This document provides an outline and overview of an approach to fever. It begins with an introduction that defines fever and classifies levels of fever. It then discusses signs and symptoms in adults and pediatrics, including elevated core temperature and associated symptoms like chills, sweating and fatigue. Differentials, clinical correlates, investigations, management and treatment are also outlined. Symptomatic treatment includes antipyretics like paracetamol and ibuprofen. The document concludes with potential complications if fever is left untreated, such as febrile seizures.

1. Hulbert & Marion A. Donovan College of Health Sciences
Department of Physician Assistant
Fundamentals of Medicine I Presentation
Topic: Approach to Fever
Submitted To: Doctor Prince Patrick Myers
Lecturer
Submitted by:
Ma-watta Toure ……. 2210053
Rita S. Dahn ………… 221022
Date of Submission: December 6, 2022

2. Outline
 Introduction
 Signs and symptoms
 Differentials
 Clinical correlate
 Investigation
 Management/treatment
 Complication of fever
 Bibliography

3. Introduction
 Fever, or pyrexia, is the elevation of individual’s core body temperature above a set
point regulated by the body’s thermoregulatory center in the hypothalamus. This
increase in the body set-point temperature is often due to a physiological process
brought about by infectious causes or noninfectious causes such as inflammation,
malignancy, or autoimmune processes. These processes involve the release of
immunological mediators, which trigger the thermoregulatory center of the
hypothalamus, leading to an increase in the body’s core temperature.
Classification of fever:
Low-grade: 37.3 to 38.0.C (99.1 to 100.4.F)
Moderate grade: 38.1 to 39.0.C (100.6 to 102.2.F)
High grade: 39.1 to 41.C (102.4 to 105.8.F)
Hyperthermia: Greater than 41.C (105.8.F)
 Cells of the immune system release pyrogenic cytokines that bind to receptors on
vascular endothelial cells within the hypothalamus. Thermoregulatory mechanisms
are controlled by the preoptic area of the anterior hypothalamus. A local sensing
mechanism links blood temperature to sympathetic autonomic discharge shivering
thermogenesis, dermal vasoconstriction.

4. Signs and symptoms (In Adult)
 • Anorexia , Chills and sweating (occur during variation of body temperature), Fatigue
 • Headache, Malaise, Myalgia, Night sweats, Depression, Dehydration, Hyperalgesia, Lethargy,
Problems concentrating, Sleepiness, Sweating
 Suggestive of chronic inflammatory conditions
Elevated core temperature
 • Oral temperature >37.5c or 99.5F, Rectal temperature > 38.0C or 100.4F
 • Temperature >106F suggest failure of thermoregulation
Fever every other day or every third day
 • Malaria
Relapsing fever
 • -Fever daily for 3-6 days followed by a fever-free interval or about one week, Borrelia
infections, Rat-bite fever
Undulating fever
 • -Brucellosis, Typhoid
 Periodic pyrexia, Hodgkin’s disease
 • Heart rate is increased
Dissociation o the heart rate and temperature suggest certain types of infection
 • Typhoid fever, Legionnaire’s disease, Psittacosis, Brucellosis, Factitious fever
 Increase respirator rate -absent with factitious fever
 In a febrile patient, first look for signs of serious illness, then try to establish a diagnosis in Infants or
young children who have fever with no obvious source of infection.

5. Signs and symptoms (In Peds)
 Toxicity associated with lethargy, poor perfusion, hypo/hyperventilation,
weak cry; purpuric petechial rash
 Altered mental status
 Lethargy presenting with decreased level of consciousness
 Irritability
 Impaired interaction with environment,
 Parents, physician, toys
 Febrile seizures
 10% of children <2 years old with temperature >41.1C have bacterial
meningitis
 53% of children with temperature >41.1C have serious illness
 Temperatures >42C often have a noninfectious etiology
 Serious infection may occur in the absence of fever

6. Differentials
Failure of thermoregulation
 Adrenergic syndrome
 Anticholinergic syndrome
 Neuroleptic malignant syndrome
 Malignant hyperthermia
Hyperthermia from impaired heat loss
 Climatic temperature exceeding body heat – heat stroke
 Congenital absence of sweat glands during hot weather
Factitious elevations in temperature
 Manipulation or exchange of thermometers

7. Clinical correlate
 High grade fever ( that exceeds 38.C)
 Sweating
 Chills and shivering
 Headache
 Muscle aches
 Loss of appetite (anorexia)
 Irritability
 Dehydration
 General weakness

8. Clinical correlate cont…
 Symptoms and signs of inflammation may be minimal or
absent in the severely neutropenic patients.
 History and examination
 Look for inflammation/ infection at the following sites and
sample as appropriate: mouth-gums ,pharynx, sinuses, upper
gastrointestinal, lung, perineum, skin lesion genito-urinary
,vascular sites, bone marrow aspiration sites, diarrhea.

9. Investigation
History
Performing a routine investigation or examination is important. You need to
obtain an accurate history from a patient when assessing fever; the history
obtained should include the following information:
 Fever history
 Fever at presentation
 Current level of activity or lethargy
 Activity level prior to fever onset (i.e, active, lethargic)
 Current eating and drinking pattern
 Eating and drinking pattern prior to fever onset
 Appearance: fever sometimes makes a child appear rather ill
 Vomiting or diarrhea
 Ill contacts
 Medical history
 Immunization history (especially recent immunization)
 Urinary output: inquire as to the number of wet diapers (peds.)

10. Investigation cont….
Physical
While performing a complete physical examination, pay particular attention to assessing
hydration status and identifying the source of infection. Physical examination of every febrile
patient should include the following:
 Record vital signs: (temperature; rectal temperature, tympanic, axillary, or oral methods)
 Pulse rate
 Respiratory rate
 Blood pressure
 Measure pulse oximetry levels
 Record and accurate weight on every chart
During the examination, concentrate on identifying any of the following:
 Toxic appearance which suggest possible signs of lethargy, poor perfusion, hypoventilation or
hyperventilation, or cyanosis
 A focus of infection that is the apparent cause of the fever
 Minor foci (e.g. otitis media, pharyngitis, sinusitis, skin or soft tissue infection
 Identifiable viral infection (e.g. Bronchiolitis, croup, gingivostomatis, viral gastroenteritis,
varicella, hand-foot-and-mouth disease)
 Petechial or purpuric rashes, often associated with bacteremia
 Purpura, which is associated more often with meningococcemia than is the presence of
petechial alone.

11. Management or treatment
 For patients with fever without a focus who appear ill, conduct a
complete investigation to identify the sources/causes o the infection.
Follow the evaluation with empiric antibiotic treatment and admit the
patient to a hospital or further monitoring and treatment pending culture
results.
 Patient age 2 – 36 months may not require admission I they meet the
following criteria: Patient was healthy prior to onset of fever
 Patient is fully immunized
 Patient has no significant risk factors.
 Patient appears nontoxic and otherwise healthy
 Patient’s parents (or caregivers) appear reliable and have access to
transportation if the child’s symptoms should worsen.

12. Management and treatment cont..
 Treatment recommendations or children with eve
without a focus are based on the child’s appearance,
age and temperature.
 For children who do not appear toxic, treatment
recommendations are as follow:
 Schedule a follow-up appointment within 24-48 hours
and instruct parents to return with the child sooner if
the condition worsens.
 Hospital admission is indicated for children whose
condition worsens or whose evaluation findings suggest
serious infection.
 They need to consult with specialists depends on the
specialty of the physician who initially evaluated the
patient and the ultimate source o ever. Typically,
general pediatricians easily manage febrile infants on
both an inpatient and outpatient follow-up basis.

13. Management cont..
Symptomatic treatment:
 Undress the patient
 Antipyretics:
 Paracetamol PO
 Children: 60mg/kg/day in 3 or 4 divided doses
 Adults: 3 to 4g/day in 3 or 4 divided doses or
 ASA: PO (to be avoided in children under 16 years)
 Adults: 1 to 3g/day in 3 or 4 divided doses

14. Management cont..
Age
Weight
2 months 1 Year 5Years 15 Years Adult
4kg 8kg 15kg 35kg
Paracetamol
120mg/5ml
oral solution
2ml x 3 3 to 6 ml x 3 - - -
100mg tablet ½ tab x 3 ¾ to 1 ½ tab
the
1 ½ to 3 tab x 3 - -
500mg tablet ¼ to ½ tab x 3 ½ to 1 ½ tab x 3 2 tab x 3
A.S.A
300mg tablet
2 tab x 3
500mg tablet 1 tab x 3

15. Management cont..
Ibuprofen PO
 Children under 3 months: do not administer
 Children over 3 months: 30mg/kg/day in 3 divided doses
 Children over 15 years around 35kg 200 mg tablet 1 to 2 tab x3
 Adults: 1200 to 1800mg/day in 3 to 4 divided doses
Red flag caution
 Paracetamol is the drug o choice or pregnant and breast-feeding
women.
 Acetylsalicylic acid is not recommended during the first 5months of
pregnancy, contra-indicated from the beginning of the 6th month, and
to be avoided in breast-feeding women. Ibuprofen is not
recommended during the first 5 months of pregnancy and
contraindicated from the beginning of the 6th month. It can be
administered to breastfeeding- women as short-term treatment.

16. Complication of fever
In most cases, fever can break on their own or with
home remedies. However, high fevers that linger or
worsen can cause significant health complications if
left untreated, including
Febrile seizures, brain damage, and even death

17. Bibliography
1. The 5 minute Emergency medicine consult (Pages 408, 409,
410, 411)
by: Peter Rosen
Roger M. Barkin
Stephen R. Hayden
Jeffrey Schaider
Richard Wolfe
2. www.ncbi.nlm.nih.gov (Physiology, fever): Balli S, Shumway
KR, Sharan S.