Fever (also known as pyrexia or controlled hyperthermia[1]) is a common medical sign A medical sign is an objective indication of some medical fact or characteristic that may be detected by a physician during a physical examination of a patient characterized by an elevation of temperature above the normal range of 36.5–37.5 °C (98–100 °F) due to an increase in the body temperature Normal human body temperature, also known as normothermia or euthermia, is a concept that depends upon the place in the body at which the measurement is made, and the time of day and level of activity of the person. There is no single number that represents a normal or healthy temperature for all people under all circumstances using any place of regulatory set-point.[2] This increase in set-point triggers increased muscle tone In physiology, medicine, and anatomy, muscle tone is the continuous and passive partial contraction of the muscles. It helps maintain posture, and it declines during REM sleep. It is not to be confused with the concept of toning in physical exercise and shivering Shivering is a bodily function in response to early hypothermia in warm-blooded animals. When the core body temperature drops, the shivering reflex is triggered to maintain homeostasis. Muscle groups around the vital organs begin to shake in small movements in an attempt to create warmth by expending energy. Shivering can also be a response to a.

As a person's temperature increases, there is, in general, a feeling of cold Cold refers to the condition or subjective perception of having low temperature; it is the absence of heat or warmth despite an increasing body temperature. Once the new temperature is reached, there is a feeling of warmth. A fever is one of the body's immune Immunity is a biological term that describes a state of having sufficient biological defenses to avoid infection, disease, or other unwanted biological invasion. Immunity involves both specific and non-specific components. The non-specific components act either as barriers or as eliminators of wide range of pathogens irrespective of antigenic responses that attempt to neutralize a bacterial or viral infection An infection is the detrimental colonization of a host organism by a foreign species. In an infection, the infecting organism seeks to utilize the host's resources to multiply, usually at the expense of the host. The infecting organism, or pathogen, interferes with the normal functioning of the host and can lead to chronic wounds, gangrene, loss. A fever can be caused by many different conditions ranging from benign to potentially serious. With the exception of very high temperatures, treatment to reduce fever is often not necessary; however, antipyretic Antipyretics are drugs that reduce fever. They will not normally lower body temperature if one does not have a fever. Antipyretics cause the hypothalamus to override an interleukin-induced increase in temperature. The body will then work to lower the temperature and the result is a reduction in fever medications can be effective at lowering the temperature, which may improve the affected person's comfort.

Fever differs from uncontrolled hyperthermia Hyperthermia is an elevated body temperature due to failed thermoregulation. Hyperthermia occurs when the body produces or absorbs more heat than it can dissipate. When the elevated body temperatures are sufficiently high, hyperthermia is a medical emergency and requires immediate treatment to prevent disability and death[1], usually just referred to as hyperthermia, in that hyperthermia is an increase in body temperature over the body's thermoregulatory set-point, due to excessive heat production and/or insufficient thermoregulation Thermoregulation is the ability of an organism to keep its body temperature within certain boundaries, even when the surrounding temperature is very different. This process is one aspect of homeostasis: a dynamic state of stability between an animal's internal environment and its external environment . If the body is unable to maintain a normal.

Contents

Definition

Temperature Classification
Core Normal human body temperature, also known as normothermia or euthermia, is a concept that depends upon the place in the body at which the measurement is made, and the time of day and level of activity of the person. There is no single number that represents a normal or healthy temperature for all people under all circumstances using any place of (rectal, esophageal, etc.)
Normal Normal human body temperature, also known as normothermia or euthermia, is a concept that depends upon the place in the body at which the measurement is made, and the time of day and level of activity of the body. Although the value 37.0 °C is the commonly accepted average core body temperature, the value of 36.8±0.7 °C, or 98.2±1.3 °F is an 36.5–37.5 °C (98–100 °F)[3]
Hypothermia Hypothermia is a condition in which core temperature drops below that required for normal metabolism and body functions which is defined as 35.0 °C . Body temperature is usually maintained near a constant level of 36.5–37.5 °C (98–100 °F) through biologic homeostasis or thermoregulation. If exposed to cold and the internal mechanisms are <35.0 °C (95.0 °F)[4]
Fever >37.5–38.3 °C (100–101 °F)[1][5]
Hyperthermia Hyperthermia is an elevated body temperature due to failed thermoregulation. Hyperthermia occurs when the body produces or absorbs more heat than it can dissipate. When the elevated body temperatures are sufficiently high, hyperthermia is a medical emergency and requires immediate treatment to prevent disability and death >37.5–38.3 °C (100–101 °F)[1][5]
Hyperpyrexia >40.0–41.5 °C (104–107 °F)[6][7]

A wide range for normal temperatures Normal human body temperature, also known as normothermia or euthermia, is a concept that depends upon the place in the body at which the measurement is made, and the time of day and level of activity of the body. Although the value 37.0 °C is the commonly accepted average core body temperature, the value of 36.8±0.7 °C, or 98.2±1.3 °F is an has been found.[5] Fever is generally agreed to be present if:

In healthy adult men and women, the range for oral temperature is 33.2–38.2 °C (92–101 °F), for rectal it is 34.4–37.8 °C (94–100 °F), for tympanic membrane it is 35.4–37.8 °C (96–100 °F), and for axillary it is 35.5–37.0 °C (96–99 °F).[9]

People develop higher temperatures with activities, but this is not considered a fever, as the set-point is normal. Elderly people have a decreased ability to generate body heat, so even a low-grade temperature may represent a serious underlying illness.

Types

The pattern of temperature changes may occasionally hint at the diagnosis Medical diagnosis refers both to the process of attempting to determine the identity of a possible disease or disorder and to the opinion reached by this process:

A neutropenic fever, also called febrile neutropenia, is a fever in the absence of normal immune system function. Because of the lack of infection-fighting neutrophils Neutrophil granulocytes, generally referred to as neutrophils, are the most abundant type of white blood cells in mammals and form an essential part of the innate immune system. They form part of the polymorphonuclear cell family together with basophils and eosinophils .), a bacterial infection can spread rapidly; this fever is, therefore, usually considered a medical emergency. This kind of fever is more commonly seen in people receiving immune-suppressing chemotherapy Chemotherapy, in its most general sense, is the treatment of disease by chemicals especially by killing micro-organisms or cancerous cells. In popular usage, it refers to antineoplastic drugs used to treat cancer or the combination of these drugs into a cytotoxic standardized treatment regimen. In its non-oncological use, the term may also refer than in apparently healthy people.

Febricula[11] is a mild fever of short duration, of indefinite origin, and without any distinctive pathology.

Hyperpyrexia

Hyperpyrexia is a fever with an extreme elevation of body temperature Normal human body temperature, also known as normothermia or euthermia, is a concept that depends upon the place in the body at which the measurement is made, and the time of day and level of activity of the person. There is no single number that represents a normal or healthy temperature for all people under all circumstances using any place of greater than or equal to 41.5 °C (106.7 °F).[12] Such a high temperature is considered a medical emergency A medical emergency is an injury or illness that is acute and poses an immediate risk to a person's life or long term health. These emergencies may require assistance from another person, who should ideally be suitably qualified to do so, although some of these emergencies can be dealt with by the victim themselves. Dependent on the severity of as it may indicate a serious underlying condition or lead to significant side effects.[13] The most common cause is an intracranial hemorrhage Intracranial bleeding occurs when a blood vessel within the skull is ruptured or leaks. It can result from physical trauma or nontraumatic causes (as occurs in hemorrhagic stroke) such as a ruptured aneurysm. Anticoagulant therapy, as well as disorders with blood clotting can heighten the risk that an intracranial hemorrhage will occur.[12] Other possible causes include sepsis Sepsis is a serious medical condition that is characterized by a whole-body inflammatory state and the presence of a known or suspected infection. The body may develop this inflammatory response by the immune system to microbes in the blood, urine, lungs, skin, or other tissues. A lay term for sepsis is blood poisoning, more aptly applied to, Kawasaki syndrome,[14] neuroleptic malignant syndrome Neuroleptic malignant syndrome is a life threatening, although rare neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. It generally presents with muscle rigidity, fever, autonomic instability and cognitive changes such as delirium, and is associated with elevated creatine phosphokinase (CPK), drug effects, serotonin syndrome Serotonin syndrome is a potentially life-threatening adverse drug reaction that may occur following therapeutic drug use, inadvertent interactions between drugs, overdose of particular drugs, or the recreational use of certain drugs. Serotonin syndrome is not an idiosyncratic drug reaction; it is a predictable consequence of excess serotonergic, and thyroid storm.[13] Infections are the most common cause of fevers, however as the temperature rises other causes become more common.[13] Infections commonly associated with hyperpyrexia include: roseola Exanthema subitum , also referred to as roseola infantum (or rose rash of infants), sixth disease (as the sixth rash-causing childhood disease) and (confusingly) baby measles, or three-day fever, is a disease of children, generally under two years old, whose manifestations are usually limited to a transient rash ("exanthem") that occurs, rubeola and enteroviral infections.[15] Immediate aggressive cooling to less than <38.9 °C (102.0 °F) has been found to improve survival.[13] Hyperpyrexia differs from hyperthermia Hyperthermia is an elevated body temperature due to failed thermoregulation. Hyperthermia occurs when the body produces or absorbs more heat than it can dissipate. When the elevated body temperatures are sufficiently high, hyperthermia is a medical emergency and requires immediate treatment to prevent disability and death in that in hyperpyrexia the body's temperature regulation mechanism sets the body temperature above the normal temperature, then generates heat to achieve this temperature, while in hyperthermia the body temperature rises above its set point.[12]

Hyperthermia

Hyperthermia Hyperthermia is an elevated body temperature due to failed thermoregulation. Hyperthermia occurs when the body produces or absorbs more heat than it can dissipate. When the elevated body temperatures are sufficiently high, hyperthermia is a medical emergency and requires immediate treatment to prevent disability and death occurs from a number of causes including heatstroke Heat stroke is defined as a temperature of greater than 40.6 °C due to environmental heat exposure with lack of thermoregulation. This is distinct from a fever, where there is a physiological increase in the temperature set point of the body, neuroleptic malignant syndrome Neuroleptic malignant syndrome is a life threatening, although rare neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. It generally presents with muscle rigidity, fever, autonomic instability and cognitive changes such as delirium, and is associated with elevated creatine phosphokinase (CPK), malignant hyperthermia Malignant hyperthermia is a rare life-threatening condition that is triggered by exposure to certain drugs used for general anesthesia (specifically all volatile anesthetics), nearly all gas anesthetics, and the neuromuscular blocking agent succinylcholine. In susceptible individuals, these drugs can induce a drastic and uncontrolled increase in, stimulants such as amphetamines Amphetamine or amfetamine (INN) is a psychostimulant drug that is known to produce increased wakefulness and focus in association with decreased fatigue and appetite. Amphetamine is chemically related to methamphetamine and lisdexamfetamine, a class of potent drugs that act by increasing levels of dopamine and norepinephrine in the brain, inducing and cocaine Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic. Specifically, it is a serotonin-norepinephrine-dopamine, idiosyncratic drug reactions Idiosyncratic drug reactions, also known as type B reactions, are drug reactions which occur rarely and unpredictably amongst the population. This is not to be mistaken with idiopathic which implies that the cause is not known. They frequently occur with exposure to new drugs, as they have not been fully tested and the full range of possible side, and serotonin syndrome Serotonin syndrome is a potentially life-threatening adverse drug reaction that may occur following therapeutic drug use, inadvertent interactions between drugs, overdose of particular drugs, or the recreational use of certain drugs. Serotonin syndrome is not an idiosyncratic drug reaction; it is a predictable consequence of excess serotonergic.

Signs and symptoms

Ancher, Michael, "The Sick Girl", 1882, Statens Museum for Kunst Statens Museum for Kunst is the Danish national gallery located in Copenhagen

A fever is usually accompanied by sickness behavior Sickness behavior is a coordinated set of adaptive behavioral changes that develop in ill individuals during the course of an infection. They usually accompany fever and aid survival. Such illness responses include lethargy, depression, anorexia, sleepiness, hyperalgesia, reduction in grooming and failure to concentrate. Sickness behavior is a, which consists of lethargy Fatigue is a state of awareness. It can describe a range of afflictions, varying from a general state of lethargy to a specific work-induced burning sensation within one's muscles. It can be both physical and mental. Physical fatigue is the inability to continue functioning at the level of one's normal abilities. It is ubiquitous in everyday life,, depression Depression is a state of low mood and aversion to activity. The Diagnostic and Statistical Manual of Mental Disorders defines a depressed person as experiencing feelings of sadness, helplessness and hopelessness. In traditional colloquy, feeling "depressed" is often synonymous with feeling "sad", but both clinical depression, anorexia, sleepiness, hyperalgesia, and the inability to concentrate.[16][17][18]

Differential diagnosis

Fever is a common symptom of many medical conditions:

Persistent fever that cannot be explained after repeated routine clinical inquiries is called fever of unknown origin.

Pathophysiology

Hyperthermia: Characterized on the left. Normal body temperature (thermoregulatory set-point) is shown in green, while the hyperthermic temperature is shown in red. As can be seen, hyperthermia can be conceptualized as an increase above the thermoregulatory set-point. Hypothermia: Characterized in the center: Normal body temperature is shown in green, while the hypothermic temperature is shown in blue. As can be seen, hypothermia can be conceptualized as a decrease below the thermoregulatory set-point. Fever: Characterized on the right: Normal body temperature is shown in green. It reads "New Normal" because the thermoregulatory set-point has risen. This has caused what was the normal body temperature (in blue) to be considered hypothermic.

Temperature is ultimately regulated in the hypothalamus. A trigger of the fever, called a pyrogen, causes a release of prostaglandin E2 (PGE2). PGE2 then in turn acts on the hypothalamus, which generates a systemic response back to the rest of the body, causing heat-creating effects to match a new temperature level.

In many respects, the hypothalamus works like a thermostat.[19] When the set point is raised, the body increases its temperature through both active generation of heat and retaining heat. Vasoconstriction both reduces heat loss through the skin and causes the person to feel cold. The liver produces extra heat. If these measures are insufficient to make the blood temperature in the brain match the new setting in the hypothalamus, then shivering begins in order to use muscle movements to produce more heat. When the fever stops, and the hypothalamic setting is set lower; the reverse of these processes (vasodilation, end of shivering and nonshivering heat production) and sweating are used to cool the body to the new, lower setting.

This contrasts with hyperthermia, in which the normal setting remains, and the body overheats through undesirable retention of excess heat or over-production of heat.[19] Hyperthermia is usually the result of an excessively hot environment (heat stroke) or an adverse reaction to drugs. Fever can be differentiated from hyperthermia by the circumstances surrounding it and its response to anti-pyretic medications.

Pyrogens

A pyrogen is a substance that induces fever. These can be either internal (endogenous) or external (exogenous) to the body. The bacterial substance lipopolysaccharide (LPS), present in the cell wall of some bacteria, is an example of an exogenous pyrogen. Pyrogenicity can vary: In extreme examples, some bacterial pyrogens known as superantigens can cause rapid and dangerous fevers. Depyrogenation may be achieved through filtration, distillation, chromatography, or inactivation.

Endogenous

In essence, all endogenous pyrogens are cytokines, molecules that are a part of the innate immune system. They are produced by phagocytic cells and cause the increase in the thermoregulatory set-point in the hypothalamus. Major endogenous pyrogens are interleukin 1 (α and β) [20], interleukin 6 (IL-6) and tumor necrosis factor-alpha. Minor endogenous pyrogens include interleukin-8, tumor necrosis factor-α, tumor necrosis factor-β, macrophage inflammatory protein-α and macrophage inflammatory protein-β as well as interferon-α, interferon-β, and interferon-γ.[20]

These cytokine factors are released into general circulation, where they migrate to the circumventricular organs of the brain due to easier absorption caused by the blood-brain barrier's reduced filtration action there. The cytokine factors then bind with endothelial receptors on vessel walls, or interact with local microglial cells. When these cytokine factors bind, the arachidonic acid pathway is then activated.

Exogenous

One model for the mechanism of fever caused by exogenous pyrogens includes LPS, which is a cell wall component of gram-negative bacteria. An immunological protein called lipopolysaccharide-binding protein (LBP) binds to LPS. The LBP–LPS complex then binds to the CD14 receptor of a nearby macrophage. This binding results in the synthesis and release of various endogenous cytokine factors, such as interleukin 1 (IL-1), interleukin 6 (IL-6), and the tumor necrosis factor-alpha. In other words, exogenous factors cause release of endogenous factors, which, in turn, activate the arachidonic acid pathway.

PGE2 release

PGE2 release comes from the arachidonic acid pathway. This pathway (as it relates to fever), is mediated by the enzymes phospholipase A2 (PLA2), cyclooxygenase-2 (COX-2), and prostaglandin E2 synthase. These enzymes ultimately mediate the synthesis and release of PGE2.

PGE2 is the ultimate mediator of the febrile response. The set-point temperature of the body will remain elevated until PGE2 is no longer present. PGE2 acts on neurons in the preoptic area (POA) through the prostaglandin E receptor 3 (EP3). EP3-expressing neurons in the POA innervate the dorsomedial hypothalamus (DMH), the rostral raphe pallidus nucleus in the medulla oblongata (rRPa), and the paraventricular nucleus (PVN) of the hypothalamus . Fever signals sent to the DMH and rRPa lead to stimulation of the sympathetic output system, which evokes non-shivering thermogenesis to produce body heat and skin vasoconstriction to decrease heat loss from the body surface. It is presumed that the innervation from the POA to the PVN mediates the neuroendocrine effects of fever through the pathway involving pituitary gland and various endocrine organs.

Hypothalamus

The brain ultimately orchestrates heat effector mechanisms via the autonomic nervous system. These may be:

The autonomic nervous system may also activate brown adipose tissue to produce heat (non-exercise-associated thermogenesis, also known as non-shivering thermogenesis), but this seems important mostly for babies. Increased heart rate and vasoconstriction contribute to increased blood pressure in fever.

Usefulness

There are arguments for and against the usefulness of fever, and the issue is controversial.[21][22] There are studies using warm-blooded vertebrates[23] and humans[24] in vivo, with some suggesting that they recover more rapidly from infections or critical illness due to fever. A Finnish study suggested reduced mortality in bacterial infections when fever was present.[25]

In theory, fever can aid in host defense.[21] There are certainly some important immunological reactions that are sped up by temperature, and some pathogens with strict temperature preferences could be hindered.[26] Fevers may be useful to some extent since they allow the body to reach high temperatures, causing an unbearable environment for some pathogens. White blood cells also rapidly proliferate due to the suitable environment and can also help fight off the harmful pathogens and microbes that invaded the body.[citation needed]

Research[27] has demonstrated that fever has several important functions in the healing process:

Management

Fever should not necessarily be treated.[29] Most people recover without specific medical attention.[30] In general, people are advised to keep adequately hydrated. Oral rehydration solutions or water are generally used for this purpose. Excessive water may lead however to hyponatremia. Some limited evidence supports the use of tepid sponging.[31] If the temperature reaches the level of hyperpyrexia aggressive cooling is required.[13]

Medications

The antipyretic ibuprofen is effective in treating a fever.[32] It is more effective than acetaminophen / paracetamol in children however both may be used together,[33] safely.[34] The effectiveness of acetaminophen by itself is questionable.[35] Ibuprofen is also superior to aspirin,[36] which is not usually recommended in children due to the risk of Reye's syndrome.

Etymology

The print depicts Kiyomori, suffering from fever, as he confronts Enma, the king of hell, and the ghosts of Kiyomori's victims.

Pyrexia is from the Greek pyretos meaning fire. Febrile is from the Latin word febris, meaning fever, and archaically known as ague.

In other animals

Fever is an important feature for the diagnosis of disease in domestic animals. The body temperature of animals, which is taken rectally, is different from one species to another. For example, a horse is said to have a fever above 101.0 °F (38.3 °C). [37]

In species that allow the body to have a wide range of "normal" temperatures, such as camels,[38] it is sometimes difficult to determine a febrile stage. Fever is a common symptom of medicines and prescription drugs.

References

  1. ^ a b c d e Axelrod YK, Diringer MN (May 2008). "Temperature management in acute neurologic disorders". Neurol Clin 26 (2): 585–603, xi. doi:10.1016/j.ncl.2008.02.005. PMID 18514828.
  2. ^ Karakitsos D, Karabinis A (September 2008). "Hypothermia therapy after traumatic brain injury in children". N. Engl. J. Med. 359 (11): 1179–80. PMID 18788094.
  3. ^ Karakitsos D, Karabinis A (September 2008). "Hypothermia therapy after traumatic brain injury in children". N. Engl. J. Med. 359 (11): 1179–80. PMID 18788094.
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  6. ^ Manson's Tropical Diseases: Expert Consult. Saunders Ltd. 2008. pp. 1229. ISBN 1-4160-4470-1.
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  9. ^ Sund-Levander M, Forsberg C, Wahren LK (June 2002). "Normal oral, rectal, tympanic and axillary body temperature in adult men and women: a systematic literature review". Scand J Caring Sci 16 (2): 122–8. doi:10.1046/j.1471-6712.2002.00069.x. PMID 12000664.
  10. ^ Hilson AJ (July 1995). "Pel-Ebstein fever". N. Engl. J. Med. 333 (1): 66–7. doi:10.1056/NEJM199507063330118. PMID 7777006. . They cite Richard Asher's lecture Making Sense (Lancet, 1959, 2, 359)
  11. ^ Febricula, definition from Biology-Online.org, consulted June 7, 2006 http://www.biology-online.org/dictionary/Febricula
  12. ^ a b c Loscalzo, Joseph; Fauci, Anthony S.; Braunwald, Eugene; Dennis L. Kasper; Hauser, Stephen L; Longo, Dan L. (2008). Harrison's principles of internal medicine. McGraw-Hill Medical. pp. Chapter 17, Fever versus hyperthermia. ISBN 0-07-146633-9.
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  17. ^ Johnson, R. (2002) "The concept of sickness behavior: a brief chronological account of four key discoveries". Veterinary Immunology and Immunopathology. 87: 443-450 PubMed
  18. ^ Kelley, K. W., Bluthe, R. M., Dantzer, R., Zhou, J. H., Shen, W. H., Johnson, R. W. Broussard, S. R. (2003) "Cytokine-induced sickness behavior". Brain Behav Immun. 17 Suppl 1: S112-118 PubMed
  19. ^ a b Fauci, Anthony, et al. (2008). Harrison's Principles of Internal Medicine (17 ed.). McGraw-Hill Professional. pp. 117–121. ISBN 9780071466332.
  20. ^ a b Chapter 58 in: Walter F., PhD. Boron (2003). Medical Physiology: A Cellular And Molecular Approaoch. Elsevier/Saunders. pp. 1300. ISBN 1-4160-2328-3.
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  23. ^ Su, F.; Nguyen, N.D.; Wang, Z.; Cai, Y.; Rogiers, P.; Vincent, J.L. Fever control in septic shock: beneficial or harmful? Shock 2005; 23: 516-20. PMID 15897803
  24. ^ Schulman, C.I.; Namias, N.; Doherty, J., et al. The effect of antipyretic therapy upon outcomes in critically ill patients: a randomized, prospective study. Surg Infect (Larchmt) 2005; 6:369-75. PMID 16433601
  25. ^ Rantala S, Vuopio-Varkila J, Vuento R, Huhtala H, Syrjänen J. Predictors of mortality in beta-hemolytic streptococcal bacteremia: A population-based study. J Infect. March 2, 2009. PMID 19261333
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  32. ^ Perrott DA, Piira T, Goodenough B, Champion GD (June 2004). "Efficacy and safety of acetaminophen vs ibuprofen for treating children's pain or fever: a meta-analysis". Arch Pediatr Adolesc Med 158 (6): 521–6. doi:10.1001/archpedi.158.6.521. PMID 15184213.
  33. ^ Hay AD, Redmond NM, Costelloe C, et al. (May 2009). "Paracetamol and ibuprofen for the treatment of fever in children: the PITCH randomised controlled trial". Health Technol Assess 13 (27): iii–iv, ix–x, 1–163. doi:10.3310/hta13270. PMID 19454182.
  34. ^ Southey ER, Soares-Weiser K, Kleijnen J (September 2009). "Systematic review and meta-analysis of the clinical safety and tolerability of ibuprofen compared with paracetamol in paediatric pain and fever". Curr Med Res Opin 25 (9): 2207–22. doi:10.1185/03007990903116255. PMID 19606950.
  35. ^ Meremikwu M, Oyo-Ita A (2002). "Paracetamol for treating fever in children". Cochrane Database Syst Rev (2): CD003676. doi:10.1002/14651858.CD003676. PMID 12076499.
  36. ^ Autret E, Reboul-Marty J, Henry-Launois B, et al. (1997). "Evaluation of ibuprofen versus aspirin and paracetamol on efficacy and comfort in children with fever". Eur. J. Clin. Pharmacol. 51 (5): 367–71. doi:10.1007/s002280050215. PMID 9049576.
  37. ^ "Equusite Vital Signs". www.equusite.com. http://www.equusite.com/articles/health/healthVitalSigns.shtml. Retrieved 2010-03-22.
  38. ^ "Body Temperature of the Camel and Its Relation to Water Economy". ajplegacy.physiology.org. http://ajplegacy.physiology.org/cgi/content/abstract/188/1/103. Retrieved 2010-03-22.

Further reading

External links

Symptoms and signs: general / constitutional (R50-R61, 780.6-780.9)
Temperature

heat: Fever (Fever of unknown origin, Drug-induced fever) • Hyperhidrosis (e.g., Sleep Hyperhidrosis; "Sweating") • Hyperpyrexia • Hyperthermia

cold: Chills
Aches/Pains Headache • Chronic pain
Malaise and fatigue Atrophy (e.g., Muscle Atrophy) • Debility (or Asthenia) • Lassitude • Lethargy • Muscle tremors • Tenderness
Miscellaneous Flu-Like Symptoms

Categories: Symptoms

 

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Exposicion Internacional de Oviedo Los Chatos del Turia Saturday Night Fever Exc 1 Mejor Joven y Best in Show Joven

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'Fever' Blogs
What protects farm children from hay fever : The protective ...
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What protects farm children from hay fever : The protective ...

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Mon, 19 Jul 2010 12:53:29 GM

The researchers were not surprised that a grass component - of all things - protects children against hay . fever. . Dr. Marcus Peters stated that it is all a question of the concentration. Low concentrations of Meadow Foxtail pollen can ...

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'Fever' Answers
How long does a fever from MMR vaccine last?
Q. My 1 year old son got his MMR vaccination last week. A few days after his shot, he caught a slight cold (little runny nose and cough). On the 6th night after his vaccination, he had a fever of 100. He's had the fever (99-101) the past 2 nights. When will it go away? Should i be worried since he also has the cold?
Asked by B M - Fri Jul 10 11:07:51 2009 - - 6 Answers - 0 Comments

A. When my daughter got her vaccine she got a slight fever the next day but no cold symptoms. You should probably bring him to see a doctor if you are concerned he has likely picked up something else.
Answered by lovebug - Fri Jul 10 11:18:01 2009

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