diease

Fever


OVERVIEW OF Fever :

When our body want to regulate the temperature by its own way it results in feverness of the body. During the fever the body the muscles contracts and relaxes spontaneously which might result in the warming up process of the body and the core temperature is maintained. Fever might result in increase in temperature of the body. It is also known as pyrexia. The normal temperature is 96.4 degree farenheuit.


CAUSES :

Fever may be associated with the following reasons:

Infections

Appendicitis

Bacterial gastroenteritis(food poisoning)

Viral gastroenteritis(stomach flu)

Bronchitis

Common cold

Diverticulitis(inflammation of an abnormal pocket in the colon)

Ear infections

Infectious mononucleosis

Influenza(flu)

Meningitis(infection or inflammation of the sac around the brain or spinal cord)

Pneumonia

Streptococcal infection of the throat

Urinary trat infection especially a kidney infection(pyelonephritis)

 

Other infectious causes of fever:

Abscess(collection of pus in the skin, brain, liver, kidney or other organ)

Acquired immunodeficiency syndrome

Cellulitis( bacterial skin infection)

Chest infection

Endocarditis(inflammation and infection of the lining inside the heart)

Kidney infection

Malaria

Pelvic inflammatory disease

Sepsis(life threatening bacterial blood infection)

Septic or infectious arthritis

Sexually transmitted diseases

Tuberculosis(serous infection affecting the lungs and other organs)

Inflammatory causes of fever:

Fever can also be caused by inflammatory conditions including:

Allergic reaction

Blood transfusion reaction

Inflammatory bowel disease including crohns disease and ulcerative colitis

Systemic lupus erythematosus( an autoimmune disorder meaning the body’s own immune system attacks the normal cells).

Malignant causes of fever:

Fever can also be caused by the malignant conditions including the following:

Leukaemia

Lymphoma

Cancer

Other causes:

Drug withdrawal(substance abuse)

Hangover symptoms

Low blood sugar which is termed as hypglycaemia in people with diabetes

Menopausal night sweats

Panic attacks

Parasitic infections like giardiasis

Viral infections

Sepsis

 


PATHOPHYSIOLOGY :

The mechanism of fever appears to be a defensive reaction by the body against infectious disease. When bacteria or virus invade the body and cause tissue injury, one of the immune system responses is to produce pyrogens. These chemicals are carried by the blood to the brain, where they disturb the functioning of the hypothalamus, the part of the brain that regulates body temperature. The pyrogens inhibit heat-sensing neurons and excite cold-sensing ones, and the altering of these temperature sensors deceives the hypothalamus into thinking the body is cooler than it actually is. In response, the hypothalamus raises the body’s temperature above the normal range, thereby causing a fever. The above-normal temperatures are thought to help defend against microbial invasion because they stimulate the motion, activity, and multiplication of white blood cells and increase the production of antibodies. At the same time, elevated heat levels may directly kill or inhibit the growth of some bacteria and viruses that can tolerate only a narrow temperature range.


COMMON CLINICAL SIGNS AND SYMPTOMS :

chills may or may not accompany

Shivering

Aches and pain

Cough

Diarrhoea

Nausea

Vomiting

Lethargy

Sweating

Shortness of breathe

Wheezing

Seizures

Cyanosis might occur in complicated cases

 


DIAGNOSTIC :

Diagnosis is mainly done by:

Blood test and blood culture

Sputum culture – lungs and bronchi

Urinanlysis

Chest Xray – In the cases of Pneumonia, tuberculosis and other infections.

 

Blood Culture:

1. culture-based methods;

2. nucleic acid amplification technology (NAAT)-based assays.

Culture based method for CRE screening:

Culture based methods have been widely used for CRE screening, several different cultural approaches have been described

 

NAAT for molecular screening:

Molecular based methods (NAAT) for CRE screening usually detect the presence of one or more  genes. For these characteristics these assays are able to identify only previously known resistance determinants.

NAAT-based assays validated for carbapenemase genes detection from rectal swabs can also be used as a confirmatory test for suspected colonies identified by culture-based methods, although not all commercial assays have an on-label indication for this.

The three types of NAAT based assays for the Surveillance of  CRE  is as follows:

In house molecular methods

Commercial molecular assays

Rapid/easy to use commercial molecular assays:

In house molecular methods can reveal best level of sensitivity and specificity . Moreover, these assays are less expensive if compared to molecular commercial method. Also it has important disadvantages are low level of automation, standardization and validation, and suboptimal inter-laboratory reproducibility.

Commercial molecular assays:

they are highly sensitive, specific and standardized, with TAT of few hours; the level of automation of these methods can vary from poor (need of sample preparation step, including extraction or lysis, and/or multiple hands-on steps), to good, but for all these assays laboratory experience and equipment are required.

Rapid/easy to use commercial molecular assays (REU-CMA) :

They might provide the same high standard of quality of results with shorter hands-on time and TAT (less than 1 h) and no requirement for batching


TREATMENT AND PROGNOSIS :

Treatment :

Aspirin

Acetaminophen

Ibuprofen


PROGNOSIS :

The person might get recovered from fever when the triggering factors is taken away. Fever occurring due to septicaemia requires immediate treatment otherwise it might result in life threatening to the patients.With the aid of antipyretics the symptoms might get subside within 1 week


PREVENTION :

  • Give lots to drink. This helps to prevent a lack of fluid in the body (dehydration). You might find that a child is more willing to have a drink if they are not so irritable. It may help to give some paracetamol and then try again with drinks half an hour or so later.
  • Tepid sponging is not recommended because the blood vessels under the skin become narrower if the water is too cold and this may further raise the temperature. People with rigors also find sponging uncomfortable in the shivery phase.
  • Cold fans are not recommended for the same reasons, although cooling an over-warm room with adequate ventilation is sensible.
  • Children with high temperature (fever) should not be underdressed or over-wrapped.
  • Medicines like  ibuprofen should not be used for fever unless your child appears distressed
  • Avoid coming into contact with the contaminated objects

 


Medicines used in the Treatment :

Acetaminophen

Ibuprofen

Antibiotics-  amoxicillin,azithromycin and third generation cephalosporins such as cephalosporins , cefixime.

Gentamicin