Treatment of diseases. Features of the occurrence and course of drug fever Symptoms during the period of increasing fever

Fever- increase in body temperature over 37.2°C when measured in the armpit.

Fever is not a disease. Usually this is a sign of our body's fight against infection, or fever can occur as a symptom of a disease of a non-infectious nature (for example, cancer, myocardial infarction, autoimmune process). In addition, a febrile state can occur after taking medications such as contraceptives, antibiotics, and drugs for the treatment of arterial hypertension. Also, an increase in body temperature appears when the balance between the processes of heat production and heat transfer is disturbed in the normal state of the thermoregulation center (hypothalamus). This condition occurs during heat stroke.

Normal body temperature varies among people and depends on factors such as food, exercise, sleep and time of day. The highest temperature is reached around 6 pm and drops to its maximum around 3 am. The difference between morning and evening temperatures in healthy people does not exceed 0.6° C.

Depending on the cause of occurrence, infectious and non-infectious fever are distinguished.

According to the degree of increase, body temperature is:

• subfebrile (37.2 - 37.9 °C);
• febrile (38.0 – 38.9 °C);
• high or pyretic (39.0 – 40.9 °C);
• excessive or hyperpyretic (41 °C and above).

Low-grade fever does not require medical intervention; taking medications at temperatures up to 38.0 °C is recommended only in cases where there are subjective sensations that bring discomfort. In other cases, when the temperature rises above 38.0 °C, it is necessary to prescribe medications whose action is aimed at normalizing the temperature.

It is important to remember that fever can be a symptom not only of a cold, but also of many other serious diseases. Therefore, even if you managed to lower your temperature on your own at home, you still need to consult a doctor to find out the reason that led to the development of a febrile state.

Symptoms

Often a person does not feel a slight rise in temperature. However, when the temperature is above 38.0 °C, the clinic most often appears. There is redness of the skin (mainly the face) and increased sweating, due to which the person begins to worry about thirst. Fever may also be accompanied by a headache and a feeling of aching bones. There is an increase in breathing rate, a decrease in appetite, and confusion may occur. The person becomes lethargic, inactive, and drowsiness occurs.

In children, it is important to distinguish between “red” and “white” fevers, as there are different treatment approaches. In the first type, the child’s condition and behavior are slightly disturbed, the skin is pink, moist, hot, and the limbs are warm. This fever is more common in children and is more favorable.

The second type is characterized by a severe general condition of the child, behavior is disrupted, lethargy, moodiness, chills, pale and dry skin, acrocyanosis (bluish tint of lips and nails), increased pulse and blood pressure appear. Against this background, serious complications may appear, such as febrile convulsions and toxic encephalopathy, which require emergency medical attention.

Diagnostics

Measuring temperature makes it possible to identify a febrile state and is of great importance for diagnosis.

The measurement is made with a medical thermometer, which can be mercury or digital. Before the measurement, you should lower the mercury column of the thermometer to 35 - 35.5 ° C, check the condition of the armpit (it should be dry and without damage), and also evaluate the condition of the thermometer itself (its integrity, serviceability). After this, the thermometer is placed in the armpit for 10 minutes. In this case, the shoulder should fit snugly to the chest so that the armpit is closed. In weak patients, as well as in children, it is necessary to hold your hand during measurement. Normal body temperature when measured in the armpit is considered to be 36.4-37.2°C.

To measure rectal temperature, it is better to purchase a special thermometer for this purpose, the end of which will be rounded rather than sharp.

It is not always possible to measure rectal temperature; there are also contraindications. In case of intestinal disorders, stool retention, inflammatory processes in the rectum, the presence of hemorrhoids and anal fissures (during their exacerbation), this is contraindicated.

The patient's position is lying on his side with his knees brought to his chest. A layer of Vaseline is applied to the end of the thermometer to prevent trauma to the rectum. The end of the Vaseline-lubricated thermometer is inserted into the anus approximately 2.5 cm or until the measuring tip is completely covered. During the measurement, it is recommended not to move for 2-3 minutes. If a thermometer, when measuring rectal temperature, shows 37.1–37.9 ° C, this is a normal temperature.

Sometimes the temperature is measured in the mouth (orally). In this case, for safe measurements, it is better to use an electronic thermometer. You should not take your temperature orally if your mouth is damaged. You will also get distorted results if the person recently drank cold or hot drinks before the measurement. The thermometer is placed under the tongue, the mouth is closed, tightly squeezing the thermometer with the lips. Normal temperature under the tongue is 36.7 -37.4 ° C.

Since fever is a symptom and not an independent disease, it is worth seeing a doctor for a diagnosis. To clarify the cause of the development of a febrile state, a number of studies are prescribed: a general blood test, a general urinalysis, a biochemical blood test, a plain X-ray of the chest organs, an ECG, etc.

Treatment

Since during a rise in temperature a metabolic disorder occurs, resulting in general weakness and exhaustion of the body, bed rest is recommended. You should also pay special attention to nutrition. Food should be easily digestible and high in calories. Meals should be divided into 5-6 meals, preference is given to dishes prepared in liquid or semi-liquid form. It is recommended to limit the intake of spicy and spicy foods. Additionally, anyone with a fever should drink plenty of fluids to prevent dehydration and also to help flush toxins out of the body faster.

If the temperature rises above 38°C, antipyretic drugs are prescribed. These include non-steroidal anti-inflammatory drugs (NSAIDs). This group of drugs helps reduce temperatures and eliminate pain, and also has an anti-inflammatory effect. In order to reduce temperature, preference is given to those medications that have the most pronounced antipyretic effect. If the temperature does not reach 38°C, you should not resort to medications, since the body is able to fight such fever figures on its own without disturbing the general condition of the person.

In cases where the fever is caused by a bacterial infection, the doctor will prescribe antibiotics. Their action is aimed at eliminating the immediate cause of the disease, the symptoms of which are fever. Therefore, in the case of competent selection of an antibiotic, a decrease in temperature should occur within the first 3 days of starting to take the drug. If this does not happen, the drug was selected incorrectly, so it is necessary to replace it with one of the representatives of another group of antibiotics. In addition, to ease general well-being and speed up the process of lowering the temperature, NSAIDs are used (together with antibacterial drugs).

If the increase in body temperature is caused by heatstroke, taking NSAIDs is not rational. In this case, the main goal is to cool the body to normal temperature to prevent damage to the brain and other vital organs. For this, ice packs that are placed in the armpits and popliteal fossae, a cold water bath, and cool wraps are suitable. In addition, you can spray the victim’s body with water to enhance the evaporation process, which will lead to a decrease in temperature. It is also recommended to drink plenty of fluids to normalize the water-salt balance.

Medicines

In the treatment of fever, non-steroidal anti-inflammatory drugs (NSAIDs) are used, which have antipyretic, anti-inflammatory and analgesic effects. To reduce fever, preference is given to drugs with a pronounced antipyretic effect.

These include:

1. Paracetamol. A drug with a pronounced antipyretic effect, due to which the temperature decreases. It is well tolerated by both children and adults, and is therefore often prescribed for the treatment of fever. But it is important to remember that long-term use of paracetamol in large doses has a toxic effect on the liver. Therefore, before taking the drug, you should consult your doctor and ensure that you do not exceed the maximum recommended dose. Paracetamol is included in many powders (Theraflu, ORVIcold, Fervex, etc.).
2. Aspirin. It still remains relevant due to its low cost and low toxicity. But it is important to remember that in children under 12 years of age, aspirin is contraindicated due to the possibility of developing Reye's syndrome. This syndrome is characterized by severe encephalopathy and toxic liver damage, often leading to death.
3. Ibuprofen. Available in the form of tablets, syrup, suspension, rectal suppositories. It is used in both adults and children. It has moderate antipyretic, anti-inflammatory and analgesic effects. There is evidence that ibuprofen is able to stimulate the immune system and increase the body's protective properties by influencing the production of endogenous interferon. In the treatment of fever it is inferior to paracetamol, therefore it is a second-line drug.

Since all NSAIDs are, to a greater or lesser extent, capable of affecting the mucous membrane of the gastrointestinal tract with the further development of gastritis and peptic ulcers, it is recommended to take drugs in this group exclusively after meals.

Folk remedies

Treatment of fever with folk remedies can be carried out at home, but it is important to remember that an increase in body temperature very often accompanies severe and dangerous diseases that require immediate medical attention, therefore, to make a diagnosis and prescribe the necessary treatment, you should consult a doctor as soon as possible.

Drinking warm and plenty of fluids helps to bring down the temperature and sweat thoroughly when you have a cold. When sweat is released, natural thermoregulation occurs: sweat begins to evaporate, and the surface of the body cools down. The means that give this effect are berry compotes and fruit drinks, which are recommended to be consumed warm. Cranberries, raspberries, lingonberries, rose hips, and red currants are suitable for preparing such drinks. Fruit drinks and infusions from these berries are a means of increasing sweating; they are also rich in vitamin C. In addition, vitamin C is found in citrus fruits: lemons, oranges, grapefruits.

An infusion of lilac leaves also helps against fever. To prepare it, you need to prepare 20 leaves in advance, which are poured with boiling water and infused for two hours. After filtering, the infusion is taken 2 times a day, 100 ml. The duration of the course is 10 days.

You can also use antipyretic medicinal plants and herbs, for example, nettle, flowers and leaves of clasp, elderberry, rose hips and rowan, linden tea. It should be remembered that when using them, the temperature will not drop immediately, but only after some time.

Cranberry copes well with elevated body temperature. It is a very effective anti-inflammatory, antimicrobial, diuretic and tonic. But do not forget that cranberries can increase the acidity of gastric juice, so those who suffer from gastritis, gastric ulcers and duodenal ulcers should avoid this remedy.

The most popular folk remedy for treating fever is raspberry, popularly called natural aspirin. It is noteworthy that after brewing raspberries with boiling water, all its beneficial properties are only enhanced. This is why we are used to drinking raspberry tea when we have a cold.

The room where there is a person with elevated body temperature must be systematically ventilated. It is also necessary to change bed and underwear frequently, especially if the patient has sweated. While the temperature remains high, bed rest must be observed.

Remember that under no circumstances should you self-medicate, but should consult a doctor!

The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.

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

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

Relapsing fevers (typhoid) are a group of acute infectious diseases caused by treponemes of the genus Borrelia that are pathogenic for humans; manifested by a series of febrile attacks with headaches, muscle and joint pain, diarrhea, vomiting, cough, eye pain, and enlarged spleen. The 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 systemic fever with joint pain or hemorrhagic syndrome.

Hemorrhagic Congo-Crimean 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.

Laotian hemorrhagic fever 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 is an acute infectious disease that occurs in the form of chronic progressive nephritis with the development of renal 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.

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

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

Trench fever is an acute infectious disease that typically occurs in a paroxysmal form with repeated four- or 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 Rickettsia Rochalimaea quintana.

Acute rheumatic fever is a disease characterized by systemic inflammatory damage to connective tissue of an 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, widely used in practice, is currently used to designate a pathological condition that combines acute rheumatic fever and rheumatic heart disease.

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

Pappataci 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 a papular-hemorrhagic rash throughout the body, enanthema of the mucous membranes and various complications, especially skin necrosis in the groin area.

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

Treatment of fever

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

A more detailed course of treatment is drawn up by a 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-infectious diseases due to the body’s reaction either to endotoxins entering the blood during the death of its own microflora, or to endogenous pyrogens released during the destruction primarily of leukocytes, other normal and pathologically altered tissues during septic inflammation, as well as autoimmune and metabolic disorders.

Development mechanism

Thermoregulation in the human body is ensured 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 ensure physiological fluctuations in human body temperature, can be disrupted by various exo- or endogenous factors (infection, intoxication, tumor, etc.). In this case, pyrogens formed during inflammation primarily affect activated leukocytes, which synthesize IL-1 (as well as IL-6, TNF and other biologically active substances), which stimulates 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 in 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.

By changes in body temperature over time The following types of fever are distinguished::

1. Constant- body temperature is usually high (about 39 °C), lasting 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 after 1-3 days of normal and hyperthermic states (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 increased temperature up to 39-40 ° C and periods of normal or subfebrile temperature (with relapsing fever).

   wavy- with a gradual increase day by day and the same gradual decrease (with lymphogranulomatosis, brucellosis, etc.).

   Wrong fever- without a specific pattern in daily fluctuations (with rheumatism, pneumonia, influenza, cancer).

   Kinky Fever- morning temperature is higher than evening temperature (with tuberculosis, viral diseases, sepsis).

Based on combination with other symptoms of the disease, the following forms of fever are distinguished:

1. Fever is a significant manifestation of the disease or its combination with such nonspecific symptoms as weakness, sweating, increased excitability 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 you should, with tact, measure the temperature simultaneously in both armpits and even in the rectum in the presence of medical workers.

   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 tests exclude evidence in favor of any acute specific infection. In a word, the patient seems to “burn out” for an unknown reason.

   Fever is combined with both pronounced nonspecific acute phase reactions and organ changes of unknown nature (abdominal pain, hepatomegaly, arthralgia, etc.). Options for combining organ changes can be very different, although they are not always connected by a single development mechanism. 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 of initial examination of a patient with fever includes such generally accepted methods of laboratory and instrumental diagnostics as a general blood test, urine test, chest X-ray, ECG and Echo CG. When their information content is low and depending on the clinical manifestations of the disease, more complex laboratory diagnostic methods are used (microbiological, serological, endoscopic with biopsy, CT, arteriography, etc.). By the way, in the structure of fever of unknown origin, 5-7% is accounted for by the so-called drug fever. Therefore, if there are no obvious signs of acute abdomen, bacterial sepsis or endocarditis, then during 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 manifested by hyperthermia for a long time makes it difficult to formulate reliable principles of differential diagnosis. Taking into account the prevalence of diseases with severe fever, it is recommended that the differential diagnostic search be focused 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 due to illnesses caused by infection

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

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

classical infectious diseases with severe acute specific fever.

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

This section discusses those that are most often encountered in the medical practice of a doctor and can manifest themselves for a long time only as fever of unknown origin.

Endocarditis. In the practice of a therapist, infective endocarditis currently occupies a special place as a cause of fever of unknown origin, in which fever (chills) often far outstrips the physical manifestations of heart disease (murmurs, enlargement of the borders of the heart, thromboembolism, etc.). At risk for infective endocarditis are drug addicts (injecting drugs) and people who have been administered parenteral medications for a long time. 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-fold 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 is antibacterial drugs after determining the sensitivity of the pathogen to them.

Tuberculosis. Fever is often the only manifestation of tuberculosis of the lymph nodes, liver, kidneys, adrenal glands, pericardium, peritoneum, mesentery, and mediastinum. Currently, tuberculosis is often combined with congenital and acquired immunodeficiency. The lungs are most often affected by tuberculosis, and the x-ray method is one of the most informative. Reliable bacteriological research method. Mycobacterium tuberculosis can be isolated not only from sputum, but also from urine, gastric juice, cerebrospinal fluid, and from peritoneal and pleural effusion.

Fever I Fever (febris, pyrexia)

a typical thermoregulatory protective-adaptive body response to the effects of pyrogenic substances, expressed by a temporary restructuring of heat exchange to maintain a higher than normal heat content and body temperature.

L. is based on the peculiar reaction of the hypothalamic centers of thermoregulation in various diseases to the action of pyrogenic substances (pyrogens). The entry of exogenous (for example, bacterial) pyrogens causes the appearance in the blood of secondary (endogenous) pyrogenic substances, which are characterized by bacterial thermal stability. Endogenous are formed in the body by granulocytes and macrophages when they come into contact with bacterial pyrogens or products of aseptic inflammation.

In infectious L., pyrogens are microbial products, products of metabolism and decay of microorganisms. Bacterial pyrogens are strong stress agents, and their introduction into the body causes a stress (hormonal) reaction, accompanied by neutrophilic leukocytosis. This reaction, developed during evolution, is nonspecific to many infectious diseases. Non-infectious L. can be caused by plant, animal, or industrial poisons; it is possible with allergic reactions, parenteral administration of protein, aseptic inflammation, tissue necrosis caused by circulatory disorders, tumors, neuroses, vegetative-vascular dystonia. They penetrate into the site of inflammation or tissue, which produces leukocyte pyrogen. An increase in body temperature without the participation of pyrogens is observed during emotional stress; some researchers view this reaction as a fever-like state of mixed origin.

An increase in body temperature during L. is carried out by the mechanisms of physical and chemical thermoregulation (thermoregulation). An increase in heat production occurs mainly due to muscle tremors (see Chills), and a limitation of heat transfer occurs as a result of spasm of peripheral blood vessels and decreased sweating. Normally, these thermoregulatory reactions develop during cooling. Their activation during L. is determined by the action of pyrogen on the neurons of the medial preoptic region of the anterior hypothalamus. With L., before the body temperature rises, there is a change in the sensitivity thresholds of the thermoregulation center to the temperature afferent signals entering it. cold-sensitive neurons in the medial preoptic area increases, and heat-sensitive neurons decrease. An increase in body temperature during L. differs from overheating of the body (Overheating of the body) in that it develops regardless of fluctuations in ambient temperature, and the degree of this increase is actively regulated by the body. When the body overheats, it increases only after the maximum tension of the physiological mechanisms of heat transfer turns out to be insufficient to remove heat into the environment at the same rate as its formation in the body.

Fever goes through three stages in its development ( rice. 1 ): in the first stage - there is an increase in body temperature; in the second stage - the temperature remains at high levels; in the third stage the temperature decreases. In the first stage of L., there is a limitation of heat transfer, as indicated by a narrowing of the blood vessels of the skin and, in connection with this, a limitation of blood flow, a decrease in skin temperature, and a decrease or cessation of sweating. At the same time, it increases and increases. Usually these phenomena are accompanied by general malaise, chills, nagging muscle pain, and headache. With the cessation of the rise in body temperature and the transition of heat to the second stage, it increases and is balanced with heat production at a new level. in the skin becomes intense, the pallor of the skin gives way to hyperemia, the skin temperature rises. The feeling of cold passes and intensifies. The third stage is characterized by the predominance of heat transfer by heat production. The skin continues to expand and sweating increases.

Based on the degree of increase in body temperature, subfebrile (from 37° to 38°), moderate (from 38° to 39°), high (from 39° to 41°) and excessive, or hyperpyretic, fever (over 41°) are distinguished. In typical cases of acute infectious diseases, the most favorable form is moderate fever with daily temperature fluctuations within 1°.

Based on the types of temperature curves, the following main types of fever are distinguished: constant, remitting (laxative), intermittent (intermittent), perverted, hectic (depleting) and irregular. With constant L., elevated body temperature lasts for several days or weeks with daily fluctuations within 1° ( rice. 2, a ). Such L. is characteristic, for example, of lobar pneumonia and typhus. In remitting L., which is observed in purulent diseases (for example, exudative pleurisy, lung abscess), temperature fluctuations during the day reach 2°C or more ( rice. 2, b ). Intermittent fever is characterized by alternating periods of normal body temperature and elevated ones; in this case, it is possible as sharp, for example with malaria ( rice. 2 in ), relapsing fever (relapsing L.), and gradual, for example with brucellosis (undulating L.), an increase and decrease in body temperature ( rice. 2, g, d ). With perverted L., morning body temperature is higher than evening. This type of L. can sometimes occur with severe tuberculosis and prolonged forms of sepsis. With hectic L. ( rice. 2, e ) changes in body temperature are 3-4° and occur 2-3 times a day; this is typical for severe forms of tuberculosis and sepsis. With incorrect L. ( rice. 2, f ) there is no certain pattern in daily fluctuations in body temperature; occurs most often in rheumatism, pneumonia, influenza, dysentery.

Types of L. during illness can alternate or change from one to another. The intensity of the feverish reaction may vary depending on the functional state of the central nervous system. at the time of exposure to pyrogens. The duration of each stage is determined by many factors, in particular the dose of pyrogen, the time of its action, disorders that have arisen in the body under the influence of a pathogenic agent, etc. L. can end with a sudden and rapid drop in body temperature to normal and even below () or a gradual slow decrease body temperature (). The most severe toxic forms of some infectious diseases, as well as in the elderly, weakened people, and young children, often occur almost without L. or even with hypothermia, which is an unfavorable prognostic sign.

With L., a change in metabolism occurs (protein breakdown increases), sometimes disruption of the activity of the central nervous system, cardiovascular and respiratory systems, and gastrointestinal tract occurs. At altitude, delirium and subsequent loss of consciousness are sometimes observed. These phenomena are not directly related to the nervous mechanism of L. development; they reflect the features of intoxication and pathogenesis of the disease.

An increase in body temperature during L. is accompanied by an increase in heart rate. This does not occur in all febrile illnesses. So, with typhoid fever it is noted. The effect of increased body temperature on heart rhythm is weakened by other pathogenetic factors of the disease. An increase in heart rate, directly proportional to the increase in body temperature, is observed in L. caused by low-toxic pyrogens.

Breathing becomes more frequent as body temperature rises. The degree of increased breathing is subject to significant fluctuations and is not always proportional to the increase in body temperature. Increased breathing is mostly combined with a decrease in its depth.

With L., the digestive organs are disrupted (decreased digestion and absorption of food). Patients are coated, have dry mouth, and are sharply reduced. The secretory activity of the submandibular glands, stomach and pancreas is weakened. The motor activity of the gastrointestinal tract is characterized by dystonia with a predominance of increased tone and a tendency to spastic contractions, especially in the pyloric region. As a result of decreased opening of the pylorus, the rate of evacuation of food from the stomach slows down. The formation of bile decreases somewhat, but it increases.

Kidney activity during L. is not noticeably impaired. The increase in diuresis at the beginning of L. is explained by the redistribution of blood and an increase in its quantity in the kidneys. Water retention in tissues at altitude is often accompanied by a decrease in diuresis and an increase in urine concentration. There is an increase in the barrier and antitoxic function of the liver, urea formation and an increase in fibrinogen production. The phagocytic activity of leukocytes and fixed macrophages increases, as well as the intensity of antibody production. The production and release of corticosteroids by the pituitary gland, which have a desensitizing and anti-inflammatory effect, is enhanced.

Metabolic disorders depend more on the development of the underlying disease than on an increase in body temperature. Strengthening the immune system and mobilizing humoral mediators help increase the body’s protective functions against infection and the inflammatory process. creates less favorable conditions in the body for the proliferation of many pathogenic viruses and bacteria. In this regard, the main focus should be on eliminating the disease that caused L. The question of the use of antipyretics is decided by the doctor in each specific case, depending on the nature of the disease, the age of the patient, his premorbid condition and individual characteristics.

Treatment tactics with L. of infectious and non-infectious origin is the same in relation to the overriding importance of therapy for the underlying disease, but it differs fundamentally in the indications for symptomatic antipyretic therapy. The differences are determined by the fact that non-infectious L. is often a pathological phenomenon, the elimination of which in many cases is advisable, while infectious L., as a rule, serves as an adequate protective reaction of the body to the introduction of a pathogen. Elimination of infectious L., achieved with the help of antipyretics, is accompanied by a decrease in phagocytosis and other immune reactions, which leads to an increase in the duration of inflammatory infectious processes and the wedge period. manifestations of illness (for example, cough, runny nose), incl. and such, in addition to L., manifestations of infectious intoxication as general and muscle weakness, lack of appetite, exhaustion, . Therefore, in case of infectious L., the prescription of symptomatic therapy requires the doctor to clearly justify its need, determined individually.

In acute infectious diseases, the indication for symptomatic treatment of L. is an increase in body temperature to 38°C or more in patients with bleeding, hemoptysis, mitral stenosis, circulatory failure of II-III degree, decompensated diabetes mellitus, in pregnant women, or an increase to 40°C or more in previously healthy individuals, including children, especially if an inadequate rise in temperature is suspected due to an infectious lesion of the central nervous system. with thermoregulation disorder. Subjectively bad fever in patients is not always a sufficient justification for the use of drugs to reduce body temperature. In many cases, even with significant hyperthermia (40°-41°) in adults, you can limit yourself to non-medicinal methods of increasing heat transfer that improve the patient’s well-being: ventilating the room where it is located, eliminating excess underwear and warm bed linen, wiping the body with a damp towel, drinking small portions ( absorbed almost in the oral cavity) cool water. At the same time, one must monitor changes in breathing and; in case of pronounced deviations (in older people they are possible when body temperature rises to 38-38.5°), it should be used. Since L. is often combined with aches in the joints and muscles, headache, preference is given to antipyretics from the group of non-narcotic analgesics, especially analgin (for adults - up to 1 G appointment). For low-grade infectious fever, symptomatic treatment is not performed.

For non-infectious L., symptomatic therapy is carried out in the same cases as for infectious L., and in addition, if the patient has poor tolerance to increases in body temperature, even if it does not reach febrile values. However, in the latter case, the doctor must compare the expected effectiveness of treatment with the possible adverse effects of the use of drugs, especially if it is long-term. It should be taken into account that antipyretic drugs from the group of non-narcotic analgesics are practically ineffective for non-infectious L..

In some pathological conditions, such as thyrotoxic crisis, malignant hyperthermia (see Hyperthermic syndrome), the appearance of significant L. requires emergency treatment measures. An increase in body temperature to febrile levels in patients with thyrotoxicosis (both against the background of an infectious disease and without it) may be one of the symptoms of a developing thyrotoxic crisis, in which the patient must be urgently hospitalized, providing emergency care.

Bibliography: Veselkin P.N. Fever, M., 1963, bibliogr.; aka. Fever, BME, vol. 13, p. 217, M., 1980, bibliogr.; Multi-volume guide to pathological physiology, ed. N.N. Sirotinina, vol. 2, p. 203, M., 1966; man, ed. R. Schmidt and G. Tevs, . from English, vol. 4, p. 18, M., 1986.

a protective-adaptive reaction of the body that occurs in response to the action of pathogenic stimuli and is expressed in the restructuring of thermoregulation to maintain a higher than normal level of heat content and body temperature.

Nutritional fever(f. alimentaria) - L. in infants, caused by inadequate food composition (usually insufficient amount

Atypical fever(f. atypica) - A., occurring in a form that is not typical for this disease.

Wave-like fever(f. undulans; L. undulating) - L., characterized by alternating periods of increase and decrease in body temperature over several days.

Fever is high- L., at which the body temperature is in the range from 39 to 41°.

Hectic fever(f. hectica; synonym: L. debilitating, L. debilitating) - L., characterized by very large (3-5°) rises and rapid declines in body temperature, repeated 2-3 times a day; observed, for example, in sepsis.

Hyperpyretic fever(f. hyperpyretica; syn. L. excessive) - L. with body temperature above 41°.

Purulent-resorptive fever(f. purulentoresorptiva; synonym: L. wound, L. toxic-resorptive,) - L. caused by the absorption of toxic products from the focus of purulent inflammation.

Perverted fever(f. inversa) - L., in which the morning body temperature is higher than the evening.

Debilitating fever(f. hectica) - see Hectic fever .

Fever is intermittent(f. intermittens) - see Intermittent fever .

Infectious fever(f. infectiva) - L. that occurs during an infectious disease and is caused by the impact on the body of metabolic products or decay of pathogens, as well as endogenous pyrogens formed during the infectious process.

Debilitating fever(f. ictalis) - see Hectic fever .

Milk fever(f. lactea) - L., which occurs during acute stagnation of milk in the mammary gland.

Non-infectious fever(f. non infectiva) - L. not associated with an infectious process, for example, caused by aseptic tissue damage, irritation of certain receptor zones, or the introduction of pyrogenic substances into the body.

Fever is wrong(f. irregularis) - L. without any pattern in the alternation of periods of increase and decrease in body temperature.

Intermittent fever(f. intermittens; synonym L. intermittent) - L., characterized by alternating periods of elevated body temperature with periods of normal or reduced temperature during the day.

Relieving fever(obsolete) - see Remitting fever .

Constant fever(f. continua) - L., in which daily fluctuations in body temperature do not exceed 1°; observed, for example, with typhus, lobar pneumonia.

Wound fever(f. vulneralis) - see Purulent-resorptive fever .

Remitting fever(f. remittens: synonym L. laxative - outdated) - L. with daily fluctuations in body temperature within 1-1.5 ° without decreasing to normal levels.

Recurrent fever(f. recidiva) - L., characterized by repeated rises in the patient’s body temperature after it has decreased for several days to normal values.

Salt fever- L., developing with uncompensated retention of sodium chloride in the body; observed, for example, in infants with malnutrition.

Low-grade fever(f. subfebrilis) - L., in which the body temperature does not rise above 38°.

Toxic-resorptive fever(f. toxicoresorptiva) - see Purulent-resorptive fever .

Moderate fever- L., at which the body temperature is in the range from 38 to 39°.

Undulating fever(f. undulans) -

1) see Wavy fever;

Fever is a protective-adaptive mechanism of the human body that develops as a reaction to the influence of pathogenic stimuli. Sometimes fever also occurs with non-infectious illnesses. 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?

The processes of thermoregulation in the human body are determined by the thermoregulation center, which is located in the person. These processes may be disrupted exogenous or endogenous factors. Sometimes the temperature rises in the event of a disturbance in the processes of heat production and heat transfer and in the normal state of the thermoregulation center.

The main manifestations of fever are increased body temperature. If normal body temperature, measured in the armpit, should be 36.0-36.9, then with fever these indicators increase. With a fever, a person experiences chills, headache, weakness, and severe muscle aches.

Classification of fevers is practiced depending on various factors. Taking into account the reason for 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 varies low-grade fever fever (body temperature 37-37.9 °C), febrile fever (body temperature 38-38.9 °C), pyretic or high fever (body temperature 39-40.9 °C) And hyperpyretic or excessive fever (body temperature 41 °C and more).

Depending on the duration of this condition, it varies acute , subacute And chronic fever.

According to the assessment of body temperature indicators and the time when they appear, it is determined constant , laxative , intermittent , returnable , wavy , wrong , perverted , hectic fever. All types of fever have peculiarities of their course. For example, hectic fever develops with strong fluctuations in body temperature. These types of fever appear with 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 Crimea. Signs of this disease were discovered in 1944. Its causative agent is RNA virus, which enters the body through the skin when a person is bitten by a tick.

Symptoms of hemorrhagic fever manifest themselves acutely: body temperature rises sharply, intoxication is noted, as well as hemorrhagic syndrome (high level of bleeding). The patient may be bothered by vomiting, and in the initial period there is noticeable redness of the face. After 2-6 days, hemorrhagic syndrome is observed, which is characterized by the appearance hemorrhagic rash on the shoulders, feet, hands.

If hemorrhagic fever with renal syndrome develops, then the acute onset of fever is combined with symptoms of intoxication and serious kidney damage. As a consequence, hemorrhagic renal fever leads to kidney damage and liver failure. There is bleeding from the gums, nosebleeds, and the person may lose consciousness. Viral diseases associated with hemorrhagic syndrome, are also dangerous because a person may develop bleeding in the stomach and intestines. Development of complications ( sepsis , pulmonary edema , pneumonia ) and improper treatment can be fatal. Therefore, prevention of infection is important: immediately after a tick bite, you need to consult a specialist. Far Eastern hemorrhagic fever is a serious disease that requires urgent treatment.

Prolonged fever of unknown origin can be diagnosed if the body temperature is high (above 38 degrees) lasts for more than two weeks in the patient, and the reasons for this phenomenon remain unknown. At the same time, a comprehensive examination was carried out and all diagnostic standards were taken into account. A very important point is the differential diagnosis of fever of unknown origin, since sometimes this diagnosis can be made incorrectly. According to some experts, this type of fever is based on infection, the development of a malignant tumor, and systemic connective tissue diseases. Approximately at 20% In cases of this type of fever, both in children and adults, the cause remains unclear. Treatment of the disease is prescribed depending on the intensity of the fever.

Yellow fever humans become infected from animals and people; the pathogen is transmitted by mosquitoes. The first symptoms of yellow fever appear approximately 3-6 days after a mosquito bite. The onset of yellow fever is acute: body temperature rises to 40 degrees, severe headache and pain in the joints, back, and legs appear. There is also a hemorrhagic component: the patient’s face becomes very red and swollen. Already on the second day the 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 only lasts a few hours. Then the person becomes worse, as thrombohemorrhagic syndrome develops. Bleeding and bloody vomiting are possible. 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. The main preventive measures are vaccination. Vaccination against yellow fever is mandatory if a person travels to areas where this disease is endemic. More than 45 endemic countries have been identified in Latin America And Africa, when traveling to which it is necessary to get vaccinated ( Colombia, Peru, Brazil, Ecuador, Kenya and etc.)

After making a diagnosis, the doctor prescribes treatment for the disease that has been diagnosed. It is important not to delay contacting a specialist for conditions that cause anxiety. Eg, white fever Children exhibit inadequate heat transfer, so there is a danger of serious overheating of the body. In this case, you should consult a doctor immediately to determine the causes of this condition and prescribe treatment. You should consult your doctor if your child has post-immunization fever , that is, an increase in temperature after vaccinations.

If a woman exhibits milk fever , that is, the body’s reaction to the appearance of milk in the breasts of a nursing mother, you should not wait until this condition goes away on its own. This is fraught with complications, so the breast must be examined by a doctor.

Fever on the lips (as people call rashes) periodically appears in people who are infected with the herpes virus. Doctors still don’t know how to cure herpes completely. However, local remedies can reduce the manifestations of the disease. How to treat lip fever is worth asking your doctor.