ABSTRACT
Fever is one of the body’s immune responses that attempts to neutralise the bacterial, viral or parasitic infection who cannot survive at a higher temperature. As fever regulatory mechanism accompanies inflammation, increased body temperature accelerates certain biochemical reaction of use to the host in combating infection and help the body cells to repair themselves research demonstrate that fever has several important functions in the healing process. Fever should not be confused with hyperthermia, which is a defect in body’s response to heat (thermoregulation), which can also raise the body temperature. Fever should also not be confused with hot flashes or night sweats due to hormonal changes during perimenopause.
KEYWORDS: Homoeopathy, fever, temperature, psoric.
ABBREVIATIONS: HIV – human immunodeficiency virus, SLE – systemic lupus erythematosus.
INTRODUCTION
Fever, pyrexia, or febrile response is a condition of elevated body temperature above the normal range 37.5 and 38.3 degree centigrade or 99.5- and 100.9-degree Fahrenheit[1]. A complex physiologic response to disease mediated by pyrogenic cytokines and characterised by an increase in core temperature, generation of acute phase reactants and activation of immune systems. A full-day temperature fluctuations from lowest level in the early morning to highest in late afternoon, with an average mean maximum variation of about 0.6 degree Celsius is considered normal. Body temperature is determined by the balance between heat production from tissues, particularly the liver and the muscles, and the heat loss from periphery.[1]
In a healthy individual, the hypothalamic thermoregulatory centre maintains body temperature of the internal organs from 37 to 38 degree Celsius.
AETIOLOGY
| Infectious causes: | Non-infectious causes: |
| Upper and lower respiratory tract infections | Drug fever |
| Gastrointestinal infections | Malignancies |
| Urinary tract infections | Collagen vascular diseases |
| Skin infections | Miscellaneous |
TYPES OF FEVER
- Continuous fever
- Intermittent fever
- Remittent fever
- Hyperpyrexia[2]
PATHOGENESIS OF FEVER
Fever may be produced by many stimuli including bacteria and their endotoxins, viruses, yeast, protozoa, immune reaction, and drug and synthetic polynucleotides. The substance which has been termed collectively exogenous pyrogen, are both diverse and complex[2].
Substantial evidence supports a key role in fever production for cytokine, termed endogenous pyrogen, which are produced by cells interacting with exogenous pyrogen. These endogenous pyrogen act centrally on thermosensitive neurons in the pre-optic hypothalamus to trigger increased heat production and to decrease heat loss. The core body temperature rises until a higher sustainable point is reached.
EVALUATION:
Two general issues are important in the initial evaluation of acute fever.
- Identifying any localising symptoms (headache, cough) help to understand the possible cause. The localising symptom may be a part of the patient’s chief complaint or identified only by specific questioning.
- Determining whether the patient is seriously or chronically ill, many causes of fever in healthy people are self-limited, and many of the possible viral infection are difficult to diagnose specifically[3].
HISTORY OF PRESENT ILLNESS
- History of present illness should cover magnitude and duration of fever.
- True rigors (severe shaking, teeth chattering chills not simply feeling cold) suggest fever due to infection but are not otherwise specific.
- Pain is an important clue to the possible source the patient should be asked.
- Other localising symptoms include nasal congestion and or discharge cough, diarrhoea and urinary symptoms.
- Presence of rash (including nature, location, and time of onset in relation to other symptom) and lymphadenopathy may help.
- Review of system should identify symptoms of chronic illness, including recurrent fever, nights fever, night sweats, and weight loss[3].
PAST MEDICAL HISTORY SHOULD PARTICULARLY COVER THE FOLLOWING
1. Recurrent surgery.
2. Known disorders that predispose to infection (HIV infection, diabetes, cancer, organ transplantation, sickle cell disease).
3. Other known disorders that predispose to fever (rheumatologic disorders, SLE, gout sarcoidosis, hyperthyroidism, cancer).
4. Enquire about recent travel include location, time since return, locale, vaccinations received before travel, any use of prophylactic antimalarial drugs, if required).
5. All patients should be asked about possible exposure (via unsafe food or water, insect bites, animal contact, or unprotected sex).
6. Vaccination’s history, particularly HEPATITIS A and HEPATITIS B, and against organisms that cause infections, should be noted[3].
DRUG HISTORY SHOULD INCLUDE SPECIFIC QUESTIONS ABOUT THE FOLLOWING:
a. Drugs known to cause fever.
b. Drugs that predispose to infection.
PHYSICAL EXAMINATION
- Measuring rectal temperature, oral temperature or axillary temperature.
- Other vital signs are reviewed for presence of tachypnoea, tachycardia, or hypotension.
- The patient’s general appearance, including any weakness, lethargy, confusion, cachexia, distress should be noted.
- All the skin should be inspected for rash, particularly petechial or haemorrhagic rash
- Axilla and epitrochlear and inguinal areas should be examined for adenopathy.
- The lungs are examined for crackles or signs of consolidation, and the heart is auscultated.
- The abdomen is palpated for hepato-splenomegaly and tenderness suggestive of infection. The flanks are percussed for tenderness over the kidney suggesting pyelonephritis. Genital examination is done in men to check for urethral discharge and local tenderness.
- The rectum is examined for tenderness and swelling, suggesting perirectal abscess.
- All major joints are examined for swelling erythema and tenderness.
- The hands and feet are signs of endocarditis, including splinter haemorrhages under nail, painful, erythematous, subcutaneous nodule on the tip of digits[4].
COMPLICATION
- Dehydration
- Delirium and hallucination
- Coma
- Seizures
- Sepsis[4]
TREATMENT AND MANAGEMENT
When the body temperature starts reaching 106.1-degree Fahrenheit and higher, it may be necessary to treat the fever itself, as well as the underlying cause. Direct treatment of hyperpyrexia may include[5].
- A cool bath or cold, wet sponging put on skin.
- Especially cold compression on axilla will reduce the temperature.
- Liquid hydration through intravenous or from drinking.
Dietetic management of febrile state is always the matter of interest. During an acute fever, appetite is diminished, hydrochloric acid is reduced. A low diet protects impaired digestive system, and favor’s absorption of liquid from tissues, thus relieves congestion. Light food is advised always. Proper feeding of liquid diet in fevers must be given regularly. Eggs as food in fevers are distinctly contraindicated. Meats fallen into same category[5].
HOMOEOPATHIC REMEDIES
Belladonna: Sudden onset of symptoms. Along with headache and feet is icy cold. No thirst with fever. Patient has a flushed face, high temperature, and pulse is strong[6].
Gelsemium sempervirens: Slow onset, dullness, dizziness, drowsiness and delirium are the concomitant. Patient is chilly, doesn’t want to move. Drooping of eyelids, chills up and down back with no thirst.
Cedron : Regular paroxysm of fever, coming at same hour, periodicity is marked, commencing with chills in back and limbs. Feet and hand will be cold[7].
Pyrogenium: Pulse is weak and rapid, and not proportionate with temperature, most indicated in blood poisonings. Temperature goes up and down, aches all over the body. Has chills, is alternatively hot and cold and complaining bed is hard. Especially indicated in septicaemia.
Arsenicum album: Restless, fearful, fear of death, burning pain relieved by warmth. Worse after midnight, increasing weakness, very thirsty for frequent sips of water.
Bryonia alba: Patient prefers to lie still as they are worse from very little movement. Usually pale and quiet, very thirsty, drink large amount of water. Marked homesickness.
Ferrum phosphoricum: Gradual onset, red cheeks, pulse is fast and weak. Throbbing headache and better by cold application on the head. Usually give in first stage of inflammation.
Aconitum napellus: Restless, anxious, and fearful. Sudden onset, skin is dry and hot, pulse will be bounding and unquenchable thirst for large quantity of water. Barking, dry cough[8] .
HOMOEOPATHIC VIEW ON FEVER[9]
Dr Hahnemann tells about intermittent fever in 6thedition of Organon of Medicine in aphorism from 235 to 244. The power of producing a similar series of alternating state comprising the whole paroxysmal phase.
In Organon of Medicine, Master Hahnemann affirms that acute disease generally only a transitory outbreak an explosion of latent psoric affection. The symptomatic expression of this or any other dyscrasia must be selected based on the totality thus obtained[10].
Correspondence by similarity of symptoms to the strongest, best marked and most peculiar alternating state. But the remedy selected to stop the paroxysms must be also acute remedies and not the anti-psoric drugs having deeper action.
PHILOSOPHICAL ASPECT OF FEVER[11]
Dr H.C. ALLEN – “All fevers that tend to be protracted, low or malignant type, occur in the psoric or tubercular patient and the more deeply psoric, the more malignant the attack.” Dr H.C. Allen is following Dr Hahnemann’s view regarding fever.
CONCLUSION
A fever is a body temperature that’s higher than is considered normal. Fever may be produced by many stimuli. It’s also called a high temperature, hyperthermia, or pyrexia, and it’s usually a sign that your body is working very hard to keep you healthy from an infection. A part of your brain called the hypothalamus controls the body temperature. In response to an infection, or due to some other cause, the hypothalamus may reset the body to a higher temperature. So, when a fever comes on, it’s a sign that something is altered in the body.
REFERENCES
- Merckann, Porter R, Kaplan J. The Merck Manual of Diagnosis and Therapy 19th Edition United Kingdom Merck Co Inc., 2011.P.1158
- Davidson’s Davidsons, Principal and Practice of medicine 20th Edition 2016
- Symptoms of influenza .Svg- Wikipedia common (internet).common Wikipedia. Org 2018(cited 27 December 2018) available from https://common.wikipedia org/wiki/file: symptoms-of-influenza, svg
- Http:/www.who.int /Medicine /Factsheets/F5211/En//’’Influenza, (seasonal)”.Who.Nov 2016, Accessed on March 17, 2018, 5.4tpm.
- India P.22 lakh People Affected by fever, 420 Deaths: Kerala Government (internet).NPTV.com.2018.Available from https://www.ndtv.com/kerala-news/22 lakh-people-Affected -By-fever-420-Deaths-Kerala-Goverment 1735998
- Clarke Henry John MD, Clarke a Dictionary of Practical MateriaMedica. vol- III Delh, B Jain Publishers (P) Ltd; 1995; P. 990-93.
- Boericke William, M.D, Pocket manual of Homoeopathic MateriaMedica and Repertory and a chapter on Rare and Uncommon Remedies: Delhi Jain Publishers PVT Ltd, 1991; p. 554
- Murphy Robin ND, Lotus MateriaMedica 1400 homoeopathic and herbal remedies. 3rd Edition: Delhi, B Jain Publishers (P) Ltd; 2004; p. 1660.
- Hughe Richard L.R.C.S. A Manual of pharmacodynamics. Sixth Edition: Delhi, B Jain publishers (P) Ltd; 1999; p .779
- Sarkar B.K., Organon of medicine 5th& 6th edition by Hahnemann Samuel, Audesapere with introduction and commentary on the text publishers :M. Bhattacharyya and co.(P)Ltd 2015; P.96
- Hahnemann, S. Boericke, W, and Dudgeon (1984). Organon of Medicine .New Delhi: B Jain Publisher.
ABOUT THE AUTHOR:
Dr MINI. I. V, Associate Professor, working in Father Muller Homoeopathic Medical College, Department of Homoeopathic Materia Medica, has shown a keen interest in research activities. Also, the author of many articles, published in Index Journals and credited with presenting posters and papers in National and International platforms. She is the guide for UG and PG dissertations as well as guide the students in CCRH and RGUHS – STSH Projects.
