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Fever

From Wikipedia, the free encyclopedia


This article is about the medical condition. For other uses, see Fever (disambiguation).
Fever

An analog medical thermometer showing a


temperature of 38.8 C or 101.8 F
ICD-10
R50
ICD-9
780.6
DiseasesDB
18924
MedlinePlus
003090
eMedicine
med/785
MeSH
D005334
Fever (also known as pyrexia[1] or febrile response) is one of the most common medical
signs and is characterized by an elevation of body temperature above the normal range of
36.537.5 C (97.799.5 F) due to an increase in the temperature regulatory set-point.[2] This
increase in set-point triggers increased muscle tone and chills.
As a person's temperature increases, there is, in general, a feeling of cold despite an increase
in body temperature. Once body temperature has increased to the new set-point temperature,
there is a feeling of warmth.
A fever can be caused by many medical conditions ranging from benign to potentially
serious. Some studies suggest that fever is useful as a defense mechanism as the body's
immune response can be strengthened at higher temperatures; however, there are arguments
for and against the usefulness of fever, and the issue is controversial. With the exception of
very high temperatures, treatment to reduce fever is often not necessary; however, antipyretic
medications can be effective at lowering the temperature, which may improve the affected
person's comfort.
Fever differs from uncontrolled hyperthermia,[1] in that hyperthermia is an increase in body
temperature over the body's thermoregulatory set-point, due to excessive heat production or
insufficient thermoregulation.

Contents

1 Definition

o 1.1 Types
o 1.2 Hyperpyrexia
o 1.3 Hyperthermia

2 Signs and symptoms

3 Differential diagnosis

4 Pathophysiology
o 4.1 Pyrogens
o 4.2 PGE2 release
o 4.3 Hypothalamus
o 4.4 Usefulness

5 Management
o 5.1 Conservative measures
o 5.2 Medications

6 Epidemiology

7 History

8 Society and culture


o 8.1 Etymology
o 8.2 Fever phobia

9 Other animals

10 References

11 Further reading

12 External links

Definition
Temperature classification

Hypothermia
Normal
Fever
Hyperthermia
Hyperpyrexia
Note: The difference between fever and hyperthermia is the underlying mechanism.
Different sources have different cuts offs for fever, hyperthermia and hyperpyrexia.

A wide range for normal temperatures has been found.[4] Fever is generally agreed to be
present if the elevated temperature is caused by a raised set point and:

Temperature in the anus (rectum/rectal) is at or over 37.538.3 C (99.5100.9 F)[1][4]

Temperature in the mouth (oral) is at or over 37.7 C (99.9 F)[7]

Temperature under the arm (axillary) or in the ear (otic) is at or over 37.2 C (99.0 F)

In healthy adult men and women, the range of normal, healthy temperatures for oral
temperature is 33.238.2 C (91.8100.8 F), for rectal it is 34.437.8 C (93.9100.0 F), for
tympanic membrane (the ear drum) it is 35.437.8 C (95.7100.0 F), and for axillary (the
armpit) it is 35.537.0 C (95.998.6 F).[8] Harrison's textbook of internal medicine defines a
fever as a morning oral temperature of >37.2 C (>98.9 F) or an afternoon oral temperature
of >37.7 C (>99.9 F) while the normal daily temperature variation is typically 0.5 C
(0.9 F).[9]
Normal body temperatures vary depending on many factors, including age, sex, time of day,
ambient temperature, activity level, and more. A raised temperature is not always a fever. For
example, the temperature of a healthy person rises when he or she exercises, but this is not
considered a fever, as the set-point is normal. On the other hand, a "normal" temperature may
be a fever, if it is unusually high for that person. For example, medically frail elderly people
have a decreased ability to generate body heat, so a "normal" temperature of 37.3 C
(99.1 F) may represent a clinically significant fever.

Types

Performance of the various types of fever


a) Fever continues
b) Fever continues to abrupt onset and remission
c) Fever remittent
d) Intermittent fever
e) Undulant fever
f) Relapsing fever
The pattern of temperature changes may occasionally hint at the diagnosis:

Continuous fever: Temperature remains above normal throughout the day and does
not fluctuate more than 1 C in 24 hours, e.g. lobar pneumonia, typhoid, urinary tract
infection, brucellosis, or typhus. Typhoid fever may show a specific fever pattern
(Wunderlich curve of typhoid fever), with a slow stepwise increase and a high plateau.
(Drops due to fever-reducing drugs are excluded.)

Intermittent fever: The temperature elevation is present only for a certain period, later
cycling back to normal, e.g. malaria, kala-azar, pyaemia, or septicemia. Following are
its types [10]
o Quotidian fever, with a periodicity of 24 hours, typical of Plasmodium
falciparum or Plasmodium knowlesi malaria
o Tertian fever (48 hour periodicity), typical of Plasmodium vivax or
Plasmodium ovale malaria
o Quartan fever (72 hour periodicity), typical of Plasmodium malariae malaria.

Remittent fever: Temperature remains above normal throughout the day and fluctuates
more than 1 C in 24 hours, e.g., infective endocarditis.

Pel-Ebstein fever: A specific kind of fever associated with Hodgkin's lymphoma,


being high for one week and low for the next week and so on. However, there is some
debate as to whether this pattern truly exists.[11]

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, a bacterial
infection can spread rapidly; this fever is, therefore, usually considered to require urgent
medical attention. This kind of fever is more commonly seen in people receiving immunesuppressing chemotherapy than in apparently healthy people.
Febricula is an old term for a low-grade fever, especially if the cause is unknown, no other
symptoms are present, and the patient recovers fully in less than a week.[12]

Hyperpyrexia
Hyperpyrexia is a fever with an extreme elevation of body temperature greater than or equal
to 41.5 C (106.7 F).[13] Such a high temperature is considered a medical emergency as it
may indicate a serious underlying condition or lead to significant side effects.[14] The most
common cause is an intracranial hemorrhage.[13] Other possible causes include sepsis,
Kawasaki syndrome,[15] neuroleptic malignant syndrome, drug effects, serotonin syndrome,
and thyroid storm.[14] Infections are the most common cause of fevers, however as the
temperature rises other causes become more common.[14] Infections commonly associated
with hyperpyrexia include roseola, rubeola and enteroviral infections.[15] Immediate
aggressive cooling to less than 38.9 C (102.0 F) has been found to improve survival.[14]
Hyperpyrexia differs from hyperthermia 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 due to an outside source.[13]

Hyperthermia
Hyperthermia is an example of a high temperature that is not a fever. It occurs from a number
of causes including heatstroke, neuroleptic malignant syndrome, malignant hyperthermia,
stimulants such as amphetamines and cocaine, idiosyncratic drug reactions, and serotonin
syndrome.

Signs and symptoms

Michael Ancher, "The Sick Girl", 1882, Statens Museum for Kunst
A fever is usually accompanied by sickness behavior, which consists of lethargy, depression,
anorexia, sleepiness, hyperalgesia, and the inability to concentrate.[16][17][18]

Differential diagnosis
Fever is a common symptom of many medical conditions:

Infectious disease, e.g., influenza, HIV, malaria, Ebola, infectious mononucleosis, or


gastroenteritis, Lyme disease

Various skin inflammations, e.g., boils, or abscess

Immunological diseases, e.g., lupus erythematosus, sarcoidosis, inflammatory bowel


diseases, Kawasaki disease, Still disease, Horton disease, Wegener disease, Hepatitis
autoimmune

Tissue destruction, which can occur in hemolysis, surgery, infarction, crush


syndrome, rhabdomyolysis, cerebral hemorrhage, etc.

Reaction to incompatible blood products

Cancers, most commonly kidney cancer and leukemia and lymphomas

Metabolic disorders, e.g., gout or porphyria

Thrombo-embolic processes, e.g., pulmonary embolism or deep venous thrombosis

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. 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 immune
system. They are produced by activated immune cells and cause the increase in the
thermoregulatory set point in the hypothalamus. Major endogenous pyrogens are interleukin
1 ( and )[20] and interleukin 6 (IL-6). Minor endogenous pyrogens include interleukin-8,
tumor necrosis factor-, macrophage inflammatory protein- and macrophage inflammatory
protein- as well as interferon-, interferon-, and interferon-.[20] Tumor necrosis factor-
also acts as a pyrogen. It is mediated by interleukin 1 (IL-1) release.[21]
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 bloodbrain
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 LBPLPS 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:

Increased heat production by increased muscle tone, shivering and hormones like
epinephrine (adrenaline)

Prevention of heat loss, such as vasoconstriction.

In infants, the autonomic nervous system may also activate brown adipose tissue to produce
heat (non-exercise-associated thermogenesis, also known as non-shivering thermogenesis).
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.[22]
[23]
There are studies using warm-blooded vertebrates[24] and humans[25] 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.[26]
In theory, fever can aid in host defense.[22] There are certainly some important immunological
reactions that are sped up by temperature, and some pathogens with strict temperature
preferences could be hindered.[27]
Research[28] has demonstrated that fever assists the healing process in several important ways:

Increased mobility of leukocytes

Enhanced leukocyte phagocytosis

Endotoxin effects decreased

Increased proliferation of T cells[29]

Management
Fever should not necessarily be treated.[30] Most people recover without specific medical
attention.[31] Although it is unpleasant, fever rarely rises to a dangerous level even if
untreated. Damage to the brain generally does not occur until temperatures reach 42 C
(107.6 F), and it is rare for an untreated fever to exceed 40.6 C (105 F).[30]

Conservative measures
Some limited evidence supports sponging or bathing feverish children with tepid water.[32]
The use of a fan or air conditioning may somewhat reduce the temperature and increase
comfort. If the temperature reaches the extremely high level of hyperpyrexia, aggressive
cooling is required.[14] In general, people are advised to keep adequately hydrated.[33] Whether
increased fluid intake improves symptoms or shortens respiratory illnesses such as the
common cold is not known.[34]

Medications
Medications that lower fevers are called antipyretics. The antipyretic ibuprofen is effective in
reducing fevers in children.[35] It is more effective than acetaminophen (paracetamol) in
children. Ibuprofen and acetaminophen may be safely used together in children with fevers.
[36][37]
The efficacy of acetaminophen by itself in children with fevers has been questioned.[38]
Ibuprofen is also superior to aspirin in children with fevers.[39] Additionally, aspirin is not
recommended in children and young adults (those under the age of 16 or 19 depending on the
country) due to the risk of Reye's syndrome.[40]
Using both paracetamol and ibuprofen at the same time or alternating between the two is
more effective at decreasing fever than using only paracetamol or ibuprofen.[41] It is not clear
if it increases child comfort.[41]

Epidemiology
About 5% of people who go to an emergency room have a fever.[42]

History
A number of types of fever were known as early as 460 BC to 370 BC when Hippocrates was
practicing medicine including that due to malaria (tertian or every 2 days and quartan or
every 3 days).[43] It also became clear around this time that fevers were a symptom of a
disease rather than a disease in and of itself.[43]

Society and culture


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

Fever phobia
Fever phobia is the name given by medical experts to parents' misconceptions about fever in
their children. Among them, many parents incorrectly believe that fever is a disease rather
than a medical sign, that even low fevers are harmful, and that any temperature even briefly
or slightly above the oversimplified "normal" number marked on a thermometer is a
clinically significant fever.[44] They are also afraid of harmless side effects like febrile seizures
and dramatically overestimate the likelihood of permanent damage from typical fevers.[44] The
underlying problem, according to professor of pediatrics Barton D. Schmitt, is "as parents we
tend to suspect that our childrens brains may melt."[45]
As a result of these misconceptions parents are anxious, give the child fever-reducing
medicine when the temperature is technically normal or only slightly elevated, and interfere
with the child's sleep to give the child more medicine.[44]

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 F (38.3 C).[46] In species that allow the
body to have a wide range of "normal" temperatures, such as camels,[47] it is sometimes
difficult to determine a febrile stage.
Fever can also be behaviorally induced by invertebrates that do not have immune-system
based fever. For instance, some species of grasshopper will thermoregulate to achieve body
temperatures that are 2 - 5 C higher than normal in order to inhibit the growth of fungal
pathogens such as Beauveria bassiana and Metarhizium acridum.[48] Honeybee colonies are
also able to induce a fever in response to a fungal parasite Ascosphaera apis. [48]

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Mungkin maksud Anda adalah: Fever From Wikipedia, the free encyclopedia This article is
about the medical condition. For other uses, see Fever (disambiguation). Fever Clinical
thermometer 38.7.JPG An analog medical thermometer showing a temperature of 38.8 C or

101.8 F ICD-10 R50 ICD-9 780.6 Disease sDB 18924 MedlinePlus 003090 eMedicine
med/785 MeSH D005334 Fever (also known as pyrexia[1] or febrile response) is one of the
most common medical signs and is characterized by an elevation of body temperature above
the normal range of 36.537.5 C (97.799.5 F) due to an increase in the temperature
regulatory set-point.[2] This increase in set-point triggers increased muscle tone and chills.
As a person's temperature increases, there is, in general, a feeling of cold despite an increase
in body temperature. Once body temperature has increased to the new set-point temperature,
there is a feeling of warmth. A fever can be caused by many medical conditions ranging from
benign to potentially serious. Some studies suggest that fever is useful as a defense
mechanism as the body's immune response can be strengthened at higher temperatures;
however, there are arguments for and against the usefulness of fever, and the issue is
controversial. With the exception of very high temperatures, treatment to reduce fever is often
not necessary; however, antipyretic medications can be effective at lowering the temperature,
which may improve the affected person's comfort. Fever differs from uncontrolled
hyperthermia,[1] in that hyperthermia is an increase in body temperature over the body's
thermoregulatory set-point, due to excessive heat production or insufficient thermoregulation.
Contents 1 Definition 1.1 Types 1.2 Hyperpyrexia 1.3 Hyperthermia 2 Signs and symptoms 3
Differential diagnosis 4 Pathophysiology 4.1 Pyrogens 4.2 PGE2 release 4.3 Hypothalamus
4.4 Usefulness 5 Management 5.1 Conservative measures 5.2 Medications 6 Epidemiology 7
History 8 Society and culture 8.1 Etymology 8.2 Fever phobia 9 Other animals 10 References
11 Further reading 12 External links Definition Temperature classification Core (rectal,
esophageal, etc.) Hypothermia <35.0 C (95.0 F)[3] Normal 36.537.5 C (97.799.5 F)[2]
Fever >37.5 or 38.3 C (99.5 or 100.9 F)[1][4] Hyperthermia >38.3 or 40.0 C (100.9 or
104.0 F)[1][4] Hyperpyrexia >40.0 or 41.5 C (104.0 or 106.7 F)[5][6] Note: The
difference between fever and hyperthermia is the underlying mechanism. Different sources
have different cuts offs for fever, hyperthermia and hyperpyrexia. v t e A wide range for
normal temperatures has been found.[4] Fever is generally agreed to be present if the elevated
temperature is caused by a raised set point and: Temperature in the anus (rectum/rectal) is at
or over 37.538.3 C (99.5100.9 F)[1][4] Temperature in the mouth (oral) is at or over 37.7
C (99.9 F)[7] Temperature under the arm (axillary) or in the ear (otic) is at or over 37.2 C
(99.0 F) In healthy adult men and women, the range of normal, healthy temperatures for oral
temperature is 33.238.2 C (91.8100.8 F), for rectal it is 34.437.8 C (93.9100.0 F), for
tympanic membrane (the ear drum) it is 35.437.8 C (95.7100.0 F), and for axillary (the
armpit) it is 35.537.0 C (95.998.6 F).[8] Harrison's textbook of internal medicine defines
a fever as a morning oral temperature of >37.2 C (>98.9 F) or an afternoon oral temperature
of >37.7 C (>99.9 F) while the normal daily temperature variation is typically 0.5 C (0.9
F).[9] Normal body temperatures vary depending on many factors, including age, sex, time
of day, ambient temperature, activity level, and more. A raised temperature is not always a
fever. For example, the temperature of a healthy person rises when he or she exercises, but
this is not considered a fever, as the set-point is normal. On the other hand, a "normal"
temperature may be a fever, if it is unusually high for that person. For example, medically
frail elderly people have a decreased ability to generate body heat, so a "normal" temperature
of 37.3 C (99.1 F) may represent a clinically significant fever. Types Performance of the
various types of fever a) Fever continues b) Fever continues to abrupt onset and remission c)
Fever remittent d) Intermittent fever e) Undulant fever f) Relapsing fever The pattern of
temperature changes may occasionally hint at the diagnosis: Continuous fever: Temperature
remains above normal throughout the day and does not fluctuate more than 1 C in 24 hours,
e.g. lobar pneumonia, typhoid, urinary tract infection, brucellosis, or typhus. Typhoid fever
may show a specific fever pattern (Wunderlich curve of typhoid fever), with a slow stepwise
increase and a high plateau. (Drops due to fever-reducing drugs are excluded.) Intermittent

fever: The temperature elevation is present only for a certain period, later cycling back to
normal, e.g. malaria, kala-azar, pyaemia, or septicemia. Following are its types [10]
Quotidian fever, with a periodicity of 24 hours, typical of Plasmodium falciparum or
Plasmodium knowlesi malaria Tertian fever (48 hour periodicity), typical of Plasmodium
vivax or Plasmodium ovale malaria Quartan fever (72 hour periodicity), typical of
Plasmodium malariae malaria. Remittent fever: Temperature remains above normal
throughout the day and fluctuates more than 1 C in 24 hours, e.g., infective endocarditis.
Pel-Ebstein fever: A specific kind of fever associated with Hodgkin's lymphoma, being high
for one week and low for the next week and so on. However, there is some debate as to
whether this pattern truly exists.[11] A neutropenic fever, also called febrile neutropenia, is a
fever in the absence of normal immune system function. Because of the lack of infectionfighting neutrophils, a bacterial infection can spread rapidly; this fever is, therefore, usually
considered to require urgent medical attention. This kind of fever is more commonly seen in
people receiving immune-suppressing chemotherapy than in apparently healthy people.
Febricula is an old term for a low-grade fever, especially if the cause is unknown, no other
symptoms are present, and the patient recovers fully in less than a week.[12] Hyperpyrexia
Hyperpyrexia is a fever with an extreme elevation of body temperature greater than or equal
to 41.5 C (106.7 F).[13] Such a high temperature is considered a medical emergency as it
may indicate a serious underlying condition or lead to significant side effects.[14] The most
common cause is an intracranial hemorrhage.[13] Other possible causes include sepsis,
Kawasaki syndrome,[15] neuroleptic malignant syndrome, drug effects, serotonin syndrome,
and thyroid storm.[14] Infections are the most common cause of fevers, however as the
temperature rises other causes become more common.[14] Infections commonly associated
with hyperpyrexia include roseola, rubeola and enteroviral infections.[15] Immediate
aggressive cooling to less than 38.9 C (102.0 F) has been found to improve survival.[14]
Hyperpyrexia differs from hyperthermia 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 due to an outside source.[13] Hyperthermia Hyperthermia is an example of
a high temperature that is not a fever. It occurs from a number of causes including heatstroke,
neuroleptic malignant syndrome, malignant hyperthermia, stimulants such as amphetamines
and cocaine, idiosyncratic drug reactions, and serotonin syndrome. Signs and symptoms
Michael Ancher, "The Sick Girl", 1882, Statens Museum for Kunst A fever is usually
accompanied by sickness behavior, which consists of lethargy, depression, anorexia,
sleepiness, hyperalgesia, and the inability to concentrate.[16][17][18] Differential diagnosis
Fever is a common symptom of many medical conditions: Infectious disease, e.g., influenza,
HIV, malaria, Ebola, infectious mononucleosis, or gastroenteritis, Lyme disease Various skin
inflammations, e.g., boils, or abscess Immunological diseases, e.g., lupus erythematosus,
sarcoidosis, inflammatory bowel diseases, Kawasaki disease, Still disease, Horton disease,
Wegener disease, Hepatitis autoimmune Tissue destruction, which can occur in hemolysis,
surgery, infarction, crush syndrome, rhabdomyolysis, cerebral hemorrhage, etc. Reaction to
incompatible blood products Cancers, most commonly kidney cancer and leukemia and
lymphomas Metabolic disorders, e.g., gout or porphyria Thrombo-embolic processes, e.g.,
pulmonary embolism or deep venous thrombosis 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. 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 immune
system. They are produced by activated immune cells and cause the increase in the
thermoregulatory set point in the hypothalamus. Major endogenous pyrogens are interleukin
1 ( and )[20] and interleukin 6 (IL-6). Minor endogenous pyrogens include interleukin-8,
tumor necrosis factor-, macrophage inflammatory protein- and macrophage inflammatory
protein- as well as interferon-, interferon-, and interferon-.[20] Tumor necrosis factor-
also acts as a pyrogen. It is mediated by interleukin 1 (IL-1) release.[21] 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 bloodbrain 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 gramnegative bacteria. An immunological protein called lipopolysaccharide-binding protein (LBP)
binds to LPS. The LBPLPS 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: Increased heat
production by increased muscle tone, shivering and hormones like epinephrine (adrenaline)
Prevention of heat loss, such as vasoconstriction. In infants, the autonomic nervous system
may also activate brown adipose tissue to produce heat (non-exercise-associated
thermogenesis, also known as non-shivering thermogenesis). 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.[22][23]
There are studies using warm-blooded vertebrates[24] and humans[25] 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.[26]
In theory, fever can aid in host defense.[22] There are certainly some important
immunological reactions that are sped up by temperature, and some pathogens with strict
temperature preferences could be hindered.[27] Research[28] has demonstrated that fever
assists the healing process in several important ways: Increased mobility of leukocytes
Enhanced leukocyte phagocytosis Endotoxin effects decreased Increased proliferation of T
cells[29] Management Fever should not necessarily be treated.[30] Most people recover
without specific medical attention.[31] Although it is unpleasant, fever rarely rises to a
dangerous level even if untreated. Damage to the brain generally does not occur until
temperatures reach 42 C (107.6 F), and it is rare for an untreated fever to exceed 40.6 C
(105 F).[30] Conservative measures Some limited evidence supports sponging or bathing
feverish children with tepid water.[32] The use of a fan or air conditioning may somewhat
reduce the temperature and increase comfort. If the temperature reaches the extremely high
level of hyperpyrexia, aggressive cooling is required.[14] In general, people are advised to
keep adequately hydrated.[33] Whether increased fluid intake improves symptoms or
shortens respiratory illnesses such as the common cold is not known.[34] Medications
Medications that lower fevers are called antipyretics. The antipyretic ibuprofen is effective in
reducing fevers in children.[35] It is more effective than acetaminophen (paracetamol) in
children. Ibuprofen and acetaminophen may be safely used together in children with fevers.
[36][37] The efficacy of acetaminophen by itself in children with fevers has been questioned.
[38] Ibuprofen is also superior to aspirin in children with fevers.[39] Additionally, aspirin is
not recommended in children and young adults (those under the age of 16 or 19 depending on
the country) due to the risk of Reye's syndrome.[40] Using both paracetamol and ibuprofen at
the same time or alternating between the two is more effective at decreasing fever than using
only paracetamol or ibuprofen.[41] It is not clear if it increases child comfort.[41]
Epidemiology About 5% of people who go to an emergency room have a fever.[42] History A
number of types of fever were known as early as 460 BC to 370 BC when Hippocrates was
practicing medicine including that due to malaria (tertian or every 2 days and quartan or
every 3 days).[43] It also became clear around this time that fevers were a symptom of a
disease rather than a disease in and of itself.[43] Society and culture Etymology Pyrexia is
from the Greek pyr meaning fire. Febrile is from the Latin word febris, meaning fever, and
archaically known as ague. Fever phobia Fever phobia is the name given by medical experts
to parents' misconceptions about fever in their children. Among them, many parents
incorrectly believe that fever is a disease rather than a medical sign, that even low fevers are

harmful, and that any temperature even briefly or slightly above the oversimplified "normal"
number marked on a thermometer is a clinically significant fever.[44] They are also afraid of
harmless side effects like febrile seizures and dramatically overestimate the likelihood of
permanent damage from typical fevers.[44] The underlying problem, according to professor
of pediatrics Barton D. Schmitt, is "as parents we tend to suspect that our childrens brains
may melt."[45] As a result of these misconceptions parents are anxious, give the child feverreducing medicine when the temperature is technically normal or only slightly elevated, and
interfere with the child's sleep to give the child more medicine.[44] 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 F (38.3 C).[46] In species that allow the body to have a
wide range of "normal" temperatures, such as camels,[47] it is sometimes difficult to
determine a febrile stage. Fever can also be behaviorally induced by invertebrates that do not
have immune-system based fever. For instance, some species of grasshopper will
thermoregulate to achieve body temperatures that are 2 - 5 C higher than normal in order to
inhibit the growth of fungal pathogens such as Beauveria bassiana and Metarhizium acridum.
[48] Honeybee colonies are also able to induce a fever in response to a fungal parasite
Ascosphaera apis. [48]

Dari Wikipedia, ensiklopedia bebas


Artikel ini adalah tentang kondisi medis. Untuk kegunaan lain, lihat Demam (disambiguasi).
demam
Klinis termometer 38.7.JPG
Termometer medis analog menunjukkan suhu 38,8 C atau 101,8 F
ICD-10 R50
ICD-9 780,6
DiseasesDB 18924
MedlinePlus 003090

eMedicine med / 785


MeSH D005334
Demam (juga dikenal sebagai demam [1] atau respon demam) adalah salah satu tanda
kesehatan yang paling umum dan ditandai oleh peningkatan suhu tubuh di atas kisaran
normal 36,5-37,5 C (97,7-99,5 F) karena untuk peningkatan suhu peraturan set-point. [2]
peningkatan set-point memicu peningkatan tonus otot dan menggigil.
Sebagai suhu meningkat seseorang, ada, secara umum, perasaan dingin meskipun
peningkatan suhu tubuh. Setelah suhu tubuh meningkat dengan suhu set-titik yang baru, ada
perasaan kehangatan.
Demam dapat disebabkan oleh banyak kondisi medis mulai dari jinak berpotensi serius.
Beberapa studi menunjukkan bahwa demam berguna sebagai mekanisme pertahanan sebagai
respon kekebalan tubuh dapat diperkuat pada suhu yang lebih tinggi; Namun, ada argumen
untuk dan terhadap kegunaan dari demam, dan isu yang kontroversial. Dengan pengecualian
dari suhu yang sangat tinggi, pengobatan untuk mengurangi demam sering tidak diperlukan;
Namun, obat antipiretik dapat efektif untuk menurunkan suhu, yang dapat meningkatkan
kenyamanan orang yang terkena dampak.
Demam berbeda dari hipertermia yang tidak terkendali, [1] di hipertermia yang merupakan
peningkatan suhu tubuh di atas thermoregulatory set-titik tubuh, karena produksi panas yang
berlebihan atau tidak cukup termoregulasi.
isi
1 Definisi
1.1 Jenis
1.2 hiperpireksia
1.3 Hipertermia
2 Tanda dan gejala
3 Differential diagnosis
4 Patofisiologi
4.1 Pirogen
4.2 rilis PGE2
4.3 Hipotalamus
4.4 Kegunaan
5 Manajemen
5.1 Tindakan konservatif
5.2 Obat-obatan
6 Epidemiologi
7 Sejarah
8 Masyarakat dan budaya
8.1 Etimologi
8.2 Demam fobia
9 hewan lain
10 Referensi
11 Bacaan lebih lanjut
12 Pranala luar
definisi

klasifikasi suhu
Inti (rektum, esofagus, dll)
Hipotermia <35,0 C (95.0 F) [3]
36,5-37,5 C yang normal (97,7-99,5 F) [2]
Demam> 37,5 atau 38,3 C (99,5 atau 100,9 F) [1] [4]
Hipertermia> 38.3 atau 40.0 C (100,9 atau 104,0 F) [1] [4]
Hiperpireksia> 40.0 atau 41.5 C (104,0 atau 106,7 F) [5] [6]
Catatan: Perbedaan antara demam dan hipertermia adalah mekanisme yang mendasari.
Sumber yang berbeda memiliki luka yang berbeda off untuk demam, hipertermia dan
hiperpireksia.
v
t
e
Berbagai macam untuk suhu normal telah ditemukan [4] Demam umumnya sepakat untuk
hadir jika suhu tinggi disebabkan oleh set point mengangkat dan.:
Suhu di anus (rektum / anus) berada pada atau lebih dari 37,5-38,3 C (99,5-100,9 F) [1]
[4]
Suhu di mulut (oral) berada pada atau lebih dari 37,7 C (99,9 F) [7]
Suhu di bawah lengan (ketiak) atau di telinga (otic) berada pada atau lebih dari 37,2 C
(99,0 F)
Pada pria dewasa yang sehat dan perempuan, kisaran normal, suhu sehat untuk suhu oral
adalah 33,2-38,2 C (91,8-100,8 F), untuk rektal itu adalah 34,4-37,8 C (93,9-100,0 F),
untuk timpani membran (gendang telinga) itu adalah 35,4-37,8 C (95,7-100,0 F), dan
untuk aksila (ketiak) itu adalah 35,5-37,0 C (95,9-98,6 F) [8] buku teks internal. Harrison
obat mendefinisikan demam sebagai suhu oral pagi> 37,2 C (> 98,9 F) atau suhu oral
sore> 37,7 C (> 99,9 F) sedangkan variasi suhu normal sehari-hari biasanya 0,5 C (0,9
F). [9]
Suhu tubuh normal bervariasi tergantung pada banyak faktor, termasuk usia, jenis kelamin,
waktu hari, suhu lingkungan, tingkat aktivitas, dan banyak lagi. Sebuah mengangkat suhu
tidak selalu demam. Sebagai contoh, suhu orang yang sehat naik ketika ia latihan, tapi ini
tidak dianggap demam, sebagai set-point normal. Di sisi lain, "normal" suhu mungkin
demam, jika sangat tinggi untuk orang tersebut. Sebagai contoh, orang tua medis lemah
memiliki penurunan kemampuan untuk menghasilkan panas tubuh, sehingga "normal" suhu
37,3 C (99,1 F) mungkin merupakan demam klinis yang signifikan.
jenis
Kinerja berbagai jenis demam
a) Demam terus
b) Demam terus onset mendadak dan remisi
c) Demam remiten
d) demam intermiten
e) Demam Undulant
f) demam Relapsing
Pola perubahan suhu kadang-kadang mungkin mengisyaratkan diagnosis:

Terus menerus demam: Suhu tetap di atas normal sepanjang hari dan tidak berfluktuasi
lebih dari 1 C dalam 24 jam, misalnya lobar pneumonia, tifus, infeksi saluran kemih,
brucellosis, atau tifus. Demam tifoid dapat menunjukkan pola yang spesifik demam
(Wunderlich kurva demam tifoid), dengan peningkatan bertahap lambat dan dataran tinggi.
(Drops karena demam-mengurangi obat dikecualikan.)
Demam intermiten: Ketinggian suhu hadir hanya untuk jangka waktu tertentu, kemudian
bersepeda kembali normal, misalnya malaria, kala-azar, pyaemia, atau septicemia. Berikut ini
adalah jenis yang [10]
Demam yg terjadi setiap hari, dengan periode 24 jam, khas Plasmodium falciparum atau
Plasmodium knowlesi malaria
Demam malaria (48 jam periodisitas), khas Plasmodium vivax atau Plasmodium ovale
malaria
Demam quartan (72 jam periodisitas), khas malaria malariae Plasmodium.
Remiten demam: Suhu tetap di atas normal sepanjang hari dan berfluktuasi lebih dari 1
C dalam 24 jam, misalnya, endokarditis infektif.
Pel-Ebstein demam: Sebuah jenis tertentu demam yang berhubungan dengan limfoma
Hodgkin, yang tinggi selama satu minggu dan rendah untuk minggu depan dan seterusnya.
Namun, ada beberapa perdebatan mengenai apakah pola ini benar-benar ada. [11]
Demam neutropenia, juga disebut febrile neutropenia, adalah demam tanpa adanya fungsi
sistem kekebalan tubuh normal. Karena kurangnya neutrofil melawan infeksi, infeksi bakteri
dapat menyebar dengan cepat; demam ini, oleh karena itu, biasanya dianggap membutuhkan
perhatian medis yang mendesak. Jenis demam ini lebih sering terlihat pada orang yang
menerima kemoterapi penekan kekebalan dibandingkan orang yang tampak sehat.
Febricula adalah istilah tua untuk demam ringan, terutama jika penyebabnya tidak diketahui,
tidak ada gejala lain yang hadir, dan pasien pulih sepenuhnya dalam waktu kurang dari
seminggu. [12]
hiperpireksia
Hiperpireksia adalah demam dengan ketinggian yang ekstrim dari suhu tubuh lebih besar dari
atau sama dengan 41,5 C (106,7 F). [13] suhu tinggi tersebut dianggap sebagai darurat
medis karena dapat menunjukkan kondisi yang mendasari serius atau menyebabkan samping
yang signifikan efek. [14] penyebab paling umum adalah perdarahan intrakranial. [13]
kemungkinan penyebab lainnya termasuk sepsis, sindrom Kawasaki, [14] Infeksi paling [15]
sindrom neuroleptik ganas, efek obat, sindrom serotonin, dan tiroid badai. penyebab umum
dari demam, namun dengan meningkatnya suhu penyebab lain menjadi lebih umum. [14]
infeksi umumnya terkait dengan hiperpireksia termasuk roseola, rubeola dan infeksi
enterovirus. [15] pendinginan agresif Segera menjadi kurang dari 38,9 C (102.0 F)
memiliki telah ditemukan untuk meningkatkan kelangsungan hidup. [14] hiperpireksia
berbeda dari hipertermia di bahwa dalam hiperpireksia mekanisme pengaturan suhu tubuh
menetapkan suhu tubuh di atas suhu normal, kemudian menghasilkan panas untuk mencapai
suhu ini, sementara di hipertermia suhu tubuh naik di atas titik set karena sumber luar. [13]
hipertermia
Hipertermia adalah contoh dari suhu tinggi yang tidak demam. Hal ini terjadi dari sejumlah
penyebab termasuk pitam panas, sindrom neuroleptik maligna, malignant hyperthermia,
stimulan seperti amfetamin dan kokain, reaksi obat idiosinkratik, dan sindrom serotonin.
Tanda dan gejala

Michael Ancher, "The Sakit Girl", 1882, Statens Museum untuk Kunst
Demam biasanya disertai dengan perilaku sakit, yang terdiri dari kelesuan, depresi, anoreksia,
mengantuk, hiperalgesia, dan ketidakmampuan untuk berkonsentrasi. [16] [17] [18]
diagnosis
Demam adalah gejala yang umum dari banyak kondisi medis:
Penyakit menular, misalnya, influenza,, malaria, Ebola, infeksi mononucleosis, atau
gastroenteritis, penyakit Lyme HIV
Berbagai radang kulit, misalnya, bisul, atau abses
Penyakit imunologi, misalnya, lupus eritematosus, sarkoidosis, penyakit radang usus,
penyakit Kawasaki, Masih penyakit, penyakit Horton, penyakit Wegener, Hepatitis autoimun
Kerusakan jaringan, yang dapat terjadi pada hemolisis, operasi, infark, sindrom
menghancurkan, rhabdomyolysis, pendarahan otak, dll
Reaksi terhadap produk darah yang tidak cocok
Kanker, kanker ginjal yang paling umum dan leukemia dan limfoma
Gangguan metabolisme, misalnya, gout atau porfiria
Thrombo-emboli proses, misalnya, emboli paru atau trombosis vena dalam
Demam persisten yang tidak dapat dijelaskan setelah pertanyaan klinis rutin berulang disebut
demam yang tidak diketahui.
patofisiologi
Hipertermia: Ditandai di sebelah kiri. Suhu tubuh normal (set point termoregulasi)
ditampilkan dalam warna hijau, sedangkan suhu Hyperthermic ditampilkan dalam warna
merah. Seperti dapat dilihat, hipertermia dapat dikonseptualisasikan sebagai peningkatan atas
titik termoregulasi set.
Hipotermia: Ditandai di tengah: Suhu tubuh normal ditampilkan dalam warna hijau,
sedangkan suhu hipotermia ditunjukkan dengan warna biru. Seperti dapat dilihat, hipotermia
dapat dikonseptualisasikan sebagai penurunan di bawah titik termoregulasi set.
Demam: Ditandai di sebelah kanan: Suhu tubuh normal ditampilkan dalam warna hijau.
Bunyinya "New Normal" karena thermoregulatory set point meningkat. Hal ini telah
menyebabkan apa yang suhu tubuh normal (warna biru) untuk dipertimbangkan hipotermia.
Suhu pada akhirnya diatur di hipotalamus. Sebuah pemicu demam, disebut pirogen sebuah,
menyebabkan pelepasan prostaglandin E2 (PGE2). PGE2 kemudian pada gilirannya bekerja
pada hipotalamus, yang menghasilkan respon sistemik kembali ke seluruh tubuh,
menyebabkan efek panas menciptakan untuk mencocokkan tingkat suhu baru.
Dalam banyak hal, hipotalamus bekerja seperti termostat. [19] Ketika set point dinaikkan,
tubuh meningkatkan suhunya melalui kedua generasi aktif panas dan menahan panas.
Vasokonstriksi baik mengurangi kehilangan panas melalui kulit dan menyebabkan orang
merasa dingin. Jika tindakan ini tidak cukup untuk membuat suhu darah di otak sesuai
dengan pengaturan baru di hipotalamus, kemudian menggigil dimulai untuk menggunakan
gerakan otot untuk menghasilkan lebih banyak panas. Ketika demam berhenti, dan
pengaturan hipotalamus diatur lebih rendah; kebalikan dari proses ini (vasodilatasi, akhir
menggigil dan nonshivering produksi panas) dan berkeringat digunakan untuk mendinginkan
tubuh ke yang baru, pengaturan yang lebih rendah.
Ini berbeda dengan hipertermia, di mana pengaturan yang normal tetap, dan tubuh terlalu

panas melalui retensi yang tidak diinginkan dari kelebihan panas atau over-produksi panas.
[19] Hipertermia biasanya merupakan akibat dari lingkungan yang terlalu panas (heat stroke)
atau reaksi yang merugikan obat-obatan. Demam dapat dibedakan dari hipertermia oleh
keadaan sekitarnya dan responnya terhadap obat anti-piretik.
pirogen
Sebuah pirogen adalah zat yang menginduksi demam. Ini dapat baik internal (endogen) atau
eksternal (eksogen) ke tubuh. Lipopolisakarida bakteri substansi (LPS), hadir dalam dinding
sel beberapa bakteri, adalah contoh dari sebuah pirogen eksogen. Pirogenitas dapat
bervariasi: Dalam contoh ekstrim, beberapa pirogen bakteri yang dikenal sebagai
superantigen dapat menyebabkan demam yang cepat dan berbahaya. Depyrogenation dapat
dicapai melalui filtrasi, distilasi, kromatografi, atau inaktivasi.
endogen
Pada intinya, semua pirogen endogen adalah sitokin, molekul yang merupakan bagian dari
sistem kekebalan tubuh. Mereka diproduksi oleh sel imun diaktifkan dan menyebabkan
peningkatan titik termoregulasi set di hipotalamus. Pirogen endogen utama interleukin 1 (
dan ) [20] dan interleukin 6 (IL-6). Pirogen endogen kecil termasuk interleukin-8, tumor
necrosis factor-, makrofag inflamasi protein- dan makrofag inflamasi protein- serta
interferon-, interferon-, dan interferon-. [20] Tumor necrosis factor- juga bertindak
sebagai pirogen a. Hal ini dimediasi oleh interleukin 1 rilis (IL-1). [21]
Faktor-faktor sitokin ini dilepaskan ke sirkulasi umum, di mana mereka bermigrasi ke organ
circumventricular otak karena penyerapan lebih mudah disebabkan oleh berkurangnya aksi
filtrasi penghalang darah-otak di sana. Faktor sitokin kemudian mengikat dengan reseptor
endotel pada dinding pembuluh, atau berinteraksi dengan sel mikroglia lokal. Ketika faktor
sitokin ini mengikat, jalur asam arakidonat kemudian diaktifkan.
eksogen
Salah satu model untuk mekanisme demam yang disebabkan oleh pirogen eksogen mencakup
LPS, yang merupakan komponen dinding sel bakteri gram negatif. Sebuah disebut
lipopolisakarida-binding protein protein kekebalan (LBP) mengikat LPS. LBP-LPS kompleks
kemudian mengikat reseptor CD14 dari makrofag dekatnya. Hasil mengikat ini dalam sintesis
dan pelepasan berbagai faktor sitokin endogen, seperti interleukin 1 (IL-1), interleukin 6 (IL6), dan tumor necrosis factor-alpha. Dengan kata lain, faktor-faktor eksogen menyebabkan
pelepasan faktor endogen, yang, pada gilirannya, mengaktifkan jalur asam arakidonat.
rilis PGE2
Rilis PGE2 berasal dari jalur asam arakidonat. Jalur ini (yang berkaitan dengan demam),
dimediasi oleh enzim fosfolipase A2 (PLA2), cyclooxygenase-2 (COX-2), dan prostaglandin
E2 synthase. Enzim ini akhirnya memediasi sintesis dan pelepasan PGE2.
PGE2 adalah mediator utama dari respon demam. Suhu set point tubuh akan tetap tinggi
sampai PGE2 tidak lagi hadir. PGE2 bekerja pada neuron di daerah preoptic (POA) melalui
reseptor prostaglandin E 3 (EP3). Neuron EP3-mengungkapkan dalam POA menginervasi
hipotalamus dorsomedial (DMH), yang rostral raphe pallidus inti di medula oblongata
(rRPa), dan inti paraventrikular (PVN) dari hipotalamus. Sinyal Demam dikirim ke DMH dan
rRPa menyebabkan stimulasi sistem keluaran simpatik, yang membangkitkan non-menggigil
thermogenesis untuk menghasilkan panas tubuh dan vasokonstriksi kulit untuk mengurangi
hilangnya panas dari permukaan tubuh. Hal ini diduga bahwa persarafan dari POA ke PVN

memediasi efek neuroendokrin demam melalui jalur yang melibatkan kelenjar hipofisis dan
berbagai organ endokrin.
hipotalamus
Otak akhirnya orchestrates mekanisme efektor panas melalui sistem saraf otonom. Ini
mungkin:
Peningkatan produksi panas oleh otot meningkat, menggigil dan hormon seperti epinefrin
(adrenalin)
Pencegahan kehilangan panas, seperti vasokonstriksi.
Pada bayi, sistem saraf otonom juga dapat mengaktifkan jaringan adiposa coklat untuk
menghasilkan panas (thermogenesis non-olahraga-terkait, juga dikenal sebagai nonmenggigil thermogenesis). Peningkatan denyut jantung dan vasokonstriksi berkontribusi
terhadap peningkatan tekanan darah pada demam.
kegunaan
Ada argumen untuk dan terhadap kegunaan dari demam, dan isu yang kontroversial. [22] [23]
Ada studi yang menggunakan vertebrata berdarah panas [24] dan manusia [25] in vivo,
dengan beberapa menunjukkan bahwa mereka pulih lebih cepat dari infeksi atau penyakit
kritis karena demam. Sebuah studi Finlandia disarankan mengurangi kematian pada infeksi
bakteri ketika demam hadir. [26]
Secara teori, demam dapat membantu dalam pertahanan tuan rumah. [22] Tentu saja ada
beberapa reaksi penting imunologi yang dipercepat oleh suhu, dan beberapa patogen dengan
preferensi suhu yang ketat dapat dihambat. [27]
Penelitian [28] telah menunjukkan demam yang membantu proses penyembuhan dalam
beberapa hal penting:
Peningkatan mobilitas leukosit
Peningkatan leukosit fagositosis
Efek endotoksin menurun
Peningkatan proliferasi sel T [29]
pengelolaan
Demam seharusnya tidak harus diobati. [30] Kebanyakan orang sembuh tanpa perhatian
medis tertentu. [31] Meskipun tidak menyenangkan, demam jarang naik ke tingkat berbahaya
bahkan jika tidak diobati. Kerusakan otak umumnya tidak terjadi sampai suhu mencapai 42
C (107,6 F), dan sangat jarang untuk demam tidak diobati melebihi 40,6 C (105 F). [30]
tindakan konservatif
Beberapa bukti terbatas mendukung spons atau memandikan anak demam dengan air hangat.
[32] Penggunaan kipas angin atau pendingin udara agak dapat mengurangi suhu dan
meningkatkan kenyamanan. Jika suhu mencapai tingkat yang sangat tinggi dari hiperpireksia,
pendinginan agresif diperlukan. [14] Secara umum, orang disarankan untuk menjaga cukup
terhidrasi. [33] Apakah asupan cairan meningkat meningkatkan gejala atau memperpendek
penyakit pernapasan seperti flu biasa tidak dikenal. [34]
obat

Obat-obatan yang demam rendah disebut antipiretik. The ibuprofen antipiretik efektif dalam
mengurangi demam pada anak-anak. [35] Hal ini lebih efektif daripada asetaminofen
(parasetamol) pada anak-anak. Ibuprofen dan acetaminophen dapat dengan aman digunakan
bersama-sama pada anak-anak dengan demam. [36] [37] Kemanjuran acetaminophen dengan
sendirinya pada anak dengan demam telah dipertanyakan. [38] Ibuprofen juga unggul aspirin
pada anak dengan demam. [39] Selain itu, aspirin tidak dianjurkan pada anak-anak dan
dewasa muda (mereka yang di bawah usia 16 atau 19, tergantung pada negara) karena risiko
sindrom Reye. [40]
Menggunakan kedua parasetamol dan ibuprofen pada waktu yang sama atau bergantian
antara keduanya adalah lebih efektif menurunkan demam dibandingkan hanya menggunakan
parasetamol atau ibuprofen. [41] Tidak jelas apakah itu meningkatkan kenyamanan anak. [41]
epidemiologi
Sekitar 5% dari orang-orang yang pergi ke ruang gawat darurat demam. [42]
sejarah
Sejumlah jenis demam dikenal sejak 460 SM sampai 370 SM ketika Hippocrates sedang
berlatih kedokteran termasuk bahwa karena malaria (malaria atau setiap 2 hari dan quartan
atau setiap 3 hari). [43] Hal ini juga menjadi jelas sekitar waktu ini bahwa demam adalah
gejala dari penyakit daripada penyakit dalam dan dari dirinya sendiri. [43]
Masyarakat dan budaya
etimologi
Pireksia adalah dari bahasa Yunani yang berarti pyr api. Demam adalah dari febris kata Latin,
yang berarti demam, dan archaically dikenal sebagai malaria.
demam fobia
Demam fobia adalah nama yang diberikan oleh para ahli medis untuk kesalahpahaman orang
tua tentang demam pada anak-anak mereka. Di antara mereka, banyak orang tua salah
percaya bahwa demam adalah penyakit daripada tanda medis, bahkan demam rendah
berbahaya, dan bahwa setiap suhu bahkan sebentar atau sedikit di atas disederhanakan
"normal" nomor yang tertera pada termometer adalah demam klinis yang signifikan. [44]
Mereka juga takut efek samping berbahaya seperti kejang demam dan secara dramatis
melebih-lebihkan kemungkinan kerusakan permanen dari demam yang khas. [44] masalah
mendasar, menurut profesor pediatri Barton D. Schmitt, adalah "orang tua kita cenderung
untuk menduga bahwa otak anak-anak kita bisa meleleh. "[45]
Sebagai hasil dari kesalahpahaman ini orang tua cemas, memberikan obat anak demammengurangi ketika suhu secara teknis normal atau hanya sedikit meningkat, dan mengganggu
tidur anak untuk memberikan anak obat lagi. [44]
hewan lain
Demam merupakan fitur penting untuk diagnosis penyakit pada hewan domestik. Suhu tubuh
hewan, yang diukur pada dubur, berbeda dari satu spesies ke spesies lain. Misalnya, kuda
dikatakan mengalami demam di atas 101 F (38,3 C). [46] Dalam spesies yang
memungkinkan tubuh untuk memiliki berbagai "normal" suhu, seperti unta, [47] itu adalah
kadang-kadang sulit untuk menentukan tahap demam.

Demam juga bisa disebabkan oleh perilaku invertebrata yang tidak memiliki sistem
kekebalan demam berbasis. Misalnya, beberapa spesies belalang akan thermoregulate untuk
mencapai suhu tubuh yang 2 -. 5 C lebih tinggi dari normal untuk menghambat
pertumbuhan jamur patogen Beauveria bassiana seperti dan Metarhizium acridum [48]
Honeybee koloni juga mampu menginduksi demam dalam menanggapi jamur parasit
Ascosphaera apis. [48]
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