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Fever

life science Maturity 7-9 Next article →

Fever, or pyrexia, is a common medical sign. It is an anti-infection defense mechanism in humans. A fever occurs when the body temperature exceeds the normal range. This happens because of an increase in the body's temperature set point. This set point is controlled by the hypothalamus in the brain. You can think of the hypothalamus as a biological thermostat.

fever-conceptual
fever-conceptual

When the thermostat is turned up, the body works to reach that new level.

The mechanism of fever is a complex chain of events. It begins when a substance called a pyrogen triggers a response. Pyrogens can be exogenous, meaning they come from outside the body. Examples include bacterial lipopolysaccharides (LPS) from Gram-negative bacteria like E. coli. Pyrogens can also be endogenous, meaning they are produced inside the body. These include cytokines like interleukin 1 (IL-1), interleukin 6 (IL-6), and tumor necrosis factor-alpha (TNFα). These chemicals are released by immune cells like monocytes and macrophages.

Once released, these pyrogens lead to a specific chemical pathway. They migrate to the brain's circumventricular organs to bypass the blood-brain barrier. This process activates the arachidonic acid pathway. This pathway uses enzymes like phospholipase A2 (PLA2) and cyclooxygenase-2 (COX-2). These enzymes facilitate the synthesis of prostaglandin E2 (PGE2). PGE2 is the ultimate mediator of the febrile response. It acts on EP3-expressing neurons in the preoptic area (POA) of the hypothalamus. This action inhibits certain neurons, which then activates the body's heat-generating systems.

To reach the new, higher set point, the body uses several heat-generating methods. One method is shivering, which is rapid muscle contraction to produce heat. The body also uses norepinephrine to increase thermogenesis in brown adipose tissue. In infants, this non-shivering thermogenesis is very important. Another method is peripheral vasoconstriction. This process reduces heat loss through the skin by narrowing blood vessels. This often makes a person feel cold or experience chills.

Virgil Solis Febris
Virgil Solis Febris

When the set point returns to normal, the body must cool down. This can happen spontaneously or through the use of medication. The body uses processes like sweating and vasodilation to release heat. Vasodilation is the widening of blood vessels to increase heat loss. A person might feel hot and become flushed during this stage. Fever is distinct from hyperthermia, which is a different medical condition. In hyperthermia, the temperature rises above the set point because of too much heat production or poor heat loss. Hyperthermia does not respond to antipyretic medications and can be life-threatening.

Fever is associated with many different medical conditions. It can be caused by viral, bacterial, or parasitic infections. Examples include influenza, COVID-19, malaria, and meningitis. Non-infectious causes also exist, such as cancer or certain vaccinations. Fever is a very common symptom in clinical settings. It is part of about 30% of healthcare visits for children. In adults who are seriously ill, fever occurs in up to 75% of cases.

Fever Patterns v1.2
Fever Patterns v1.2

While uncomfortable, treating a fever does not appear to change medical outcomes.

A fever often brings other symptoms, known as sickness behavior. These include lethargy, sleepiness, and a loss of appetite. Some people experience hyperalgesia, which is an increased sensitivity to pain. High fevers can also cause delirium or hallucinations. Some people experience intense, confusing nightmares called "fever dreams." In rare cases, a fever may trigger a febrile seizure, which is more common in young children. Doctors monitor temperature using different methods. Rectal temperatures are considered more accurate for central temperature. A fever is generally defined as a rectal temperature of 38°C (100.4°F) or higher.

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File:Fever Patterns v1.2.svg
Fever Patterns v1.2.svg
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File:Virgil Solis Febris.jpg
Virgil Solis Febris.jpg
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