Depending on the degree of temperature increase, the following types of fevers are distinguished:

subfebrile temperature - 37-38°C:

low-grade fever - 37-37.5°C;

high subfebrile condition - 37.5-38°C;

moderate fever - 38-39°C;

high fever - 39-40°C;

very high fever - over 40°C;

hyperpyretic - 41-42°C, it is accompanied by severe nervous phenomena and is itself life-threatening.

Fluctuations in body temperature throughout the day and throughout the entire period of the disease are of great importance.

Main types of fever

constant fever (febris continua). The temperature stays high for a long time. During the day, the difference between morning and evening temperatures does not exceed 1°C; characteristic of lobar pneumonia, stage II of typhoid fever;

laxative (remitting) fever (febris remittens). The temperature is high, daily temperature fluctuations exceed 1-2°C, with the morning minimum above 37°C; characteristic of tuberculosis, purulent diseases, focal pneumonia, in stage III of typhoid fever;

wasting (hectic) fever (febris hectica) is characterized by large (3-4°C) daily temperature fluctuations, which alternate with a drop to normal or below, which is accompanied by debilitating sweats; typical for severe pulmonary tuberculosis, suppuration, sepsis;

intermittent (intermittent) fever (febris intermittens) - short-term increases in temperature to high numbers strictly alternate with periods (1-2 days) of normal temperature; observed in malaria;

undulating fever (febris undulans). It is characterized by periodic increases in temperature, and then a decrease in the level to normal numbers. Such “waves” follow one another for a long time; characteristic of brucellosis, lymphogranulomatosis;

relapsing fever (febris recurrens) is a strict alternation of periods of high temperature with fever-free periods. At the same time, the temperature rises and falls very quickly. The febrile and non-febrile phases last for several days each. Characteristic of relapsing fever;

reverse type of fever (febris inversus) - morning temperature is higher than evening temperature; sometimes observed in sepsis, tuberculosis, brucellosis;

irregular fever (febris irregularis) is characterized by varied and irregular daily fluctuations; often observed in rheumatism, endocarditis, sepsis, tuberculosis. This fever is also called atypical (irregular).

Analysis of the temperature response allows us to assess the height, duration and types of temperature fluctuations, as well as the nature of the accompanying clinical manifestations of the disease.

Types of fevers

The following types of fevers in children are distinguished:

· short-term fever (up to 5-7 days) with a presumed localization, in which the diagnosis can be made on the basis of clinical history and physical findings, with or without laboratory tests;

· fever without a focus, for which the history and physical examination are not suggestive of a diagnosis, but laboratory tests can reveal the etiology;

fever of unknown origin (FUO);

low-grade fever

Feverish reactions are assessed depending on the level of temperature rise, the duration of the febrile period and the nature of the temperature curve.

Types of febrile reactions depending on the degree of increase in body temperature

Only some diseases manifest themselves with characteristic, pronounced temperature curves; however, it is important to know their types for differential diagnosis. It is not always possible to accurately correlate typical changes with the onset of the disease, especially with early antibiotic therapy. However, in some cases, the nature of the onset of fever can suggest a diagnosis. Thus, a sudden onset is characteristic of influenza, meningitis, malaria, subacute (2-3 days) - for typhus, psittacosis, Q fever, gradual - typhoid fever, brucellosis.

Based on the nature of the temperature curve, several types of fevers are distinguished

Persistent fever(febris continua) – temperature exceeds 390C, the differences between morning and evening body temperature are insignificant (maximum 10C). Body temperature remains uniformly high throughout the day. This type of fever occurs in untreated pneumococcal pneumonia, typhoid fever, paratyphoid fever and erysipelas.

Laxative(remitting) fever(febris remittens) – daily temperature fluctuations exceed 10C, and it can drop below 380C, but does not reach normal numbers; observed in pneumonia, viral diseases, acute rheumatic fever, juvenile rheumatoid arthritis, endocarditis, tuberculosis, abscesses.

Intermittent(intermittent) fever(febris intermittens) – daily fluctuations in maximum and minimum temperatures of at least 10C, periods of normal and elevated temperatures often alternate; a similar type of fever is inherent in malaria, pyelonephritis, pleurisy, and sepsis.

Exhaustive, or hectic, fever(febris hectica) - the temperature curve resembles that of a laxative fever, but its daily fluctuations are more than 2-30C; a similar type of fever can occur with tuberculosis and sepsis.

Relapsing fever(febris recurrens) – high fever for 2-7 days, alternating with periods of normal temperature lasting several days. The febrile period begins suddenly and also ends suddenly. A similar type of febrile reaction is observed in relapsing fever and malaria.

Undulating fever(febris undulans) - manifests itself as a gradual increase in temperature from day to day to high numbers, followed by a decrease in it and the repeated formation of individual waves; a similar type of fever occurs with lymphogranulomatosis and brucellosis.

Perverted(inverse) fever(febris inverse) – there is a distortion of the daily temperature rhythm with higher temperature rises in the morning; a similar type of fever occurs in patients with tuberculosis, sepsis, tumors, and is characteristic of some rheumatic diseases.

Incorrect or atypical fever(irregularis or febris atypical) - fever in which there are no patterns of rise and fall in temperature.

Monotonous type of fever - with a small range of fluctuations between morning and evening body temperature;

It should be noted that at present, typical temperature curves are rare, which is associated with the use of etiotropic and antipyretic drugs.

Types of fevers

Depending on the degree of temperature increase, the following types of fevers are distinguished:

1) subfebrile temperature - 37-38°C:

low-grade fever - 37-37.5°C;

high subfebrile condition - 37.5-38°C;

2) moderate fever - 38-39°C;

3) high fever - 39-40°C;

4) very high fever - over 40°C;

5) hyperpyretic - 41-42°C, it is accompanied by severe nervous phenomena and is itself life-threatening.

Fluctuations in body temperature throughout the day and throughout the entire period of the disease are of great importance.

Main types of fever:

1) constant fever (febris continua). The temperature stays high for a long time. During the day, the difference between morning and evening temperatures does not exceed 1°C; characteristic of lobar pneumonia, stage II of typhoid fever;

2) laxative (remitting) fever (febris remittens). The temperature is high, daily temperature fluctuations exceed 1-2°C, with the morning minimum above 37°C; characteristic of tuberculosis, purulent diseases, focal pneumonia, in stage III of typhoid fever;

3) debilitating (hectic) fever (febris hectica) is characterized by large (3-4°C) daily temperature fluctuations, which alternate with a drop to normal or below, which is accompanied by debilitating sweats; typical for severe pulmonary tuberculosis, suppuration, sepsis;

4) intermittent (intermittent) fever (febris intermittens) - short-term increases in temperature to high numbers strictly alternate with periods (1-2 days) of normal temperature; observed in malaria;

5) undulating (undulating) fever (febris undulans). It is characterized by periodic increases in temperature, and then a decrease in the level to normal numbers. Such “waves” follow one another for a long time; characteristic of brucellosis, lymphogranulomatosis;

6) recurrent fever (febris recurrens) - strict alternation of periods of high temperature with fever-free periods. At the same time, the temperature rises and falls very quickly. The febrile and non-febrile phases last for several days each. Characteristic of relapsing fever;

7) reverse type of fever (febris inversus) - morning temperature is higher than evening temperature; sometimes observed in sepsis, tuberculosis, brucellosis;

8) irregular fever (febris irregularis) is characterized by varied and irregular daily fluctuations; often observed in rheumatism, endocarditis, sepsis, tuberculosis. This fever is also called atypical (irregular).

Basic mechanisms of fever development

Fever is an increase in body temperature caused by disruption and restructuring of thermoregulation processes.

The appearance of fever is associated with the formation in the patient’s body of specific substances (pyrogens) that change the functional activity of thermoregulation centers. Most often, various pathogenic bacteria and viruses, as well as their decay products, act as pyrogens.

Therefore, fever is the leading symptom of many infectious diseases.

Feverish reactions can also be observed during inflammations of a non-infectious nature (aseptic), which are caused by mechanical, chemical and physical damage.

Fever is also accompanied by tissue necrosis, which develops as a result of circulatory disorders, for example, during myocardial infarction. Feverish conditions are observed in malignant tumors, some endocrine diseases that occur with increased metabolism (thyrotoxicosis), allergic reactions, dysfunction of the central nervous system (thermoneuroses), etc.

In many cases (taking into account the nature of fever, the age of patients, concomitant diseases), fever can play an extremely unfavorable role in the course of diseases and their outcome. Therefore, fever therapy in each specific situation requires an individual and differentiated approach.

The severity of the febrile reaction depends not only on the disease that caused it, but also to a large extent on the reactivity of the body. Thus, in elderly and weakened patients, some inflammatory diseases, such as acute pneumonia, can occur without severe fever.

In addition, patients subjectively tolerate increased temperature differently.

An artificially induced increase in body temperature (pyrotherapy) is sometimes used for medicinal purposes, in particular, for a number of indolent infections.

Based on the duration of the course, they distinguish between fleeting (lasting several hours), acute (up to 15 days), subacute (15-45 days) and chronic (over 45 days) fever.

4.1 Care of febrile patients

Care necessary for the patient during the period of fever

In the first stage of fever, when there is an increase in temperature, the patient experiences muscle tremors, headache, and malaise. During this period, the patient must be warmed, put to bed and carefully monitor the condition of various organs and systems of the body.

Care is necessary for the patient during periods of constantly elevated temperature.

In the second stage of fever, the temperature is constantly elevated, which is characterized by a relative equilibrium of the processes of heat production and heat transfer. During this period, chills and muscle tremors weaken, but general weakness, headache, and dry mouth are observed. In the second stage, pronounced changes in the central nervous system, as well as the cardiovascular system, can be observed. At the height of fever, delirium and hallucinations are possible, and in young children - convulsions. At this time, careful care of the patients’ oral cavity is necessary, lubrication of cracks in the mouth, etc., meals are prescribed in fractions, and drinking is plentiful. When patients stay in bed for a long time, mandatory prevention of bedsores is carried out.

Features of caring for a patient in the stage of fever reduction

The third stage of fever - the stage of decrease or decline in temperature is characterized by a significant predominance of heat transfer over heat production due to the expansion of peripheral blood vessels and a significant increase in sweating.

Lysis and crisis of a feverish patient

A slow drop in temperature that occurs over several days is called lysis. A rapid, often within 5-8 hours, drop in temperature from high values ​​(39-40°C) to normal and even subnormal values ​​is called a crisis.

Danger of crisis for the patient

As a result of a sharp restructuring of the regulatory mechanisms of the cardiovascular system, a crisis may carry with it the danger of developing a collaptoid state - acute vascular failure, which is manifested by severe weakness, profuse sweating, pallor and cyanosis of the skin, a drop in blood pressure, increased heart rate and a decrease in its filling up to threadlike appearance.

Caring for a patient during a crisis

Critical a drop in body temperature requires medical workers to take appropriate measures: administering drugs that stimulate the respiratory and vasomotor center (cordiamin, caffeine, camphor), increasing heart contractions and increasing blood pressure (adrenaline, norepinephrine, mesatone, cardiac glycosides, corticosteroid hormones, etc. ). The patient is covered with heating pads, warmed up, given strong hot tea or coffee, and his underwear and bed linen are changed in a timely manner. Compliance with all the requirements for caring for febrile patients, constant monitoring of their condition, primarily the functions of the respiratory and circulatory organs, allows timely prevention of the development of severe complications and contributes to a speedy recovery of patients.

Fever is classified according to the degree of increase in body temperature:

subfebrile (from 37° to 38°),

moderate (from 38° to 39°),

high (from 39° to 41°),

excessive, or hyperpyretic (over 41°).

Fever is classified according to duration:

acute (lasting up to two weeks);

subacute (lasting up to six weeks).

Based on the types of temperature curves, the following main types of fever are distinguished:

permanent,

remitting (laxative),

intermittent (intermittent),

perverted,

hectic (depleting),

wrong.

4. Character of the temperature curve

Changes in the temperature curve are of the most varied nature and are due to the immediate cause that caused these changes.

Constant fever (febris continua). With constant fever, elevated body temperature lasts for several days or weeks with daily fluctuations within 1 ° C. Body temperature may be high

Remitting fever (febris remittens). With remitting fever, which is observed in purulent diseases (for example, exudative pleurisy, lung abscess), temperature fluctuations during the day reach 2°C and

1. Sick day

   Day of my stay in the hospital

   b moreThe degree of temperature increase may vary. Daily fluctuations are 1-2 °C, not reaching normal numbers. Chilling is typical. During the phase of decreasing temperature, sweating is observed.

Intermittent fever (febris intermittens). Intermittent fever is characterized by alternating periods of normal body temperature and

1. Sick day

   Day of my stay in the hospital

   increased; in this case, both sudden, for example with malaria, and gradual, for example with relapsing typhus (relapsing fever), brucellosis (undulant fever), an increase and decrease in a person’s body temperature is possible. A rise in temperature is accompanied by chills and fever; a fall is accompanied by profuse sweat. It should be borne in mind that sometimes the intermittent type of fever is not immediately established. In the first days of the illness, it may be preceded by a so-called initial fever of a constant or irregular type. Typical for malaria, pyelonephritis, pleurisy, sepsis, etc.

G
ectic fever (febris hectica). With hectic fever, the resulting changes in body temperature are especially large, amounting to 3-4 ° C with a drop to normal or subnormal levels (below 36 ° C) and occur, as a rule, 2-3 times a day. Such fevers are characteristic of severe forms of tuberculosis and sepsis. With hectic fever, stunning chills occur, which are then replaced by profuse sweating.

Undulating fever is characterized by smooth rises and falls in body temperature with normal values ​​in the intervals between rises in temperature (some forms of lymphogranulomatosis and malignant tumors, brucellosis).

Types of fever during illness can alternate or transform into one another. The intensity of the febrile 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. Fever can end with a sudden and rapid drop in body temperature to normal or even lower (crisis) or a gradual slow decrease body temperature (lysis). The most severe toxic forms of some infectious diseases, as well as infectious diseases in the elderly, weakened people, and young children often occur with almost no fever or even hypothermia, which is an unfavorable prognostic sign.

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

An increase in body temperature during fever is accompanied by an increase in heart rate. This does not occur in all febrile illnesses. Thus, with typhoid fever, bradycardia is observed. 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 fevers 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 fever, the function of the digestive organs is impaired (decreased digestion and absorption of food). Patients have a coated tongue, dry mouth, and a sharply decreased appetite. 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, its concentration increases.

Kidney activity is not noticeably impaired during fever. The increase in diuresis at the onset of fever is explained by the redistribution of blood and an increase in its quantity in the kidneys. Water retention in tissues at the height of fever 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 of ACTH by the pituitary gland and the release of corticosteroids, which have a desensitizing and anti-inflammatory effect, are 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. Hyperthermia creates less favorable conditions in the body for the proliferation of many pathogenic viruses and bacteria. In this regard, the main treatment should be aimed at eliminating the disease that caused the fever. 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.

All processes occurring in the body are interconnected. This also applies to pathological conditions. Reactions such as redness and swelling of the skin, pain, do not occur by chance. All of them have a protective mechanism and help cope with infection. In addition, the nature of these reactions can be important in the diagnosis of diseases and also determines treatment tactics. For example, some types of fever occur only in certain pathologies. In this case, the doctor associates the increase in temperature and other symptoms, after which he makes a diagnosis. This helps to select the treatment necessary for the detected disease.

Types of Fever: Identification on Graph

Fever is a pathological condition in which the balance between heat production and heat loss is disrupted. In most cases, it is one of the components of the inflammatory process. When monitoring and treating patients with fever, a temperature chart is drawn up. It consists of three parts. The first is a rise in body temperature. At the same time, the line on the graph rushes upward. The curve shows the dependence of temperature on time. The line rises quickly (in a few minutes) or over a long period of time - over the course of hours.

The next component of fever is standing within a certain value. On the graph it is indicated by a horizontal line. The last element of a fever is a decrease in temperature. Like the rise, it can happen quickly (within minutes) and slowly (after a day). Indicated by a line going down. All types of fever have different graphic representations. From them you can judge the time during which the temperature rose and fell, and track how long it lasted.

Fever: types, types of graphs

There are 7 types of fever, each of which occurs with certain diseases. Depending on this, a temperature curve is constructed. It involves a graphic display of fever. The classification is based on temperature fluctuations and the time of its increase:

1. Fever of a constant type. Characterized by the duration of the course (several days). Temperature fluctuations throughout the day are very insignificant (up to 1 degree) or completely absent.
2. Fever of a laxative type. It has a more gentle course and is susceptible to the effects of antipyretic drugs. Temperature fluctuations exceed 1 degree, but do not reach the normal value.
3. Intermittent fever. Characterized by large temperature fluctuations. At the same time, in the morning hours there is a drop to the normal value and below. In the evening the temperature reaches high figures.
4. type (exhausting). Daily fluctuations range from 3 to 4 degrees. It is difficult for patients to tolerate.
5. Relapsing type of fever. Characterized by body episodes that can last several days.
6. Atypical fever. Daily fluctuations are inconsistent and chaotic.
7. Fever of a perverted type. The temperature rises in the morning and normalizes in the evening.

What types of fever are there?

Depending on the degree of temperature rise, several types of fever are distinguished. The classification is also based on the duration of this condition. The following types of fever are distinguished:

1. Subfebrile. The characteristic temperature is 37.0-37.9 degrees. It is observed in many infectious and viral diseases of mild severity. In some cases, it has a chronic course (with systemic pathologies, oncology).
2. Febrile (moderate) fever. Body temperature is 38.0-39.5 degrees. It is observed with any infection in its peak stage.
3. High fever. Body temperature reaches 39.6-40.9 degrees. It is less common than other species. It is more often observed in children and people with weak immune systems.
4. Hyperpyretic fever. The temperature is 41.0 degrees or more. It is observed with purulent meningitis and tetanus infection.

Relationship between the disease and the type of fever

Certain types of fever can be associated with specific diseases. For example, most nonspecific inflammatory processes of the upper respiratory tract (sore throat, ARVI) are characterized by a laxative temperature. Constant fever occurs with and An intermittent type of fever is observed in patients with tuberculosis, oncological processes, and systemic pathologies (SLE, rheumatoid arthritis). Relapsing fever often occurs with malaria, typhoid, and lymphogranulomatosis. Despite the fact that changes in the temperature curve are not always specific, it helps to predict what kind of disease the patient has.

Sepsis: diagnosis by fever

Sepsis is a systemic disease that is characterized by bacteria entering the bloodstream. It can be caused by any inflammation in the presence of a focus of infection and reduced immunity. It is impossible to answer the question about what type of fever is characteristic of sepsis. It is known that this disease is characterized by which is not easy to bring down. Most often, with sepsis, a debilitating and atypical type of fever is observed.