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Fever

Fever in Adults Overview

A fever is higher-than-normal body temperature. It is a symptom caused by a variety of illnesses.
Every one of us has experienced the wave of chills and exhaustion that a fever causes. Fever usually occurs in response to an infection or inflammation. However, many other causes are possible, including drugs, poisons, cancer, heat exposure, injuries or abnormalities to the brain, or disease of the endocrine (hormonal) system.
A fever rarely comes without other symptoms. It is often accompanied by specific complaints, which may help to identify the illness causing the fever. This can help the doctor determine which treatment is necessary.
Normal body temperature can vary depending on the individual, the time of day, and even the weather. For most people, a temperature of 98.6°F is baseline.
Temperature is usually controlled by the part of the brain called the hypothalamus. The hypothalamus is like a thermostat for the body. It maintains normal temperature through heating mechanisms, such as shivering and metabolism, and cooling mechanisms, such as sweating and dilating (opening) blood vessels close to the skin.
Fever occurs when the body’s immune response is triggered by pyrogens (fever-producing substances). Pyrogens usually come from a source outside the body and, in turn, stimulate the production of pyrogens inside the body. Pyrogens tell the hypothalamus to increase the temperature set point. In response, our body begins to shiver; our blood vessels constrict (close); we get under the covers in an attempt to reach the new temperature that is higher than our baseline.

Pyrogens (fever-producing substances) that occur outside the body
Viruses
Bacteria
Fungi
Drugs
Toxins
Viral fever

Illnesses caused by viruses are among the most frequent causes of fever in adults. Symptoms include a runny nose, sore throat, cough, hoarseness, and muscle aches. Viruses also may cause diarrhoea, vomiting, or an upset stomach.

For the most part, these viral illnesses will improve simply with time. Antibiotics will not treat a virus. Symptoms can be treated using decongestants and cough medicine bought over the counter. If diarrhoea or vomiting occurs, then the person needs to be encouraged to drink fluids. Gatorade will replace lost electrolytes. If fluids are not staying down, then the doctor should be called. Viral illnesses can last as long as 1-2 weeks.

The influenza virus occurs annually and is a major cause of death and serious illness in the elderly. Symptoms include headaches and muscle and joint aches, as well as the other common viral symptoms, including fever. An influenza vaccine is recommended for people older than 50 years and for anyone who has a high risk of being exposed to the virus. Also, there is medication to fight the influenza virus immediately after the symptoms start. This illness usually occurs during the winter.

Bacterial fever

Bacterial illnesses causing fever can affect almost any organ system in the body. They can be treated with antibiotics.
Central nervous system (brain and spinal cord) infections can cause fever, headache, neck stiffness, or confusion. A person may feel lethargic and irritable, and light may irritate the eyes. This could represent meningitis or a brain infection, so the person should go immediately to the doctor. Many colleges are now requiring the meningococcal vaccine for all students to prevent the contraction of meningitis.
Lower respiratory system infections include pneumonia and bronchitis. Symptoms include coughing, difficulty breathing, thick mucus production, and sometimes chest pain. People who smoke should stop smoking immediately. A fever that causes night sweats and blood in the mucus can sometimes indicate tuberculosis. Anyone with these symptoms needs to go to the hospital.
Upper respiratory system infections occur in the throat, ears, nose, and sinuses. A runny nose, headache, or sore throat accompanied by a fever may indicate a bacterial infection.
Infection of the genitourinary system may cause a person to have a burning sensation when urinating, blood in the urine, the urge to urinate frequently, and back pain along with a fever. This would indicate an infection in the bladder, kidney, or urinary tract. Antibiotics would treat such an infection.
If the reproductive system is affected, people often see a discharge from the penis or vagina and have pelvic pain along with the fever. This may represent pelvic inflammatory disease (PID), which does significant damage to the reproductive organs. In this case, the person and any sexual partners should see a physician.

Gastrointestinal system (digestive system) infections are indicated by diarrhoea, vomiting, stomach upset, and sometimes blood in the stool. Blood in the stool usually indicates a bacterial infection and can be treated with antibiotics. Abdominal pain may be caused by an infection of the appendix, gallbladder, or liver, and the doctor should be called.

Circulatory system (including the heart and lungs) can be invaded by bacteria. There may not be any specific symptoms with the fever. A person may feel body aches, chills, weakness, or confusion. The condition of sepsis exists when bacteria enter the bloodstream. An infection of a heart valve can occur in people who had heart surgery in the past and in people who use IV drugs. This condition requires hospitalization and immediate treatment with IV antibiotics.

Skin, the largest organ in our body, can also be the source of a bacterial infection. Redness, swelling, warmth, pus, or pain occurs at the site of the infection. An infection may result from trauma to the skin or even a clogged pore that becomes an abscess. Sometimes the infection needs to be drained. Antibiotics are often needed.

Fungal fever

Fungal infections can affect any organ system. Often a physician can identify these infections through a physical examination. Sometimes further testing is required. An antifungal medication will usually treat the infection.

Animal exposure fever

Certain people who work with animals can be exposed to rare bacteria that can cause fevers. In addition to the fever, the person may have chills, headache, and muscle and joint aches. These bacteria can exist in livestock, in unpasteurized dairy products, and in the urine of infected animals.

Travellers' fever

Anyone who travels, especially outside the United States, may develop fever after exposure to various new foods, toxins, insects, or vaccine-preventable diseases.

The only vaccines required by law at this time are yellow fever and cholera. Childhood vaccines such as those against measles, mumps, rubella, diphtheria, tetanus, and polio should be current prior to travel. Vaccines against hepatitis A, meningitis, and typhoid can be obtained before people travel to an area where exposure to those diseases is likely. The Centres for Disease Control and Prevention can advise you on the current vaccines recommended for travel to various countries.

When travelling, consumption of contaminated water, uncooked vegetables, or unpasteurized dairy products can cause a low-grade fever and traveller’s diarrhoea. Pepto-Bismol, Imodium, and certain antibiotics can help. The symptoms of abdominal cramping, nausea, vomiting, headache, and bloating should go away in 3-6 days. A fever higher than 101°F or blood in the stool is an indication to go to a doctor immediately.

Insect bites are a common way that infections are spread in some countries. Malaria is a serious infection that can occur after a mosquito bite. The bitten person may have fevers that come and go every few days. A blood test must be done to make the diagnosis. In certain infected areas, a traveller can take medication to prevent malaria. Lyme disease is spread by the bite of a tick. This is common in areas of the US where the deer tick is found. Any infection caused by an insect bite should be evaluated by a doctor.

Drug fever

A fever that occurs after starting a new medication, without another source, may be a drug fever. The fever can occur at any time after starting the drug and should go away after the drug is stopped.
Antibiotics often cause a fever after a week of treatment.
Certain heart and seizure medications have caused fever after months of treatment.
An immediate fever may be caused by an allergic response to the medication or a preservative in the medication.
Excess aspirin and thyroid hormone can increase metabolism and cause a fever.
Antihistamines, certain antidepressant medications, and sedatives can prevent heat loss from the body.
Cocaine and amphetamines can increase muscle activity and cause a fever.

Blood clot fever

Occasionally a blood clot can develop in a person’s leg and cause swelling and pain in the calf. Part of this clot may break off and travel to the lungs. This may cause chest pain and trouble breathing. In either case, a person may develop a fever because of inflammation in the blood vessels. A person with any of these symptoms should go to the hospital.

Tumour fever

Cancer can cause fever in a variety of ways. Sometimes the tumour makes pyrogens, which cause a fever on their own. Some tumours may become infected. Tumours in the brain may prevent the hypothalamus (the body’s thermostat) from regulating the temperature. Many of the medications that a cancer patient takes can cause a fever. Finally, immune systems in cancer patients may be weakened, which makes them prone to various infections.

Environmental fever

Occasionally a very high body temperature can be reached when the body becomes overheated. This condition is called hyperthermia. This often occurs with strenuous exercise or when the body is exposed to hot or humid weather. Certain drugs that alter a person’s behaviour may prevent that person from taking shelter from the heat. People with hyperthermia may be confused, lethargic, or even comatose. They may have an extremely high temperature and may not be able to sweat. Hyperthermia is treated differently than other causes of fever. The affected person must be cooled immediately.

Special medical conditions

Many people have medical illnesses that prevent their immune system (defence system) from working normally. This may make it easier for a fever-causing infection to invade their body. Depending on the illness, it may be difficult to find the source of the fever. A fever in a person with limited ability to fight off infection can be very dangerous.

Causes of a weakened immune system

Cancer
Cancer treatment medication
Organ transplant medication
Steroid therapy for a long time
HIV
Age older than 65
No spleen
Sarcoidosis
Lupus
Malnutrition
Diabetes
Heavy alcohol or drug use

Any person with one of these illnesses or conditions and a fever should see a doctor or go to a hospital's emergency department quickly. It is important for the proper treatment to be started right away. Quick action may save the person's life.


When to call the doctor

A fever has many possible causes. Most commonly, a fever is part of a virus that will go away on its own.
Call the doctor if any of these conditions exists.
If the temperature is 104°F or greater
If the fever lasts more than 7 days
If the symptoms get worse

Call the doctor immediately if any of the following symptoms occur with the fever.
Confusion or excessive sleepiness
Stiff neck
Severe headache
Sore throat
Rash
Chest pain
Trouble breathing
Repeated vomiting
Abdominal pain
Blood in stool
Pain with urination
Leg swelling
Red, hot, or swollen area of skin
People with serious medical illnesses, such as cancer or HIV, may not show these warning signs. Mild symptoms should be discussed with the doctor before they can progress into a serious infection.

When to go to the hospital

Certain illnesses that occur with a fever can be life threatening. Under these conditions, the person should go immediately to a hospital's emergency department.
Meningitis is life threatening and highly contagious if caused by certain bacteria. If a person has the combination of a fever, severe headache, and stiff neck, he or she should be taken to the emergency department immediately.
A person with difficulty breathing or chest pain and a fever should go immediately to the emergency department or call for emergency medical transport.
If a person has a fever and blood in the stool, urine, or mucus, he or she should seek emergency medical help.
A person who has a fever and is very agitated or confused with no obvious reason should be transported to the emergency department.
Any person whose immune system is weakened (for example, people with cancer or AIDS) should call their doctor or go to the emergency department immediately if a fever develops.
Hyperthermia is an emergency. Call for emergency medical transport if a person has a temperature greater than 104°F, is confused, or is not responding.

Self-Care at Home

You can make the diagnosis of fever by taking your temperature with a thermometer. The best place in an adult is to put the thermometer in the mouth or rectum, using a rectal thermometer.
In general, a fever can be reduced with ibuprofen or acetaminophen. Both medications help control pain and fever. Alternating doses of each will also work and prevent accidental overdose. At times, a combination of both acetaminophen and ibuprofen will be needed to stop the fever.
Aspirin is not the first choice for fever reduction. It may be toxic in large doses in adults or cause Reye syndrome in children.
Ibuprofen stops the hypothalamus from raising the body temperature. It comes in 200 mg tablets purchased over the counter at a drug store. You may take 1-2 tablets every 4 hours to decrease your temperature. Use the lowest possible dose.
Side effects of ibuprofen include nausea and vomiting, which may be prevented if the medication is taken with food. Rare side effects include diarrhea, constipation, heartburn, and stomach pain. People with stomach ulcers or kidney disease, pregnant women, and those with an aspirin allergy should avoid ibuprofen.
Common brand names of ibuprofen include Advil, Motrin, and Nuprin. Read the product label for specific ingredients described as ibuprofen.
A fever can cause you to become very dehydrated. Drink lots of fluids. Attempts to cool the skin may only make you more uncomfortable. This may also cause shivering, which will actually increase your body temperature if the fever is being caused by an infection. Further therapy depends on the cause of the fever and the accompanying symptoms. Basic cold symptoms can be treated with over-the-counter medications.
If the fever is caused by exposure to hot weather or overexertion, the technique is different from treating any other fever. Neither acetaminophen nor ibuprofen will be effective. The person needs to be cooled immediately.  If the person is confused or unconsciousness, seek emergency medical help immediately. While waiting for help, remove the person from the hot environment and remove his or her clothes. The body should be cooled with a wet sponge, and a fan should be directed over the person.

Essential oils can be used in two ways for a fever. The first way is to use essential oils which promote sweating to encourage the resolution of the fever and the other way is to use essential oils which actually help to reduce the temperature.

Use Basil, Chamomile Roman, Cypress, Juniper, Lavender, Peppermint, Rosemary, Tea Tree essential oils to induce sweating. (It is interesting to note that none of these oils will help you to sweat if you do not have a fever) If the sick person feels well enough use 8 drops of any oils from the above list in a warm bath or if this is not possible then massage the back gently using the oil diluted in some carrier oil.

Oils which help to cool the person are Bergamot, Eucalyptus, Lavender and Peppermint. Dilute a few drops of essential oil in some cool water and sponge the body with the mixture.


N.B.  Many ancient civilisations have used plants to help with fevers. The Egyptians used aromatic platns 3000 years before Christ for medicinal purposes which included burning plants. They discovered that the burning of these plants sometimes had an effect on sick people.  The Greeks also wrote a great deal about the theory of plant medicine. Throughout the Middle Ages and the Tudor era all forms of plant medicine were used by doctors, apothecaries and lay people. In France Lavender and Rosemary were burned until very recently on hospital wards to help combat infection and fever.

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