PROLONGED FEVER : PULMONOLOGY’S

PERSPECTIVE

JATU APHRIDASARI

DEPARTMENT OF PULMONOLOGY AND RESPIRATORY MEDICINE

FACULTY OF MEDICINE SEBELAS MARET UNIVERSITY/DR MOEWARDI HOSPITAL
CONTENTS

¡ Definition
¡ Pathogenesis
¡ Classifications
¡ Causes
¡ Clinical implications
¡ Conclusion
DEFINITION

¡ International Union of Physiological Sciences Commission for Thermal

Physiology (2001) : fever is a state of elevated core temperature, which
is often, but not necessarily, part of the defensive responses of
multicellular organisms (host) to the invasion of live (micro-organisms)
or inanimate matter recognized as pathogenic or alien by the host
¡ Core temperature is regulated by various relatively independent
thermoeffector loops, each having its own afferent and efferent branches
¡ The preoptic region of the anterior hypothalamus is still considered the
major thermoregulatory centre in the CNS
PATHOGENESIS
¡ Fever is triggered when
endogenous or exogenous
pyrogens stimulate the
synthesis of prostaglandin
E2 (PGE2).
¡ Synthesized in endothelial
cells of the brain vasculature
or in circulating
macrophages in response to
immune signals, PGE2
mediates fever when it binds
the prostaglandin E receptor
3 on neurons in the preoptic
area.
 PATHOPHYSIOLOGY OF FEVER

Walter E.J., et.al. The pathophysiological basis and consequences of fever. Critical Care (2016) 20:200. DOI 10.1186/s13054-016-1375-5
 Cytokines as Mediators of Fever

Netea M.G., et.al. Circulating Cytokines as Mediators of Fever. Clinical Infectious Diseases 2000;31:S178–84
CLASSIFICATIONS

¡ Sustained or Continuous Fever: Fever that oscillates less than 1 ºC or ~1.5 ºF

daily; doesn’t touch normal. Ex: Typhoid fever, Drug fever, Typhus, Neoplasms
¡ Remittent Fever: Fever that oscillates more than 1 ºC or ~1.5 ºF ; doesn’t touch
normal. Pattern of most fevers
¡ Intermittent Fever: Fever that falls to normal each day. Ex: Quotidian (24 hour
periodicity): P. falciparum, Double quotidian (12 hour periodicity): Kala-azar,
Gonococcal arthritis, Juvenile RA, Some drug fevers (carbamazepine)
¡ Hectic or Septic Fever: When remittent or intermittent fever shows large
variation between the peak and nadir. Ex: Kawasaki disease, Pyogenic infections
¡ Periodic or Cyclic Fever: Episodes of fever recurring at regular intervals. Ex:
Tertian (48 hour periodicity): P. vivax, P. ovale, Quartan (72 hour periodicity): P.
malariae, Pel-Ebstein Fever: bouts of fever lasting 3 to 10 days followed by
asymptomatic periods of the same length (Hodgkin’s disease), Relpasing fever (every
10-14 days): Borrelia recurrentis, Undulant fever (gradual increase in temperature that
remains high for a few days, and then gradually decreases to normal): Brucellosis
¡ Recurrent Fever: Illness involving the same organ (e.g. urinary tract) or
multiple organ systems in which fever recurs at irregular interval. Ex: Familial
Mediterranean Fever
CAUSES OF PROLONGED FEVER

Mackowiak, P. A. Concept of Fever. Arch Intern Med. 1998;158:1870-1881

ALGORITHM FEVER IN ICU
FEVER, HEAT SHOCK RESPONSE AND HEAT SHOCK PROTEINS
Heat shock proteins (HSPs) are specific proteins that are made
when cells are briefly exposed to temperatures above their
normal growth temperature.
CONCLUSION

¡ Fever is an adaptive mechanism that plays an important role in the survival of the host during infection with
pathogenic microorganisms.
¡ A mild elevation in core temperature is of benefit in sepsis.
¡ Circulating proinflammatory cytokines acting as EPs play a pivotal role in transmitting the signal responsible for
inducing a febrile response from the peripheral tissues to the CNS.
¡ Accumulation of cellular HSP70s, especially HSPA1A, in lung alveolar cells is beneficial against ARDS-induced lung
damage.