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Journal of Infection and Public Health Aug 2011Fever is a prominent feature of disease since antiquity. The febrile response is orchestrated by the central nervous system through endocrine, neurological,... (Review)
Review
Fever is a prominent feature of disease since antiquity. The febrile response is orchestrated by the central nervous system through endocrine, neurological, immunological and behavioural mechanisms. Other than a regulated rise in body temperature, fever is often accompanied by various sickness behaviours, changes in metabolic and physiological characteristics of body systems and alterations in immune responses. Fever and the febrile response, therefore, remain significant contributors to the pathogenesis, clinical presentation and outcome of many illnesses and diseases. This review highlights the pathophysiology of the febrile response and describes the fever types and patterns, including their clinical significance. The various medical illnesses called "fever" are also listed and the origins of their appellations discussed.
Topics: Communicable Diseases; Fever; Humans
PubMed: 21843857
DOI: 10.1016/j.jiph.2011.05.002 -
TheScientificWorldJournal Mar 2010Measurement of body temperature remains one of the most common ways to assess health. An increase in temperature above what is considered to be a normal value is... (Review)
Review
Measurement of body temperature remains one of the most common ways to assess health. An increase in temperature above what is considered to be a normal value is inevitably regarded as a sure sign of disease and referred to with one simple word: fever. In this review, we summarize how research on fever allowed the identification of the exogenous and endogenous molecules and pathways mediating the fever response. We also show how temperature elevation is common to different pathologies and how the molecular components of the fever-generation pathway represent drug targets for antipyretics, such as acetylsalicylic acid, the first "blockbuster drug". We also show how fever research provided new insights into temperature and energy homeostasis, and into treatment of infection and inflammation.
Topics: Aspirin; Fever; Homeostasis; Humans
PubMed: 20305990
DOI: 10.1100/tsw.2010.50 -
Cancer Control : Journal of the Moffitt... Apr 2017The definition of fever is flexible and depends on the clinical context. Fever is frequently observed in patients with cancer. (Review)
Review
BACKGROUND
The definition of fever is flexible and depends on the clinical context. Fever is frequently observed in patients with cancer.
METHODS
Infectious and noninfectious causes of fever in patients with various oncological and hematological malignancies and the usefulness of biomarkers are discussed.
RESULTS
To treat patients in a timely manner and to minimize morbidity and mortality, it is paramount that health care professionals determine the cause of fever. The usefulness of biomarkers in febrile patients with cancer continues to be controversial.
CONCLUSIONS
Fever is frequently seen in patients with cancer and can be associated with a variety of infectious and noninfectious causes. The utility of acute-phase reactants, such as erythrocyte sedimentation rate, C-reactive protein, and procalcitonin, along with a nonsteroidal anti-inflammatory drug challenge should be further evaluated as adjunct tools for the workup of fever in patients with cancer.
Topics: Biomarkers; C-Reactive Protein; Calcitonin; Erythrocytes; Fever; Humans; Neoplasms
PubMed: 28441374
DOI: 10.1177/107327481702400212 -
Critical Care (London, England) Jul 2016There are numerous causes of a raised core temperature. A fever occurring in sepsis may be associated with a survival benefit. However, this is not the case for... (Review)
Review
There are numerous causes of a raised core temperature. A fever occurring in sepsis may be associated with a survival benefit. However, this is not the case for non-infective triggers. Where heat generation exceeds heat loss and the core temperature rises above that set by the hypothalamus, a combination of cellular, local, organ-specific, and systemic effects occurs and puts the individual at risk of both short-term and long-term dysfunction which, if severe or sustained, may lead to death. This narrative review is part of a series that will outline the pathophysiology of pyrogenic and non-pyrogenic fever, concentrating primarily on the pathophysiology of non-septic causes.
Topics: Cognitive Dysfunction; Fever; Humans; Liver Failure; Sepsis
PubMed: 27411542
DOI: 10.1186/s13054-016-1375-5 -
American Journal of Physiology.... Nov 2011Body temperature regulation is a fundamental homeostatic function that is governed by the central nervous system in homeothermic animals, including humans. The central... (Review)
Review
Body temperature regulation is a fundamental homeostatic function that is governed by the central nervous system in homeothermic animals, including humans. The central thermoregulatory system also functions for host defense from invading pathogens by elevating body core temperature, a response known as fever. Thermoregulation and fever involve a variety of involuntary effector responses, and this review summarizes the current understandings of the central circuitry mechanisms that underlie nonshivering thermogenesis in brown adipose tissue, shivering thermogenesis in skeletal muscles, thermoregulatory cardiac regulation, heat-loss regulation through cutaneous vasomotion, and ACTH release. To defend thermal homeostasis from environmental thermal challenges, feedforward thermosensory information on environmental temperature sensed by skin thermoreceptors ascends through the spinal cord and lateral parabrachial nucleus to the preoptic area (POA). The POA also receives feedback signals from local thermosensitive neurons, as well as pyrogenic signals of prostaglandin E(2) produced in response to infection. These afferent signals are integrated and affect the activity of GABAergic inhibitory projection neurons descending from the POA to the dorsomedial hypothalamus (DMH) or to the rostral medullary raphe region (rMR). Attenuation of the descending inhibition by cooling or pyrogenic signals leads to disinhibition of thermogenic neurons in the DMH and sympathetic and somatic premotor neurons in the rMR, which then drive spinal motor output mechanisms to elicit thermogenesis, tachycardia, and cutaneous vasoconstriction. Warming signals enhance the descending inhibition from the POA to inhibit the motor outputs, resulting in cutaneous vasodilation and inhibited thermogenesis. This central thermoregulatory mechanism also functions for metabolic regulation and stress-induced hyperthermia.
Topics: Animals; Awards and Prizes; Body Temperature Regulation; Central Nervous System; Feedback, Physiological; Fever; Humans; Neural Pathways; Preoptic Area; Signal Transduction; Skin; Skin Temperature; Thermoreceptors; Thermosensing
PubMed: 21900642
DOI: 10.1152/ajpregu.00109.2011 -
International Journal of Molecular... May 2020Tumor necrosis factor receptor-associated periodic syndrome (TRAPS) is an autosomal dominant autoinflammatory syndrome characterized by prolonged and recurrent episodes... (Review)
Review
Tumor necrosis factor receptor-associated periodic syndrome (TRAPS) is an autosomal dominant autoinflammatory syndrome characterized by prolonged and recurrent episodes of fever, abdominal and/or chest pain, arthralgia, myalgia, and erythematous rash. TRAPS is associated with heterozygous variants in the gene, which encodes the TNFR1 (tumor necrosis factor receptor 1) receptor. Disease-causing variants are found exclusively in the extracellular domain of TNFR1 and affect receptor structure and binding to the TNF ligand. The precise mechanism of the disease is still unclear, but it is thought that intracellular accumulation of misfolded mutant protein leads to endoplasmic reticulum stress and enhanced inflammatory responses through constitutive activation of various immune pathways. Other possible mechanisms contributing to the disease pathogenesis include defective receptor shedding, TNF-induced cell death, production of reactive oxygen species, and autophagy impairment. Patients' leucocytes are hyperresponsive to stimulation and produce elevated levels of proinflammatory cytokines. Systemic autoimmune (AA) amyloidosis is an important cause of morbidity and mortality in TRAPS. Over the last two decades, new therapies have changed the progression and outcome of the disease. In this review, we summarize clinical data from 209 patients with validated pathogenic variants reported in the literature and discuss TRAPS diagnosis, pathogenesis, and treatment options.
Topics: Biomarkers; Disease Management; Disease Susceptibility; Fever; Genetic Predisposition to Disease; Genetic Variation; Hereditary Autoinflammatory Diseases; Humans; Molecular Diagnostic Techniques; Molecular Targeted Therapy; Phenotype; Receptors, Tumor Necrosis Factor, Type I
PubMed: 32380704
DOI: 10.3390/ijms21093263 -
Anaesthesiology Intensive Therapy 2017Fever is a common symptom in the Intensive Care Unit. At least half of febrile episodes are caused by infection. Excluding infectious etiology and other non-infectious... (Review)
Review
Fever is a common symptom in the Intensive Care Unit. At least half of febrile episodes are caused by infection. Excluding infectious etiology and other non-infectious causes of fever, especially in patients with central nervous system (CNS) disorders, attention should be paid to disturbances of thermoregulatory centre. In particular, subarachnoid haemorrhage, cerebral trauma, along with ischaemic or haemorrhagic stroke are strongly associated with the development of central fever. Proper, speedy diagnosis of the cause of fever makes it possible to implement preventive measures against the harmful effects of hyperthermia on the CNS and to avoid the consequences of inappropriate treatment. The aim of this review is to present the current treatment options for the management of central fever and to analyze recent recommendations for the treatment of hyperthermia, including the use of hypothermia. The recommendations of American and European associations are inconsistent, mainly due to the lack of randomized clinical trials confirming the effectiveness of such treatment. The diagnosis of central fever is still made by the exclusion of other causes. The authors of the review intended to present the characteristic features of central fever, differentiating this state from infectious fever and also analyze the presence of central fever in particular neurological diseases. It seems particularly important to establish diagnostic criteria for central fever or to find diagnostic markers. It is also necessary to conduct further randomized clinical trials evaluating the indications for treatment of hyperthermia.
Topics: Body Temperature Regulation; Central Nervous System Diseases; Fever; Humans; Infections; Intensive Care Units
PubMed: 28803441
DOI: 10.5603/AIT.2017.0042 -
Clinical Medicine (London, England) Jun 2015More than 50 years after the first definition of fever of unknown origin (FUO), it still remains a diagnostic challenge. Evaluation starts with the identification of...
More than 50 years after the first definition of fever of unknown origin (FUO), it still remains a diagnostic challenge. Evaluation starts with the identification of potential diagnostic clues (PDCs), which should guide further investigations. In the absence of PDCs a standardised diagnostic protocol should be followed with PET-CT as the imaging technique of first choice. Even with a standardised protocol, in a large proportion of patients from western countries the cause for FUO cannot be identified. The treatment of FUO is guided by the final diagnosis, but when no cause is found, antipyretic drugs can be prescribed. Corticosteroids should be avoided in the absence of a diagnosis, especially at an early stage. The prognosis of FUO is determined by the underlying cause. The majority of patients with unexplained FUO will eventually show spontaneous remission of fever. We describe the definition, diagnostic workup, causes and treatment of FUO.
Topics: Fever of Unknown Origin; Humans
PubMed: 26031980
DOI: 10.7861/clinmedicine.15-3-280 -
Archivos Argentinos de Pediatria Apr 2020In pediatrics, fever is a common reason for consultation. The objective was to assess parental knowledge, behaviors, and fears in the management of fever in their... (Observational Study)
Observational Study
INTRODUCTION
In pediatrics, fever is a common reason for consultation. The objective was to assess parental knowledge, behaviors, and fears in the management of fever in their children.
MATERIALS AND METHODS
Observational, analytical, cross-sectional study. In 2018, a survey was administered to the parents of children aged 6 months to 5 years who attended Hospital de Niños Ricardo Gutiérrez, in the Autonomous City of Buenos Aires. The association between sociodemographic outcome measures and knowledge, behaviors, and fears in cases of fever was analyzed.
RESULTS
A total of 201 surveys were completed: 56.7 % of parents considered that fever was bad for health; 37 % defined fever between 37 °C and 37.5 °C, and 59 %, between 38 °C and 38.5 °C. The mean temperature considered severe was 39.2 °C (standard deviation: 0.69). Physical methods were used by 93 % of caregivers; 97 % administered antipyretic agents, and 14.5 % used alternating agents. Fears of consequences included seizures in 82 %, dehydration in 41 %, brain damage in 18 %, and death in 12 %. Also, 86.5 % woke up their children to give them an antipyretic agent. Among the higher maternal education level, fear of fever was lower (odds ratio: 0.5; 95 % confidence interval: 0.28-0.91).
CONCLUSIONS
One-third of survey respondents considered low body temperature values as fever. Fear of fever was high, and the level of maternal education may mitigate it.
Topics: Adult; Anxiety; Child, Preschool; Cross-Sectional Studies; Fear; Female; Fever; Health Knowledge, Attitudes, Practice; Health Surveys; Hospitals, Pediatric; Humans; Infant; Male; Middle Aged; Parents; Socioeconomic Factors
PubMed: 32199042
DOI: 10.5546/aap.2020.eng.89 -
BMJ Open Jul 2017Several societies have produced and disseminated clinical practice guidelines (CPGs) for the symptomatic management of fever in children. However, to date, the quality... (Review)
Review
INTRODUCTION
Several societies have produced and disseminated clinical practice guidelines (CPGs) for the symptomatic management of fever in children. However, to date, the quality of such guidelines has not been appraised.
OBJECTIVE
To identify and evaluate guidelines for the symptomatic management of fever in children.
METHODS
The research was conducted using PubMed, guideline websites, and Google (January 2010 to July 2016). The quality of the CPGs was independently assessed by two assessors using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument, and specific recommendations in guidelines were summarised and evaluated. Domain scores were considered of sufficient quality when >60% and of good quality when >80%.
RESULTS
Seven guidelines were retrieved. The median score for the scope and purpose domain was 85.3% (range 66.6-100%). The median score for the stakeholder involvement domain was 57.5% (range 33.3-83.3%) and four guidelines scored >60%. The median score for the rigour of development domain was 52.0% (range 14.6-98.9%), and only three guidelines scored >60%. The median score for the clarity of presentation domain was 80.9% (range 50.0-94.4%). The median score for the applicability domain was 39.3% (8.3-100%). Only one guideline scored >60%. The median score for the editorial independence domain was 48.84% (0-91.6%); only three guidelines scored >60%.
CONCLUSION
Most guidelines were recommended for use even if with modification, especially in the methodology, the applicability and the editorial independence domains. Our results could help improve reporting of future guidelines, and affect the selection and use of guidelines in clinical practice.
Topics: Child; Fever; Humans; Pediatrics; Practice Guidelines as Topic; Societies, Medical
PubMed: 28760789
DOI: 10.1136/bmjopen-2016-015404