Concept of fever. Temperature curves Briefly describe the types of fever, which are the most dangerous

Fever is divided according to the degree of temperature rise into:

- low-grade fever(temperature increase within 37.1-37.9° C),

- moderate(38-39.5° C),

- high(39.6-40.9° C),

- hyperpyretic(41°C and above).

Depending on the nature of daily temperature fluctuations in the second stage of fever, it is divided into the following types:

Intermittent,

Laxative,

Exhausting

Constant,

Returnable,

Atypical

Intermittent fever(f. intermittens) is characterized by large fluctuations in body temperature during the day with its drop in the morning to normal and below (causes: purulent infection, tuberculosis, juvenile rheumatoid arthritis, lymphoma, etc.).

Relieving fever(f. remittens) - daily temperature fluctuations exceed 1° C, but it does not decrease to normal (reasons: most viral and many bacterial infections, exudative pleurisy, final period of typhoid fever, etc.).

Hectic fever(f. hectica) - daily fluctuations in body temperature reach 3-5 ° C (causes: sepsis, purulent infection).

Persistent fever(f. continua) is characterized by a high rise in temperature with daily fluctuations not exceeding 1°C (causes: typhoid and typhus, lobar pneumonia, etc.).

IN relapsing fever(f. recurrens) is characterized by alternating febrile and non-febrile periods, the duration of which can vary from one to several days (causes: relapsing fever, malaria, lymphogranulomatosis).

Atypical fever(f. athypica) is characterized by several temperature swings during the day with complete disruption of the circadian rhythm (cause: sepsis).

AND perverted fever– morning body temperature is higher than evening.

A slight short-term increase in body temperature of no more than 37.5-38°C with irregular fluctuations (febris ephemera) is observed in various neuroendocrine disorders and chronic infections.

Measuring the ambient temperature causes reactions in febrile patients similar to those in healthy people and does not significantly affect the temperature curve. The same occurs when a febrile patient performs muscular work associated with increased heat generation.

The characteristic features of the temperature curve for a particular disease were previously attributed diagnostic and prognostic significance. However, currently this indicator is no longer a reliable criterion in this regard, since the natural course of development of fever and fluctuations in body temperature is often distorted by treatment with antibacterial and antipyretic drugs (P.N. Veselkin). In old people, children early age and exhausted people infectious diseases may occur with mild or absent fever, which has a poor prognostic value.

Help with fever

1st period.

Temperature rise

Help. The patient must be put to bed and warmed up: covered with one or more blankets, covered with heating pads with warm water, and given hot tea.

2nd period.

Steady-state period high temperature

Help. It is necessary to increase heat transfer by artificial means. To reduce heating of the head (which is very important!), place a cold towel on the patient’s forehead and change it often or apply an ice pack. For more details, see Medical procedures. If the chills have completely stopped, it is necessary to open the patient to increase heat transfer from the surface of the body. Wipe your body skin frequently with a damp towel soaked in water or vodka. You can fan the patient with a towel or sheet, or blow with a fan. Give plenty of fluids (compote, juices, fruit drinks), incl. diaphoretic (linden tea, raspberry jam), moisten the oral cavity more often with a liquid, preferably sour, for example, cranberry juice (to separate saliva). Due to the fact that during this period the activity of all digestive glands is suppressed, the patient cannot be forced to eat. It is better to postpone feeding until the temperature drops. If the patient still needs to be fed, then feeding should be fractional (frequent), in small portions, liquid or semi-liquid food, easily digestible, preferably the one that the patient especially loves. If you have stool retention, you need to do a cleansing enema. See section Medical procedures. If cracks appear in the corners of the mouth, lubricate them with baby cream, glycerin or petroleum jelly. If delusions or hallucinations occur, the patient must be carefully monitored; he should not be left alone; a doctor’s consultation is necessary. If seizures develop, you must urgently call an ambulance.

3rd period. Temperature reduction

Help. It is necessary to monitor blood pressure, pulse and general condition of the patient. If signs of cardiac weakness occur, it is necessary to cover the patient with heating pads, warm him up, and give him strong hot tea or coffee. If the temperature drops, the patient should not sit or stand up. The foot end of the bed needs to be raised 30-40 cm, the pillow should be removed from under the head. We must remember that a drop in temperature is often accompanied by the urge to urinate! It is necessary to give the patient a duck or a bedpan in time and warn him so that he does not try to go to the toilet on his own at this time. Sweaty skin should be wiped with a warm, damp towel to remove sweat, which contains mass. harmful substances, products of exchange. After the patient sweats, you need to change your underwear. Sometimes, after heavy sweating, it is necessary to change the bed linen.

Fever is classified according to the degree of increase in body temperature:

subfebrile (from 37° to 38°),

moderate (from 38° to 39°),

high (from 39° to 41°),

excessive, or hyperpyretic (over 41°).

Fever is classified according to duration:

acute (lasting up to two weeks);

subacute (lasting up to six weeks).

Based on the types of temperature curves, the following main types of fever are distinguished:

permanent,

remitting (laxative),

intermittent (intermittent),

perverted,

hectic (depleting),

wrong.

4. Character of the temperature curve

Changes in the temperature curve are of the most varied nature and are due to the immediate cause that caused these changes.

Constant fever (febris continua). With constant fever, elevated body temperature lasts for several days or weeks with daily fluctuations within 1 ° C. Body temperature may be high

Remitting fever (febris remittens). With remitting fever, which is observed in purulent diseases (for example, exudative pleurisy, lung abscess), temperature fluctuations during the day reach 2°C and

1. Sick day

   Day of my stay in the hospital

   b moreThe degree of temperature increase may vary. Daily fluctuations are 1-2 °C, not reaching normal numbers. Chilling is typical. During the phase of decreasing temperature, sweating is observed.

Intermittent fever (febris intermittens). Intermittent fever is characterized by alternating periods normal temperature bodies and

1. Sick day

   Day of my stay in the hospital

   increased; in this case, both sudden, for example with malaria, and gradual, for example with relapsing typhus (relapsing fever), brucellosis (undulant fever), an increase and decrease in a person’s body temperature is possible. A rise in temperature is accompanied by chills and fever; a fall is accompanied by profuse sweat. It should be borne in mind that sometimes the intermittent type of fever is not immediately established. In the first days of the illness, it may be preceded by a so-called initial fever of a constant or irregular type. Typical for malaria, pyelonephritis, pleurisy, sepsis, etc.

G
ectic fever (febris hectica). With hectic fever, the resulting changes in body temperature are especially large, amounting to 3-4 ° C with a drop to normal or subnormal levels (below 36 ° C) and occur, as a rule, 2-3 times a day. Such fevers are characteristic of severe forms of tuberculosis and sepsis. With hectic fever, stunning chills occur, which are then replaced by profuse sweating.

Undulating fever is characterized by smooth rises and falls in body temperature with normal values ​​in the intervals between rises in temperature (some forms of lymphogranulomatosis and malignant tumors, brucellosis).

Types of fever during illness can alternate or transform into one another. The intensity of the febrile reaction may vary depending on the functional state of the central nervous system at the time of exposure to pyrogens. The duration of each stage is determined by many factors, in particular the dose of pyrogen, the time of its action, disorders that have arisen in the body under the influence of a pathogenic agent, etc. Fever can end with a sudden and rapid drop in body temperature to normal or even lower (crisis) or a gradual slow decrease body temperature (lysis). The most severe toxic forms of some infectious diseases, as well as infectious diseases in the elderly, weakened people, and young children often occur with almost no fever or even hypothermia, which is an unfavorable prognostic sign.

With fever, a change in metabolism occurs (protein breakdown increases), sometimes disruption of the central nervous system, cardiovascular and respiratory systems occurs, gastrointestinal tract. At the height of fever, confusion, delirium, hallucinations, and subsequent loss of consciousness are sometimes observed. These phenomena are not directly related to the nervous mechanism of fever development, but they reflect the characteristics of intoxication and the pathogenesis of the disease.

An increase in body temperature during fever is accompanied by an increase in heart rate. This does not occur in all febrile illnesses. Thus, with typhoid fever, bradycardia is observed. The effect of increased body temperature on heart rhythm is weakened by other pathogenetic factors of the disease. An increase in heart rate, directly proportional to the increase in body temperature, is observed in fevers caused by low-toxic pyrogens.

Breathing becomes more frequent as body temperature rises. The degree of increased breathing is subject to significant fluctuations and is not always proportional to the increase in body temperature. Increased breathing is mostly combined with a decrease in its depth.

With fever, the function of the digestive organs is impaired (decreased digestion and absorption of food). Patients have a coated tongue, dry mouth, and a sharply decreased appetite. The secretory activity of the submandibular glands, stomach and pancreas is weakened. The motor activity of the gastrointestinal tract is characterized by dystonia with a predominance of increased tone and a tendency to spastic contractions, especially in the pyloric region. As a result of decreased opening of the pylorus, the rate of evacuation of food from the stomach slows down. The formation of bile decreases somewhat, its concentration increases.

Kidney activity is not noticeably impaired during fever. The increase in diuresis at the onset of fever is explained by the redistribution of blood and an increase in its quantity in the kidneys. Water retention in tissues at the height of fever is often accompanied by a decrease in diuresis and an increase in urine concentration. There is an increase in the barrier and antitoxic function of the liver, urea formation and an increase in fibrinogen production. The phagocytic activity of leukocytes and fixed macrophages increases, as well as the intensity of antibody production. The production of ACTH by the pituitary gland and the release of corticosteroids, which have a desensitizing and anti-inflammatory effect, are enhanced.

Metabolic disorders depend more on the development of the underlying disease than on an increase in body temperature. Strengthening the immune system and mobilizing humoral mediators help increase the body’s protective functions against infection and the inflammatory process. Hyperthermia creates less favorable conditions in the body for the proliferation of many pathogenic viruses and bacteria. In this regard, the main treatment should be aimed at eliminating the disease that caused the fever. The question of the use of antipyretics is decided by the doctor in each specific case, depending on the nature of the disease, the age of the patient, his premorbid condition and individual characteristics.

FEVER is a general adaptive reaction of the body to the influence of a harmful, often infectious agent and represents a change in thermal regulation with the accumulation of heat and an increase in body temperature. Fever can result from the action of bacteria and their toxins (infectious), protein breakdown products (with hemolysis, tissue necrosis, bone fractures, in the presence of purulent foci, etc.), hormones and poisons, and also occur when the thermal center is irritated as a result injuries and bruises of the brain.

During fever, all types of metabolism are disrupted. The amount of nitrogen excreted in the urine increases, hyperglycemia develops, sometimes glucosuria, fat metabolism increases, and the water-salt balance is disturbed.

An increase in temperature of 1°C is usually accompanied by an acceleration of heart rate by 10 beats. Breathing during fever increases in parallel with an increase in heart rate and body temperature.

Fever is characterized not only by an increase in temperature, but also by disruption of all body systems. The degree of temperature increase is important, but not always decisive, in assessing the severity of the fever. It is accompanied by increased heart rate and respiration, decreased blood pressure, general symptoms of intoxication are expressed: headache, weakness, feeling of heat and thirst, dry mouth, lack of appetite; decreased urine output, increased metabolism due to catabolic processes.

A rapid and severe increase in temperature (for example, with pneumonia) is usually accompanied by chills, which can last from several minutes to an hour, rarely longer. With severe chills, the patient’s appearance is characteristic: due to a sharp narrowing blood vessels(capillary spasm), the skin becomes pale, the nail plates acquire a bluish color (cyanosis), experiencing a feeling of cold, patients tremble, and their teeth chatter. A gradual increase in temperature is characterized by slight chilling. At high temperatures, the skin has a characteristic appearance: red, warm (“fiery”). A lytic drop in temperature is accompanied by profuse sweat. With fever, the evening body temperature is usually higher than the morning. A rise in temperature above 37 °C during the day is grounds to suspect the disease.

Stages of fever.

1) temperature rise station

2) the stage of its relative standing

3) stage of temperature drop

The first stage is characterized by an increase in body temperature above normal levels. The rise in temperature can be rapid, when in a few minutes it rises to 39.0-39.5 ° C (typical of lobar pneumonia) and can be slow over several days, sometimes unnoticed by the patient himself.

The next stage is the stage of relative temperature standing. Its duration varies. By degree of maximum rise? temperature during the standing stage, fever is aimed at mild or subfebrile - the temperature does not exceed 39.00C, moderate or fibrile - 38.0-39.00C, high or pyretic - 39.0-41.0C and very high or hyperpyretic when the temperature rises above 41°C.

The drop in body temperature, as well as its increase, can be rapid, i.e. over several hours - half a day, and slowly over several days. A rapid drop in body temperature is called a crisis, and a slow drop is called lysis. The minimum temperature differs in the morning at 6 o'clock, and the maximum in the evening at 18 o'clock.

Types of fevers

Depending on the degree of temperature increase, the following types of fevers are distinguished:

1) subfebrile temperature - 37-38 °C:

low-grade fever - 37-37.5 °C;

high subfebrile condition - 37.5-38 °C;

2) moderate fever - 38-39 °C;

3) high fever - 39-40 °C;

4) very high fever - over 40 °C;

5) hyperpyretic - 41-42 °C, it is accompanied by severe nervous phenomena and is itself life-threatening.

Fluctuations in body temperature throughout the day and throughout the entire period of the disease are of great importance.

Types of fevers

1) constant fever (febriscontinua). The temperature stays high for a long time. During the day, the difference between morning and evening temperatures does not exceed 10 °C; characteristic of lobar pneumonia, stage II of typhoid fever;

2) laxative (remitting) fever (febris remittens). The temperature is high, daily temperature fluctuations exceed 1-2 °C, with the morning minimum above 37 °C; characteristic of tuberculosis, purulent diseases, focal pneumonia, in stage III of typhoid fever;

3) debilitating (hectic) fever (febrishectica) is characterized by large (3-4 °C) daily temperature fluctuations, which alternate with a drop to normal or below, which is accompanied by debilitating sweats; typical for severe pulmonary tuberculosis, suppuration, sepsis;

4) intermittent (intermittent) fever (febrisintermittens) - short-term increases in temperature to high numbers strictly alternate with periods (1-2 days) of normal temperature; observed in malaria;

5) undulating (undulating) fever (febrisundulans). It is characterized by periodic increases in temperature, and then a decrease in the level to normal numbers. Such “waves” follow one another for a long time; characteristic of brucellosis, lymphogranulomatosis;

6) relapsing fever (febris recurrens) - strict alternation of periods of high temperature with fever-free periods. At the same time, the temperature rises and falls very quickly. The febrile and non-febrile phases last for several days each. Characteristic of relapsing fever;

7) reverse type of fever (febrisinversus) - morning temperature is higher than evening temperature; sometimes observed in sepsis, tuberculosis, brucellosis;

8) irregular fever (febrisirregularis) is characterized by varied and irregular daily fluctuations; often observed in rheumatism, endocarditis, sepsis, tuberculosis. This fever is also called atypical (irregular).

Fever in outpatients. Causes and types of fever in the clinic.

Short-term fevers (lasting less than one week) usually result from viral diseases ending in spontaneous recovery. The most common nonviral causes of short-term fever are bacterial infections of the throat, ear, paranasal sinuses, bronchi, or genitourinary tract.

However, if the patient continues to have an elevated temperature for more than one or two weeks, then it is worth conducting a more thorough examination. In this case, we are dealing with a patient whose condition is most appropriately designated as “fever of undetermined nature” (FFU).

In some cases, the truth of the patient’s painful condition should be questioned, since one of the ways to simulate organic diseases is to report an alleged elevated temperature. There are techniques based on knowledge to detect simulation physiological characteristics thermoregulation. Thus, the following cases are unlikely: a temperature jump above 41 "C, which is extremely rare in adults; a rapid drop in temperature without corresponding sweating; absence of daily fluctuations in the temperature curve; absence of increased heart rate and breathing during fever; the difference between rectal temperature and the temperature just before excreted urine.At the same time, it should be remembered that in some cases, such as fever with typhoid fever, mycoplasma pneumonia, ornithosis, increased heart rate is not observed.

Depending on the degree of temperature increase, the following are distinguished: types of fevers:

Low-grade fever- 37–38 °C:

a) low-grade fever - 37–37.5 °C;

b) low-grade fever - 37.5–38 °C;

Moderate fever - 38–39 ° C;

High fever - 39–40 ° C;

Very high fever - over 40 ° C;

Hyperpyretic - 41–42 °C, it is accompanied by severe nervous phenomena and is itself life-threatening.

Fluctuations in body temperature throughout the day and throughout the febrile period are of great importance for diagnosis.

In this regard, there are main types of fever:

Persistent fever – the temperature stays high for a long time. During the day, the difference between morning and evening temperatures does not exceed 1 °C; characteristic of lobar pneumonia, stage II of typhoid fever;

Remitting (remitting) fever – high temperature, daily temperature fluctuations exceed 1–2 °C, with a morning minimum above 37 °C; characteristic of tuberculosis, purulent diseases, focal pneumonia, in stage III of typhoid fever;

Wasting (hectic) fever - characterized by large (3–4 °C) daily temperature fluctuations, which alternate with a drop to normal or below, which is accompanied by debilitating sweats; typical for severe pulmonary tuberculosis, suppuration, sepsis;

Intermittent (intermittent) fever - short-term increases in temperature to high numbers strictly alternate with periods (1-2 days) of normal temperature; observed in malaria;

Undulating (undulating) fever - it is characterized by periodic increases in temperature, and then a decrease in the level to normal numbers. Such “waves” follow one another for a long time; characteristic of brucellosis, lymphogranulomatosis;

Relapsing fever is a strict alternation of periods of high temperature with fever-free periods. At the same time, the temperature rises and falls very quickly. The febrile and non-febrile phases last for several days each. Characteristic of relapsing fever;

Reverse type of fever - morning temperature is higher than evening temperature; sometimes observed in sepsis, tuberculosis, brucellosis;

Irregular fever – characterized by varied and irregular daily fluctuations; often observed in rheumatism, endocarditis, sepsis, tuberculosis. This fever is also called atypical (irregular).

It should be noted that types of fever during illness can alternate or transform into one another. The intensity of the febrile reaction may vary depending on the functional state of the central nervous system at the time of exposure to pyrogens. The duration of each stage is determined by many factors, in particular the dose of pyrogen, the time of its action, disorders that have arisen in the body under the influence of a pathogenic agent, etc. Fever can end with a sudden and rapid drop in body temperature to normal or even lower (crisis) or a gradual slow decrease body temperature (lysis). The most severe toxic forms of some infectious diseases, as well as infectious diseases in the elderly, weakened people, and young children often occur with almost no fever or even hypothermia, which is an unfavorable prognostic sign.

Fever - an increase in body temperature above 37 o C is a protective-adaptive reaction of the body.

Fever is manifested by such symptoms as: increased body temperature, fever, chills, sweating, daily temperature changes.

Fever without temperature can be observed with small changes in temperature, close to low-grade fever.

Depending on the causes occurrences are distinguished infectious and non-infectious fever. The latter is observed in cases of poisoning, allergic reactions, malignant tumors, etc.

Types of fevers depending on body temperature

The following types of fever are distinguished (according to the degree of temperature increase):

• low-grade fever (from 37 to 38 o C);
• moderate fever (from 38 to 39 o C);
• high temperature fever (from 39 to 41 o C);
• hyperpyretic fever (excessive) (over 41 o C).

Fever reactions can occur differently in different conditions and the temperature can fluctuate within different limits.

Types of fevers depending on daily temperature fluctuations

Depending on temperature fluctuations, the following types of fever are distinguished:

• Persistent fever: body temperature is usually high (often more than 39 o C), lasts for several days or weeks with daily fluctuations in the ancestors 1 O WITH; occurs in acute infectious diseases(typhus, lobar pneumonia, etc.).
• Relieving fever: significant daily fluctuations in body temperature - from 1 to 2 o C and more; occurs in purulent diseases.
• Intermittent fever: a sharp rise in body temperature to 39-40 o C and above, with a decline in a short period of time to normal or even reduced and with the repetition of such rises after 1-2-3 days; characteristic of malaria.
• Wasting fever: significant daily fluctuations in body temperature over 3 o C (can be at intervals of several hours) with a sharp drop from higher to normal and lower numbers: observed in septic conditions.
• Relapsing fever: increase in body temperature immediately to 39-40 o C and above, which remains high for several days, then decreases to normal, low, and after a few days the fever returns and is again replaced by a decrease in temperature; occurs, for example, in relapsing fever.
• Undulating fever: a gradual increase in body temperature from day to day, which reaches a maximum within a few days, then, unlike relapsing fever, it also gradually decreases and gradually increases again, which looks on the temperature curve as alternating waves with a period of several days for each wave. Observed in brucellosis.
• Incorrect fever: does not have certain patterns in daily fluctuations; occurs most often (with rheumatism, pneumonia, dysentery, influenza and many others, including cancer).
• Kinky Fever: morning temperature is higher than evening temperature: observed with tuberculosis, prolonged sepsis, viral diseases, and thermoregulation disorders.

Treatment of fever

Treatment is aimed primarily at the underlying disease. Low-grade and moderate fevers are protective and should not be reduced.

For high and excessive fever, the doctor prescribes antipyretics. It is necessary to monitor the state of consciousness, breathing, pulse rate and its rhythm: if breathing or heart rhythm is disturbed, emergency assistance should be called immediately.

A feverish patient needs to be given water frequently, changed underwear after excessive sweating, and wipe the skin successively with wet and dry towels. The room in which a feverish patient is located must be well ventilated and have a supply of fresh air.

Algorithm for measuring body temperature

Mandatory examination procedure for patients various diseases, especially infectious ones. Many diseases are accompanied by changes in the temperature of the affected areas of the body. The cessation of blood flow, for example, when a vessel is blocked by a blood clot or an air bubble, is accompanied by decrease in temperature.

In the zone of inflammation, where, on the contrary, metabolism and blood flow are more intense, the temperature is higher. For example, malignant neoplasms in the stomach have a temperature 0.5-0.8 degrees higher than the surrounding tissues, and with liver diseases such as hepatitis or cholecystitis, its temperature rises by 0.8-2 degrees. Hemorrhages lower the temperature of the brain, and tumors, on the contrary, increase it.

How to measure body temperature correctly?

Using a mercury or electronic thermometer, body temperature is measured in the armpit (the skin is first wiped dry), less often in other areas - the groin fold, oral cavity, rectum ( basal temperature), vagina.

Temperature is usually measured 2 times a day - at 7-8 am and at 17-19 pm; If necessary, measurements are carried out more often. The duration of temperature measurement in the armpit is approximately 10 minutes.

Normal values ​​of body temperature when measured in the armpit range from 36 o C to 37 o C. During the day it fluctuates: the maximum values ​​are observed between 17 and 21 o'clock, and the minimum, as a rule, between 3 and 6 o'clock in the morning, with In this case, the temperature difference is normally less than 1 o C (no more than 0.6 o C).

P increased body temperature not necessarily associated with any disease. After great physical or emotional stress, in a hot room, body temperature may rise. In children, body temperature is 0.3-0.4 o C higher than in adults; in old age it may be slightly lower.