Fever- Covid-19 |Temperature Regulation

                           

                                              

                                                    Fever - We must know

This article will describe fever, its causes, and its prevention. Fever is a prevalent condition. This topic will talk about hyperpyrexia, heat stroke, and much more.

Keywords: Human physiology|Fever| Hyperpyrexia|Heat stroke| Heat exhaustion |Heat prostration|Bassal body temperature|Hypothermia

Table of contents: 

1. Definition 

2. Hyperpyrexia

3. Causes 

4. Diagnosis

5. Prevention

6. Treatment

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 Definition- An early morning temperature higher than 37.20 C or 990 or a late afternoon temperature higher than 37.70 C, which is 99.90 F, is typically considered a fever, assuming the temperature is elevated due to a change in the setpoint. Fever is also known as pyrexia or febrile condition.

 The 42 Code of Federal Regulations parts 70/71 Final Rule defines an ill person as someone with a fever of 100.40 F (380C) or greater who feels warm to the touch or has a feverish history.

 The average human body temperature, euthermia, for youth, is a typical  temperature range found in humans, which is stated as 36.5⁰ to 37.5⁰ C and 97.7⁰ to 99.5⁰ F. The body temperature is often expressed as 36.5⁰ to 37.50C, but there is a wide range for average, depending on age, sex, and measurement locations.

 The temperature set point is the level at which the body temperature is maintained. The set point is located in the hypothalamus. Sometimes, low thresholds are seen in elderly people. The average body temperature variation is usually 0.5⁰ C for 0.90⁰ F. A Person at optimum body temperature is considered afebrile or apyrexia without fever. If body temperature rises to a higher level through the action of the part of the brain that controls the body temperature, it is fever. Hyperthermia results if body temperature is raised, but the set point is not raised.

The temperature set point is the level at which the body attempts to maintain its temperature; when the set point is raised, the result is fever. Fever is usually due to infection. Microorganisms- viruses, bacteria, fungi- that cause infection produce external pyrogens –fever-producing materials- which cause fever.

Non-infection causes include vasculitis, autoimmune disease, some medicines, and cancer. 

 Fever is part of the body's defense mechanism. White blood cells and other cells try to destroy the invading microorganism in this process, and many White blood cells and other body cells are destroyed, releasing many chemicals –internal pyrogens- causing fever. A rise in body temperature is a normal part of this reaction. A fever will usually resolve on its own. 

Body temperature depends upon  two factors: 

First, heat gain is the production of heat inside the body or from heat absorption from the environment, and second is the body's heat loss.

 Hyperthermia occurs when a person is exposed to high temperatures for a long or even a short time. In this case, the body fails to lose heat effectively, causing the body temperature to rise beyond control. Hyperthermia at above about 40⁰ C, which is 104⁰ F, is a life-threatening condition and requires immediate treatment.

 

What are heat exhaustion and heat prostration? Mild hyperthermia is commonly called heat exhaustion or heat prostration.

 

Heatstroke 

Heat stroke usually comes suddenly but follows untreated heat exhaustion. Treatment is cooling and rehydration of the body. Fever-reducing drugs are useless in this condition. This may be done by moving out of direct sunlight to a cooler and shaded environment, drinking water, removing clothing, bathing in tapered cool water, or even just washing the face and other areas of the skin, which may be helpful in hyperthermia. The body temperature is raised without the involvement of the body's heat-controlling centers.

 

Hypothermia occurs when the body's temperature drops below the required level for normal metabolism and functions. Symptoms usually appear when the body's core temperature drops by 20 C to 2 20 C below normal. This usually happens due to excessive exposure to cold air or water, and it can be produced medically in certain operations.

 

What is basal body temperature?  

Basal body temperature is the lowest temperature attained by the body during rest, usually during sleep. It is generally measured just after awakening and before any physical activity. However, the temperature measured at that time is also somewhat higher than the actual basal body temperature human temperature difference at various points of the menstrual cycle due to functions of different hormones acting on the menstrual cycle as this can be used to track ovulation time of ovulation both to add conception for avoiding pregnancy this process is called fertility awareness.

The core temperature, also known as core body temperature, is the operating temperature of an organism, especially in the central structures of the body, e.g., the liver -in comparison to temperatures of peripheral tissue, core temperature is usually maintained within the normal range so that enzymes and hormones can work properly. Measurement of core temperature is an invasive process.

Regulation of temperature:

Temperature regulation is integral to the homeostatic mechanism that provides optimal operating temperature. As temperature affects the rate of chemical reactions, maintaining the temperature within a normal range is essential so that different enzymes, hormones, and other fluids of the body and cells function correctly.

The average internal temperature in human beings is 37degrees Celsius or 98.6 degrees Farenheight

\R Temperature variations: 

Human body temperature depends upon many factors, such as age, sex, time of day, degree of exertion, health status, emotions, and methodology. 

The Central Nervous System triggers temperature maintenance. 

Circannual rhythm

Body temperature varies with the change of seasons each year, a pattern known as circannual rhythm.

 

Circadian rhythm: 

Body temperature is not constant during the whole day. The body temperature of a healthy person varies during the day by about 0.5⁰ C, with a low temperature in the morning and higher temperatures in the late afternoon and very slightly from time to time; therefore, it is said that the morning temperature is better than the evening temperature. Body temperature is the lowest about 2 hours before the person typically wakes up, and it changes according to activities and external factors.

 

Circamensal rhythm: 

Women's basal body temperature rises after ovulation, estrogen production decreases, and progesterone increases. External factors affect the measured temperature as well as average values. Typical values are generally given for an otherwise healthy adult; dress comfortably in a room that is kept at an average room temperature of 22.7⁰ to 24.4⁰ C during the morning but not shortly after arising from sleep. To measure oral temperature, the subject has not eaten, drunk, or smoked anything before half an hour, as the temperature of food, drink, or smoke dramatically affects the reading.  

Methods of measuring body temperature 

Measuring a person's body temperature is the initial step in a complete clinical examination. Various types of medical thermometers are present. Multiple sites are used to measure temperature. They are :

 1. Rectal temperature measured in the rectum

 2. Oral temperature measured in the mouth

  3. Axillary temperature under the armpit -commonly used to measure body temperature.

 4. Tympanic temperature in the ear.

 5. On the skin of the forehead over the temporal artery using infrared radiation from the body.

 The average axillary temperature is  0.5 to 0.9⁰F (0.3 to 0.5⁰C) lower than the oral temperature.

 Prerequisites to measure the body temperature:

Temperature is measured in non-fasting adults, who dress comfortably  at a room temperature of 22.7⁰ to 24.4⁰ C during the morning.   

Temperature reading depends upon which body or part is being measured. The typical daytime temperature among healthy adults is as follows :

1. Rectal temperature or vaginal temperature is about 36⁰ to 37.5⁰C or 99.5⁰ F.

2. Tympanic temperature is  also about 36⁰ to 37.5⁰C  or 99.5⁰ F.

3. Oral temperature is about 36.8⁰ C, which is 98.2⁰ F. It is influenced by drinking, eating, chewing, smoking, and breathing with the mouth.

4. Axillary temperature is about 36.5⁰ C, which is 97.7⁰ F.

 5. Skin temperature is usually taken by an infrared thermometer, which needs to be more accurate. However, due to the chance of infection, it is now used in highly infectious diseases, such as Ebola and coronavirus.

 Signs and Symptoms:-

Fever is a symptom, not a disease. It is diagnosed by measuring temperature with a thermometer, but it is essential to diagnose the cause of the fever.

A general clinical examination is essential. Any evidence of infection, such as sore throat, cough, injury, history of surgery, chronic disease like TB, etc.

1. Chills and shivering and feeling cold when nobody feels.

2. Increased body temperature.

3. Signs of dehydration include a dry tongue, increased thirst, low volume of urine, etc.

4. Low appetite, lack of energy, lethargy,

 5. Sweating, headache

6. In high fever, irritability, confusion, delirium, and seizures (especially in babies)

 

Lab. Test

1. CBC-complete blood test

2. R/ E and C/S of urine

3. Other tests according to findings of the general clinical examination-sputum test.

 Types of fever according to duration:

Acute:  0 to 7 days.

Subacute: 0 to 14 days.

Chronic: if persists for more than 14 days.

 Types of fever according to the duration

 Continuous fever is a pattern in which the temperature does not touch the baseline, and the variation between maximum and minimum temperature is less than 1⁰C(1.5⁰F) in 24 hours. It is seen in infectious diseases. Typhoid fever is a continuous fever with a characteristic step-ladder pattern, a step-wise increase in temperature with a high  plateau.

Quotidian Fever

Tertian fever

Quartan fever

Remittent fever

Intermittent fever

Undulant fever

Relapsing fever.

Fever of unknown origin: The cause of persistent fever cannot be explained after repeated investigations.

Febricula is an old term for low-grade fever of unknown origin without any symptoms. The patient recovers fully within a week.

Prevention: 

It is also essential to reduce the risk of infection, acute and chronic, and injury and treat the cause early.

Management 

 Management is usually symptomatic. Antipyretics, like paracetamol, reduce body aches and temperature. Antibiotics are used to treat infectious diseases.

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Further reading

Medical thermometer

Other types of fever.

Heatstroke.

hermoregulation.

 Internal link: 

https://blog.totalphysiology.com/2023/06/heat-stroke-symptomstreatment-and.html

https://blog.totalphysiology.com/2024/02/protect-yourself-from-cold.html

External link:

1.en.m.wikipedia -fever

2.www.medicalnewstoday.com-fever

3.www.webmd.com- fever

4.www.healthline.com-fever.

5.www.medicinenet.com 

 6.www.who.int.iris.bitstream

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 FAQ

Is 99 degrees a fever?

An early morning temperature higher than 37.2 degree C or 99 0degree F or a late afternoon temperature higher than 37.7degree C, which is 99.9degree F, is typically considered a fever, assuming the temperature is elevated due to a change in the setpoint. Fever is also known as pyrexia or febrile condition.