acute abdomen syndrome: appendicitis, cholecystitis, mesadenitis.
- Heart disease: bacterial endocarditis, acute rheumatic fever, Libman-Sachs endocarditis.
- Damage to bones and joints : hematogenous and traumatic osteomyelitis, septic arthritis, sarcomas.
- Pathology of the genitourinary system : acute pyelonephritis, apostematous nephritis, renal colic.
- Overheating of the body : heat and sunstroke, anhidrosis, wearing clothes that do not match the weather.
- Fever of unknown origin .
- Rare causes : prion infections (Creutzfeldt-Jakob disease, kuru, fatal familial insomnia), vascular collagenosis.
Diagnostics
Examination of patients with elevated temperature is carried out by a general practitioner. The volume of diagnostic measures depends on the clinical picture and the presence of additional symptoms, if there are clear signs of damage to a particular system, its targeted diagnosis is carried out. In the case of prolonged fever of unknown cause, the examination is performed according to the standard algorithm, which includes advanced laboratory methods and instrumental visualization. The most informative studies:
- Blood test . In the general analysis, attention is paid to signs of an inflammatory process (leukocytosis, elevated ESR). The levels of acute phase proteins and antinuclear antibodies are measured to rule out autoimmune processes. In the period of acute inflammation, the procalcitonin test is informative. To assess the function of the heart, an analysis is made for antistreptolysin, troponin.
- Hemoculture . Blood sampling is carried out in the period of the most elevated temperature, at least 3 times. The material is sown on selective nutrient media; in the presence of a large number of bacterial colonies, septicemia is diagnosed. Additionally, blood is examined using ELISA, RIF - express methods for the detection of antibodies and antigens of pathogens.
- Bacteriological Research . In addition to blood, samples of feces and urine, sputum are used to isolate pathogens. If neurological symptoms are detected at elevated temperature, cerebrospinal fluid is taken. After determining the colonies of pathogenic microorganisms, a test for sensitivity to antibacterial drugs is done.
- Radiography . With prolonged preservation of elevated temperature, chest radiographs are performed in two projections, on which it is possible to detect areas of blackout, cavities with a horizontal level of fluid, and deformation of the bronchial tree. Plain radiography of the abdominal cavity helps to exclude abscesses, large inflammatory conglomerates and perforations of a hollow organ.
- Ultrasound . To clarify the cause of febrile fever, echocardiography is performed, during which signs of infective endocarditis, valve vegetation, and pathology of large arteries are determined. To exclude endocrine disorders, an ultrasound of the thyroid gland and parathyroid glands, adrenal glands is done.
- Highly Specific Imaging Techniques . If the cause of the elevated temperature cannot be established by standard methods, whole-body scintigraphy with gallium is indicated, which allows to detect chronic abscesses, volumetric neoplasms. Osteomyelitis is confirmed by bone scintigraphy with technetium. If meningitis is suspected, CT or MRI of the brain is recommended.
At high body temperature, drinking plenty of fluids is indicated.
Treatment
Help before diagnosis
With elevated subfebrile temperature, which lasts less than 2 days, specific treatment is not required. A long duration of symptoms indicates the presence of a pathological process, which is an indication for seeking medical help. Until the cause of the fever is determined, the patient must be provided with plenty of warm fluids. Apply physical methods of cooling - sponging, cold compresses. Drinking antipyretics to bring down the temperature, adults are recommended when the thermometer readings are more than 38.5 ° C, children are given antipyretics at a temperature elevated more than 38 degrees.
Conservative therapy
Medical tactics depend on the cause of the onset of symptoms and the general condition of the patient. With high fever, temperature measurements in the hospital are carried out every 2-3 hours to assess the dynamics. In children, a violation of thermoregulation is sometimes accompanied by convulsions, therefore, when an elevated febrile temperature is detected, they are immediately given antipyretic medications. A prerequisite is adequate etiotropic and pathogenetic therapy, against which the thermometry indicators are normalized. For therapeutic purposes, use:
- Antibiotics . Medicines are selected empirically, the treatment regimen is adjusted after receiving the results of bakposev. With massive purulent processes, combinations of 2 or 3 drugs are recommended, which are administered parenterally in high therapeutic doses.
- Antivirals . With influenza, specific medications are shown that block the reproduction of the virus and speed up recovery. For the treatment of viral hepatitis, drugs have been developed that reduce the viral load and alleviate the general condition.
- Anti-inflammatory drugs . Non-steroidal drugs block the synthesis of prostaglandins and cytokines that act on the thermoregulatory center, reduce the activity of the inflammatory process. NSAIDs are used, which have powerful antipyretic properties.
- Glucocorticoids . They are prescribed for severe systemic autoimmune or allergic reactions that are not amenable to other therapy. They are used with caution in infections, since adrenal hormones suppress the activity of the immune system.
- infusion solutions . At a temperature above 38 ° C and a serious condition of the patient, rehydration and detoxification therapy are required. Salt solutions containing the most important electrolytes are poured in. Treatment is supplemented with diuretics.
- Vitamins . With sluggish processes, ascorbic acid and B vitamins are used to stimulate the immune system. Metabolic drugs are effective, which improve metabolic processes in cells and have a tonic effect. Means are combined with antioxidants.
Surgery
If large abscesses or foci of osteomyelitis are detected, they must be drained and the resulting cavities washed with antiseptic solutions. In diseases manifested by an "acute abdomen", abdominal operations with wide access are indicated to remove altered sections of the intestine, followed by sanitation of the abdominal cavity. For malignant tumors, radical surgical interventions are performed (removal of the formation along with the surrounding tissue and regional lymph nodes), combined with radiation exposure and chemotherapy.