The Definition

The International Union of Physiological Sciences Commission for Thermal Physiology defines
fever/febrile as a state of elevated core temperature, which is often (but not necessarily) part of
the defense response of a multicellular organism (host) against invading microorganisms or
inanimate objects that are pathogenic or foreign to the host. . El-Rahdi and colleagues define
fever (pyrexia) in terms of pathophysiological and clinical. Pathophysiologically, fever is an
increase in the thermoregulatory set point of the hypothalamic center mediated by interleukin 1
(IL-1). While clinically, fever is an increase in body temperature of 1oC or greater above the
average value of normal temperature at the place of recording. In response to this change in set
point, there is an active process to reach the new set point. This is achieved physiologically by
minimizing heat release and producing heat.
Normal body temperature varies according to the circardian temperature rhythm (diurnal
variation). The lowest temperature is reached in the morning at 04.00 – 06.00 and the highest in
the early evening at 16.00 – 18.00. The fever curve usually also follows this diurnal pattern.1,2
Body temperature is also influenced by individual and environmental factors, including age, sex,
physical activity and ambient air temperature. It is therefore clear that there is no single value for
normal body temperature. The results of body temperature measurements vary depending on the
place of measurement.
Table 1. Normal temperature in different places
Range; average
Measurement Fever
Type of thermometer normal
place o
(oC)
temperature ( C)
Axilla Mercury, electronics 34,7 – 37,3; 36,4 37,4
Sublingual Mercury, electronics 35,5 – 37,5; 36,6 37,6
Rectal Mercury, electronics 36,6 – 37,9; 37 38
Ears Infrared emission 35,7 – 37,5; 36,6 37,6

Normal rectal temperature is 0,27o – 0,38oC (0,5 – 0,7oF) higher than oral temperature. The
axillary temperature is approximately 0,55oC (1oF) lower than the oral temperature. For practical
clinical purposes, a patient is considered to have a fever if the rectal temperature reaches 38oC,
the oral temperature is 37.6oC, the axillary temperature is 37.4oC, or the tympanic membrane
temperature is 37, 6 oC.1 Hyperpyrexia is a term used for fever when the body temperature
exceeds 41.1 oC (106 oF).

The Classification
The classification of fever is as follows:
a. Septic fever
Body temperature gradually rises to very high levels at night and drops back to above normal
levels in the morning. Often accompanied by complaints of chills and sweating. When the high
fever drops to a normal level, it is called hectic fever.
b. Remittent fever
Body temperature can drop every day but never reaches normal body temperature. The possible
causes of temperature recorded can be as high as two degrees and not as large as the temperature
difference noted for septic fever.

c. Intermittent fever
Body temperature drops to normal levels for several hours of the day. If a fever like this occurs
every two days it is called tersiana and if it occurs two days free of fever between two attacks of
fever it is called quartana.
d. Continuous fever
Temperature variations throughout the day do not differ by more than one degree. At the level of
fever that is continuously very high is called hyperpyrexia.Fever pattern in typhoid fever (shows
relative bradycardia).

e. Periodic Fever
Periodic fever is characterized by recurrent episodes of fever at regular or irregular intervals.
Each episode is followed by one to several days, weeks or months of normal temperature.
Examples that can be seen are malaria (the term tertiana is used when fever occurs every 3rd day,
quartana when fever occurs every 4th day)and brucellosis. Malaria fever pattern.
 Table 2. Fever patterns found in pediatric disease
Fever Pattern Disease
Continuous Typhoid fever, malignant falciparum malaria
remittance Most viral and bacterial diseases
intermittent Malaria, lymphoma, endocarditis
Hectic or septic Kawasaki disease, pyogenic infection
Quotidian Malaria due to P. vivax
Double quotidian Kala azar, gonococcal arthritis, juvenile rheumatoid arthritis, some drug
fevers (eg carbamazepine)
Relapse or periodic Malaria tertiana or quartana, brucellosis
Recurrent fever Familial Mediterranean fever

The Etiology
Fever is often caused by infection. Causes of fever other than infection can also be caused by
toxemia, malignancy or reactions to drug use, as well as disturbances in the central temperature
regulation center (eg cerebral hemorrhage, coma). Basically, to achieve an accurate diagnosis of
the cause of fever, it is necessary to include: accuracy in taking the patient's medical history,
carrying out a physical examination, observing the course of the disease and evaluating
laboratory examinations, as well as other supports in a precise and holistic manner.
Fever occurs when heat generation exceeds output. Fever can be associated with infection,
collagen disease, malignancy, metabolic disease or other diseases. Fever can be caused by
abnormalities in the brain itself or toxic substances that affect the temperature regulation center,
bacterial diseases, brain tumors or dehydration
Fever is often caused by; upper respiratory tract infection, otitis media, sinusitis, bronchiolitis,
pneumonia, pharyngitis, dental abscess, gingival vostomatitis, gastroenteritis, urinary tract
infection, pyelonephritis, meningitis, bacteremia, immune reaction, neoplasm, osteomyelitis.
Basically, to achieve an accurate diagnosis of the cause of fever, it is necessary to include:
thorough taking of patient's disease history, carrying out a physical examination, observing the
course of the disease and evaluating laboratory tests and other supports in a precise and holistic
manner. Some special things to pay attention to in fever are the way the fever arises, the duration
of the fever, the height of the fever and the complaints and symptoms that accompany the fever.
Reference
Pratiwi, N. R. R. (2018). Penerapan Kompres Hangat pada Anak Demam dengan Gangguan
Pemenuhan Kebutuhan Nyaman di RSUD Sleman. Eprints.Poltekkesjogja.Ac.Id, 8–30.

El-Radhi AS, Carroll J, Klein N, Abbas A. Fever. Dalam:  El-Radhi SA, Carroll J, Klein N,
penyunting. Clinical manual of fever in children. Edisi ke-9. Berlin: Springer-Verlag; 2009.h.1-
24.