SEMINAR PRESENTATION
DEPARTMENT OF
PAEDIATRICS
PRESENTED BY : DR.RICHA SATHE
MD PART 1
GUIDE : DR.POONAM SHINDE
HOD: DR.M.D.AAGE
SONAJIRAO KSHIRSAGAR HOMOEPATHIC MEDICAL COLLEGE ,BEED
2828-FEB-
2024
TOPIC:
FEVER
DEFINITION
• Fever is defined as an elevation of body temperature in
response to a pathological stimulus.
• Common oral measurement of normal human body temp is
36.8+0.7*C or 98.2+1.38*F
Fever is present if:
Anal or otic temperature higher than
38˚ Celsius(100.4˚F)
Oral temperature ia at , or higher than
37.5˚C(99.5˚F)
Axillary temprature is at, or higher than
37.2˚C(99˚F)
PATHOPHYSIOLOGY
• The normal body temperature is maintained by a complex
regulatory system in the anterior hypothalamus.
• Development of fever begins with the release of endogenous
pyrogens into the circulation as the result of infection,
inflammatory processes (rheumatic disease), or malignancy.
• Microbes and microbial toxins act as exogenous pyrogens by
stimulating release of endogenous pyrogens, which include
cytokines such as interleukin-1, interleukin-6, tumor necrosis factor,
and interferons that are released by monocytes, macrophages,
mesangial cells, glial cells, epithelial cells, and B lymphocytes.
• Endogenous pyrogens reach the anterior hypothalamus via the
arterial blood supply, liberating arachidonic acid, which is
metabolized to prostaglandin E₂, resulting in an elevation of the
hypothalamic thermostat.
• Endotoxin stimulates endogenous pyrogen release and directly
affects ther-moregulation in the hypothalamus.
PHYSIOLOGY OF FEVER
Pyrogens:
• Exogenous pyrogens:
• Bacteria, Virus, Fungus, Allergen,...
• Endogenous pyrogen
• Immune complex, lymphokine,...
• Major EPs: IL1, TNF, IL6• Pyrogens:
TYPES OF FEVER
1. Continuos fever : The temperature remains above normal
throughout the day and does not fluctuate more than IC in 24
hours eg Inbar pneumonia, typhoid, urinary tract infection,
infective endocarditis, brucellosis, typhus, etc
2. Remittent fever : Remittent fever: The temperature remains
above normal throughout the day and fluctuates more than 1"C
in 24 hours e.g. typhoid, infective endocarditis, etc. This type of
fever is most common in clinical practice
3 . Intermittent fever: The temperature is present only for
some hours in a day and remits to normal for the remaining
hours. When the spike occurs daily, it is quotidian, when every
alternate day, it is tertian and when every third day, it is
quartan. Intermittent fever is seen in malaria, kala-azar.
pyemia, septicemia etc.
4. Hectic or septic : The temperature variation between peak
and nadir is very large and exceeds 5°C e.g. septicemia
5. Pel Ebstein type: There is a regular alternation of recurrent
bouts of fever and afebrile periods. The temperature may take
3 days to rise, remains high for 3 days and remits in 3 days,
followed by apyrexia for 9 days seen in Hodgkin's lymphoma
6. Low grade fever: Temperature is present daily especially in
the evening for several days but does not exceed 37.8°C at
any time. Usually it does not indicate disease, but it is
commonly present with TB
CAUSES OF FEVER
• 1. Infections: Bacterial, viral, rickettsial, fungal parasitic, etc.
• 2. Neoplasms:
Fever may be present with any neoplasm but commonly with
hypernephroma lymphoproliferative malignancies, carcinoma
ofpancreas, lung and bone and hepatoma
• .3. Vascular:
Acute myocardial infarction, pulmonary embolism, pontine hemorrhage,
etc.
• 4. Traumatic Crush injury.
• 5. Immunological:a. Collagen disease, SLE, rheumatoid arthritis.b. Drug
feverc. Serum sickness.
• 6.Endocrine: Thyrotoxicosis, Addison's disease.
• 7. Metabolic: Gout, porphyria, acidosis, dehydration
• 8. Hematological: Acute hemolytic crisis
• 9. Physical agents: Heat stroke, radiation sickness.
• 10. Miscellaneous: Factitious fever, habitual hyperpyrexia,
cyclic neutropenia
SPECIAL TYPES OF FEVER
• 1 Fever with rigors:
This occurs in: Malaria. Kala azar. Filariasis. Urinary tract infection,
pyelonephritis. Cholangitis. Septicemia Infective endocarditis. Abscesses, any
siteLabar pneumonia
2. Fever with herpes labialiss
Elevated body temperature may activate the herpes simplex virus and cause
smail vesicles around the angle of the mouth (herpes labialis),
It occurs with Pneumonia, Malaria . Meningitis. Severe streptococcal infection
3.Fever with rash:
This is seen in: Chicken ponx Small pox Measles. Rubella.
Typhus, Allergy
4. Fever with membrane in the throat:
Occurs in: Diphtheria. Infectious mononucleosis.
Agranulocytosis Moniliasis Vincent's angina.
5 . Fever with delirium:
This is common in: Encephalitis. Typhoid state Meningitis.
Pneumonia (especially in alcoholics and elderlypeople with
dementia). Hepatic encephalopathy
BENEFITS OF FEVER
• Protective role in the immune system
Inhibition of growth and replication of microorganisms
• Aids in body's acute phase reaction
• • Enhanced immunologic function of WBC'S
↑lymphocyte response to mitogens
↑bactericidal activity of neutrophils
↑ production of interferon
• Promotion of monocyte maturation into macrophages
• Promotion of lymphocyte activation and antibody production
• Decreased availability of free iron for bacterial replication
MANAGEMENT OF FEVER
• 1. Evaluate the medical history, physical examination and laboratory investigations to develop a
working diagnosis for the etiology of fever.
• 2. Specific treatment of the infections, if present, should be undertaken.
• 3. The general treatment of pyrexia is symptomatic and supportive.
(a) Most children of more than 2 months age appear quite comfortable until their temperature
reaches 38.5°C.
(b) Temperatures higher than 39°C and less than 41.2°C (102.4°F to 106°F) need administration of
acetaminophen (paracetamol) as the first line drug in a dose of 15 mg/kg/dose. This can be
repeated at 4 hourly intervals.
(c) Ibuprofen and nimesulide can be used as second line antipyretics.
(d) Hydrotherapy. Indications for immediate sponging with lukewarm water are febrile delirium,
febrile seizure or fever > 41.1°C. Paracetamol should be given 30 minutes prior to sponging. Heat
stroke requires cold water sponging.. Hydrotherapy should be continued till the body temperature
comes down to 38 °C.
• 4. Heat hyperpyrexia.
When the temperature exceeds 41°C, body of the child below
the neck should be immersed in the cold water without further
delay to prevent irreversible brain damage. The parents should
be reassured that this seemingly drastic measures will not
induce shock. Ice cold bath does not cause significant
vasoconstriction. The rectal temperature
5.HYDRATION
Fluid requirements increase by 10 %for every 1˚C rise in temp
above baseline.
HOMOEPATHIC MANAGEMENT
01.Belladonna –Belladonna is the most prominently indicated medicine to manage fever in
children.
• In children needing it,
• excessive heat is present in the whole body during fever.
• There is marked redness on the face.
• Excessive thirst is felt during heat stage.
• Heat stage is followed by the body becoming cold. The child is restless during fever.
There is redness of the throat and tonsils. Tonsils are swollen and enlarged. Pain is felt in
the throat which gets worse while swallowing, especially liquids. Dry cough may be
present. Nausea may be felt. Everything tastes bitter. The child tends to cry frequently.
• It is one of the best homeopathic medicines for managing fever in cases of sore throat,
tonsillitis, cough.
• 2. Chamomilla – With Excessive Irritability
Chamomilla is an important medicine to manage cases of fever
with intense irritability. The child needing it needs to be
constantly carried in arms. Along with irritability, the child feel
restless. He/she may have loose stool with pain. An increased
thirst for water is noted. Vomiting may happen. There is
sleeplessness along with fever. While in fever, there is redness on
one cheek and paleness of the other cheek. It is one of the top
recommended medicines for fever during dentition with intense
irritability. It is also indicated for managing cold with fever in
children
• 3. Aconite – For Fever With Cold, Cough, Sore Throat
This medicine is indicated in case of fever with cold, cough, or sore
throat. There is marked heat in the body and dry burning skin where
this medicine is needed. There is desire to uncover the body during
fever. There is redness on the face and increased thirst for water.
During cold, there is fluent discharge from the nose and sneezing.
Sometimes there is dry cold (means blocked nose without any
discharge) accompanied with headache. The throat is inflamed and red.
General anxiety and restlessness may be present.
• 4. Ferrum Phos – In Case Of Tonsillitis And Sore Throat
• Ferrum Phos is another well-indicated medicine for fever with
tonsillitis and sore throat. The tonsils are red, swollen and
painful. In most cases, tonsils, mainly on the right side, are
affected. Throat is usually dry. Bad smell occurs from the
mouth. There is heat in the body with sweating on the hands.
Thirst for water decreases. With fever, vomiting can be there.
Besides these, Ferrum Phos is also indicated to manage fever
that occurs with complaints of teething in babies.
• 5. Hepar Sulph – For Fever With chilliness In Sore throat. This medicine is
recommended for fever along with chill spells in cases of sore throat. The
throat is painful when swallowing saliva. Throat is red with the presence
of enlarged red follicles on it. There is redness and swelling of tonsils.
There is dry cough. There is no thirst for water. Sleeplessness is there.
• 6. Cina – With Loose Stool And VomitingCina is a beneficial medicine when
there is fever with loose stool and vomiting. Fever occurs at the same
time every day when this medicine is required. Chills are felt over the
entire body followed by a heated sensation. During chills, there is
shivering and shaking of the body. A very characteristic feature is that the
tongue is clean during fever. The children requiring this medicine are very
irritable and want to be carried in arms all the time but carrying gives no
relief to them
• 7. Arsenic Album – With Weakness And Restlessness
• This medicine is well suited when there is weakness and restlessness with
fever. An important feature is that there is thirst for little quantity of water at
short intervals. There may be heated sensation or chills during fever. There is
a desire to be covered during fever. This medicine helps deal with different
kinds of infections including cold, cough, sore throat, and stomach infections.
• 8. Silicea – With Marked Chilliness And Shivering
• Silicea is of great use in cases where chills and shivering are well marked
along with fever. In most cases needing this medicine, fever occurs at night.
This medicine is very effective for managing fever during teething with
sensitive gums. Fever occurs towards the evening and night. There is heated
sensation in the head. There is excessive bad-smelling sweat, especially on
the head and feet.
THANK YOU
