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Fever Causes, Patterns, Signs, Symptoms and Treatment- Doctor Micheal

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Fever is an abnormal rise in temperature above 37.2 °C in the morning and 37.7 °C in the evening. In many cases, it is associated with other features such as discomfort, burning of the eyes, chills, rigors, aches, and pains, and malaise. The presence of fever is a definite indication for proper evaluation, and if the cause is not obvious, it necessitates a review of history and physical signs, laboratory investigation, and close observation. 

Find out what causes fever and how to treat it. Learn about the different patterns, symptoms, and signs of a fever and how it affects children, teens, and adults. Get answers to common questions about fevers, including how long they last in this article.

Fever Causes, Patterns, Signs, Symptoms, and Treatment

What Causes Fever?

Fiver is common in kids worldwide and this gives a clue to the possible underlying cause in many cases, and therefore, it is important to record the temperature regularly this helps in identifying the underlying causes.

The temperature is elevated by increasing heat production and reducing heat loss. Heat production is increased by increasing the metabolic rate and by rapid muscular contractions as in rigors. Heat loss by radiation is reduced by peripheral vasoconstriction. As in, a temperature rise may occur abruptly within hours.

Pneumococcal pneumonia: sudden onset, persistent fever, and rapid decline.

Typhoid fever: slow onset with a step-ladder pattern, continuous or remittent fever, falling by lysis.

Plasmodium vivax malaria: intermittent fever tertian periodicity.


Administration of antipyretics (fever-reducing drugs) at the commencement of fever alters its pattern and abolishes its diagnostic value.


Patterns of Fever

Continuous fever: The temperature is elevated all the time but the difference between the maximum and minimum does not exceed 1ºC, e.g. early stages of pneumonia.

Remittent fever: The temperature is elevated throughout but the fluctuation is more than 1ºC, e.g. Typhoid fever.

Intermittent fever: The temperature rises and falls, touching normal in between the peaks, e.g. malaria.

Note; Presence of chills and rigor suggests the rapid rise of temperature, as occurring in malaria, pyelonephritis, pus collection somewhere, and cholangitis.

Periodicity: Many intermittent fevers show periodicity. The fever recurs at regular intervals, but in P. falciparum malaria and in mixed infections by different species of parasites, sometimes periodicity may not be observed.

Fever And Other Associations

Fever And Body Rashes Cause:

These are eruptions occurring over the skin or mucous membranes, and many of them may be associated with fever. They are of diagnostic importance. The rash may be macular, papular, vesicular, pustular, or Hemorrhagic fever is characterized by the occurrence of rashes over the skin and is called exanthematous. fever. If the rashes occur in the mucous membranes, they are called enanthems. The distribution of the

Rashes and the time of their appearance are characteristic.

Skin rash occurring on the:

First day of fever: Chickenpox

Second day: Scarlet fever

Third day: Smallpox (eradicated)

Fourth day: Measles

Fifth day:  Typhus

Sixth day: Typhoid (rose spots, but usually not seen in Indian patients)

Early administration of antipyretics and other drugs alters the natural history of the disease. Rashes may also be due to adverse reactions to drugs.


Patterns of Rashes

Koplik’s spots are bluish-gray spots that occur inside the cheeks opposite the upper second molars in measles before the skin rashes appear. This is diagnostic.

A maculopapular rash over the butterfly area of the face is highly suggestive of systemic lupus erythematosus.

Hemorrhagic rash in rheumatic fever, coppery rash in secondary syphilis, hemorrhagic rash in meningococcemia.

Erythema chronicum migrans in Lyme disease are only a few of the many examples. In addition to these, it is common to get allergic rashes caused by medications. These have to be distinguished by a proper history and clinical features.

Common drug rashes are commonly due to hypersensitivity, the majority of them are pruritic and associated with other allergic manifestations.

 Fever and Mouth/Oral Symptoms

Appetite is lost in most fevers and the intake of food and fluids comes down. The mouth becomes dry and coated. The presence of dried-up debris over the teeth at the level of lip margins is called “sordes”. The pattern of coating of the tongue may be characteristic. In typhoid fever the tongue shows central coating, the margins being free

In many cases the tongue may show other changes:

Soreness of the tongue: Measles

Red beefy tongue: Broad-spectrum antibiotic therapy.

White curdy membrane over the tongue easily removable: Candidiasis due to prolonged broadspectrum

antibiotic, corticosteroids, or immune-suppressed states.

Ulcerations over the tongue and bleeding: Stevens-Johnson syndrome.

Invasive candidiasis: Advanced HIV infection/ immunosuppression.

Fever, urine, And Feaces Symptoms

Urine volume comes down as a result of dehydration and urine becomes concentrated and high-colored.

Constipation may occur as a result of reduced food intake, dehydration, and reduction in physical


In typhoid fever and bacterial dysentery diarrhea may occur, always examine urine and feces

macroscopically if it is available and mention any abnormalities noticed along with general examination.

General Causes of Fever

General Causes of Fever

The following are the major causes of fever both in adults and kids.

1. Infection: Commonest cause of fever in all countries, especially in developing countries is infection. This could be bacterial, viral,  rickettsial, chlamydial, protozoal, fungal, and

helminthic. Almost all infections cause fever as a general reaction.

2. Inflammatory causes not attributable to infections: Connective tissue diseases, e.g. systemic lupus erythematosus, rheumatoid disease.

3. Hypersensitivity reactions: Reaction to drugs, antisera, biological products-serum sickness.

4. Trauma: Accidents, blunt trauma, and major surgery are accompanied by fever, even in the absence of infective complications.

5. Extravasation of blood into tissue spaces: Gives rise to fever.

6. Neurological disorders: Lesions in the brainstem may give rise to high fever, e.g. pontine hemorrhage.

7. Endocrine causes: Hyperthyroidism, thyroid storm, ovulation.

8. Physical agents: Heat hyperpyrexia, postirradiation fever, dehydration fever in infants

and children.

9. Neoplasms: Several neoplasms such as hypernephroma and primary carcinoma of the liver

give rise to fever as an early manifestation. In acute leukemias and lymphomas, fever is a common symptom.

10. Moderate or severe hemolysis and resorption of hematoma from any site may give rise to fever.

11. Severe muscular effort: Convulsions, especially status epilepticus, tetanus spasms, and severe exercise in closed environments may give rise to fever.

12. Factitious fever: Factitious means “produced artificially” and not by a genuine process. Many malingerers pretend illness by manipulating the thermometer so as to record higher temperatures.

This is called factitious fever.

13. Very rarely some individuals may have their normal temperature up to 0.5°C above 37°C,

with exaggerated circadian rhythm.

14. Psychogenic fever: Patients and relatives come with complaints of fever, due to wrong

According to the proverb, "prevention is preferable to cure." Always take steps to prevent fever by following the recommendations of your medical team. Please let us know if there is anything else we can add to this article or if this article has been of great assistance to you by leaving a comment in the section below.

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