Fever also called pyrexia is one of the most common presenting complaints in medical practice. It is defined as a body temperature that is above the normal range for that individual without any physiological cause to it, in other words temperature raised due to exercise or menstrual cycle doesn’t count as fever, this is usually above 38 degrees Celsius recorded by thermometer, in this case, oral and rectal temperature readings are more accurate than exhilarate M. The most important thing to keep in mind is that fever in it of itself is not a disease but rather a symptom that indicates an underlying disease process mechanism of fever. Body temperature is usually set to its normal range by the hypothalamus which acts as sort of a thermostat when the body suffers from certain pathological processes, namely inflammation, the chemicals are released by the body collectively called pyrogens in other words of which is interleukin, 2 pyrogens set the thermo regulatory point of the hypothalamus to a higher temperature thus resulting in fever.

The causes of fever can be divided into the broad categories of one infections which is the most common cause of pyrexia, it can include bacterial, viral, fungal or parasitic infections. Two clots, three cancers, four autoimmune diseases and five miscellaneous which can include things like heat stroke, medications, brain lesions and thyroid storm to name a few diagnosing the cause of fever. We have mentioned five categories of diseases that usually result in fever, then each category consists of a multitude of possible diseases, in order to narrow down our diagnosis we need to do a thorough history and examination and request appropriate lab investigations where relevant fever is usually accompanied by other symptoms as well which may help the diagnosis of underlying disease.

Important questions to ask in history

These can be broadly divided into two categories;

One, general fever related to review of systems.
Fever specific questions include the duration of fever, the timing of the fever, what time of day is it more prominent, if the character is a remitting or relapsing, is it accompanied by chills or rigors, is there night sweating, is there weight loss, is there pain anywhere?

Review of symptoms is a systemic approach to identifying accompanying symptoms in other body organs, this is especially important in identifying a possible focus of infection, ask relevant questions pertaining to each organ system and move from head to toe so for example, ask about headache, neck stiffness eye pain, skin rashes or itching, ear pain or discharge, coughing, sore throat, pain on swallowing? Are there difficulty breathing or chest pain, is there any abdominal pain, any change in bowel habits, is there any lymph node enlargement, any burning sensation while urinating, any discharge from genitals, any recent injuries, any muscle or bone pain, any recent surgery?

Your history will be directed further by the patient’s responses and we’ll probably start moving towards a probable diagnosis. Examine the relevant organ system in thorough detail, you mainly need to decide which of the five categories does the disease belong to and which organ system is likely affected, for example, acute fever with complain of burning sensation during urination points to infection of the urinary tract whereas chronic low-grade fever with anemia and weight loss might be indicating a hematological cancer.

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