FEVER

 Definition of fever
 an elevation of body temperature that exceeds the normal daily variation and occurs in
conjunction with an increase in the hypothalamic set point [e.g., from 37°C to 39°C
(98.6°F to 102.2°F)]. (Harrison)
 which means a body temperature above the usual range of normal, can be caused by
abnormalities in the brain itself or by toxic substances that affect the temperature-
regulating centers. (Guyton)
 Temperature:
- Temperature in the anus (rectum/rectal) is at or over 37.5–38.3 °C (99.5–100.9 °F)
- Temperature in the mouth (oral) is at or over 37.7 °C (99.9 °F)
- Temperature under the arm (axillary) or in the ear (otic) is at or over 37.2 °C
(99.0 °F)

 Normal Body Temperature : 36.5–37.5 °C (97.7–99.5 °F)

 Etiology of fever
 Infections (Exogenous pyrogens) : Lipopolysaccharide, toxins
- Bacterial Infection: pneumonia, meningitis,bronkitis, tuberculosis, etc.
- Viral Infection: DHF,chikungunya, pneumonia, Influenza,etc.
- Mold Infection: coccidioides imitis, criptococcosis,etc.
- Parasite Infection; Malaria, helmintiasis, toksoplasmosis,etc.
 Non-Infections
- Environment Factors ( Extreme environment temperature)
- Teething
- Autoimune disease (SLE, arthritis)
- Malignancy
- After immunization
- cerebral hemorrhage, etc
 Type of febrile patterns
- Continue : Temperature remains above normal throughout the day and does not
fluctuate more than 1 °C in 24 hours.
e.g.lobar pneumonia, typhoid, meningitis, urinary tract infection, or typhus.
- Intermittent:  The temperature elevation is present only for a certain period (some
hours of the day), later cycling back to normal.
 e.g. malaria, kala-azar,pyaemia, or septicemia.
 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: Temperature remains above normal throughout the day and fluctuates
more than 1 °C in 24 hours. The fever usually low in the morning and higher in the
late evening. This pattern can be found in the first week of thypoid fever.

- Saddleback (biphasic/siklik) fever , with several days of fever, a gap of reduced fever
of about 1 day, and then several additional days of fever. e.g. Dengue fever, yellow
fever, colorado thick fever,etc.

- Pel-Ebstein fever: characterized by weekly or longer periods of fever and equally

long afebrile periods with repetition of the cycle. e.g. Hodgkin’s disease, brucellosis
of the Bruclla melitensis type and relapsing fever.
  Mechanism of fever

 FEVER OF UNKNOWN ORIGIN

 Children with fever,documented by a health care provider,for which cause could not be
identified even after 3 weeks of evaluation as an outpatient or after 1 week of evaluation
in the hospital
 CLASSIFICATION
- 4 categories :
1. Classic FUO :
 fever of > 38 degree C ,lasted for > 3 wks, >2 visits or 1 wk in hospital
 Patient location : community , clinic or hospital >
 Leading causes : cancer , infections , inflammatory conditions, undiagnosed ,
habitual hyperthermia
 History emphasis : H/O travel , contacts , animal & insect exposure , medicaton,
immunization , family history , cardiac valve disorder
2. Health care associated FUO
 Fever of > 38 degree C ,lasted for > 1 week , not present or incubating on
admission
 Patient location : Acute care hospital
 Leading causes : Hospital acquired infections , post- operative complications

3. Immune deficient FUO

 Fever of > 38 degree C , hitung jenis neutrofil <500 ul, lasted for > 1 wk &
negative culture after 48 hrs
 Patient location : Hospital or clinic
 Leading causes : Majority are due to infections but cause has been documented
in only 40-60%

4. HIV – related FUO

 Fever of >38 degree C , >3 wks for outpatients , >1 wk for inpatients & HIV
infection confirmed
 Patient location : Community , clinic or hospital
 Leading causes : HIV (primary infection) , typical & atypical mycobacteria ,
CMV , toxoplasmosis , cryptococcosis , lymphomas , immune reconstitution
inflammatory syndrome (IRIS)