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Fever
F ever is d efined as a tem p erature h igh er than 3 7 .5 °C axillary and 3 8 °C if m easured
rectally . I t is accep ted th at axillary tem p erature und erestim ates th e co re bo d y
tem p erature by 0 .5 °C , but th is is very ap p ro xim ate. U se an electro nic th erm o m eter
when available1.
F ever is o ften link ed , but no t exclusively , w ith infectio n. A ll clinical exam inatio ns
sh o uld includ e check ing fo r fever.
I n a febrile p atient, first lo o k fo r signs o f serio us illness, th en try to establish a
d iagno sis.
Signs of serious illness
– S igns o f sep sis with signs o f sho ck : circulato ry failure, resp irato ry d istress, p urp ura,
co nfusio n, co m a.
– S igns o f a sy stem ic illness: m eningeal sy nd ro m e, seiz ures, h eart m urm ur o n
auscultatio n, abd o m inal p ain, rash, etc.
– P atient‟s und erly ing co nd itio n: m alnutritio n, im m une sup p ressio n, sp lenecto m y ,
chro nic d isease, the very y o ung and the very o ld , bed rid d en p atients.
Aetiology
M any d ifferent d iseases, infectio us o r no ninfectio us, acute o r ch ro nic, benign o r
m alignant, m ay be acco m p anied by fever. A m o ng th e infectio us d iseases requiring
im m ed iate treatm ent, lo o k fo r:
– p urp ura fulm inans
– bacterial m eningitis
– severe m alaria
– severe bacterial sk in infectio ns
– acute p y elo nep hritis with urinary retentio n
– p erito nitis o r gastro intestinal infectio n
– p neum o nia with signs o f resp irato ry d istress
– subglo ttic o r ep iglo ttic lary ngitis
– end o card itis
– sep ticaem ia
I n the absence o f signs o f serio us illness and o bvio us d iagno sis, p atients m ay return
ho m e with an antip y retic and sho uld be ed ucated to p revent d ehy d ratio n (p lenty o f
fluid s) and to reco gniz e sy m p to m s that need m ed ical attentio n. P atients sho uld return
fo r a new co nsultatio n if th ere is no im p ro vem ent w ith in 4 8 h o urs o f th e initial
co nsultatio n o r befo re if their co nd itio n d eterio rates.
In case o f d o ubt (e.g. abo ut the evo lutio n, the quality o f surveillance) and d ep end ing o n
the co ntext ( geo grap h ical d istance, p ro blem s o f transp o rt), it m ay be better to k eep
p atients 1 2 to 2 4 ho urs fo r o bservatio n.
Complications
– C o nvulsio ns
– D ehy d ratio n
– C o nfusio n, d elirium
– S cho ck
It is im p o rtant, p articularly in child ren, to lo o k fo r signs o f these co m p licatio ns, to treat
them , and m o st im p o rtantly to p revent them .
1 Temperature should be measured over a period of 5 minutes when using a mercury thermometer.
26
Fever
F ever is d efined as a tem p erature h igh er than 3 7 .5 °C axillary and 3 8 °C if m easured
rectally . I t is accep ted th at axillary tem p erature und erestim ates th e co re bo d y
tem p erature by 0 .5 °C , but th is is very ap p ro xim ate. U se an electro nic th erm o m eter
when available1.
F ever is o ften link ed , but no t exclusively , w ith infectio n. A ll clinical exam inatio ns
sh o uld includ e check ing fo r fever.
I n a febrile p atient, first lo o k fo r signs o f serio us illness, th en try to establish a
d iagno sis.
Signs of serious illness
– S igns o f sep sis with signs o f sho ck : circulato ry failure, resp irato ry d istress, p urp ura,
co nfusio n, co m a.
– S igns o f a sy stem ic illness: m eningeal sy nd ro m e, seiz ures, h eart m urm ur o n
auscultatio n, abd o m inal p ain, rash, etc.
– P atient‟s und erly ing co nd itio n: m alnutritio n, im m une sup p ressio n, sp lenecto m y ,
chro nic d isease, the very y o ung and the very o ld , bed rid d en p atients.
Aetiology
M any d ifferent d iseases, infectio us o r no ninfectio us, acute o r ch ro nic, benign o r
m alignant, m ay be acco m p anied by fever. A m o ng th e infectio us d iseases requiring
im m ed iate treatm ent, lo o k fo r:
– p urp ura fulm inans
– bacterial m eningitis
– severe m alaria
– severe bacterial sk in infectio ns
– acute p y elo nep hritis with urinary retentio n
– p erito nitis o r gastro intestinal infectio n
– p neum o nia with signs o f resp irato ry d istress
– subglo ttic o r ep iglo ttic lary ngitis
– end o card itis
– sep ticaem ia
I n the absence o f signs o f serio us illness and o bvio us d iagno sis, p atients m ay return
ho m e with an antip y retic and sho uld be ed ucated to p revent d ehy d ratio n (p lenty o f
fluid s) and to reco gniz e sy m p to m s that need m ed ical attentio n. P atients sho uld return
fo r a new co nsultatio n if th ere is no im p ro vem ent w ith in 4 8 h o urs o f th e initial
co nsultatio n o r befo re if their co nd itio n d eterio rates.
In case o f d o ubt (e.g. abo ut the evo lutio n, the quality o f surveillance) and d ep end ing o n
the co ntext ( geo grap h ical d istance, p ro blem s o f transp o rt), it m ay be better to k eep
p atients 1 2 to 2 4 ho urs fo r o bservatio n.
Complications
– C o nvulsio ns
– D ehy d ratio n
– C o nfusio n, d elirium
– S cho ck
It is im p o rtant, p articularly in child ren, to lo o k fo r signs o f these co m p licatio ns, to treat
them , and m o st im p o rtantly to p revent them .
1 Temperature should be measured over a period of 5 minutes when using a mercury thermometer.
26
