What to do and when to worry

Cold & Flu

by




Pallavi Mukkamala, MD

Jul
7,
2020

Having a fever can leave you feeling miserable, hot and sweaty — and worried. How high is too high? When is it time to call the doctor? What do these numbers even mean? 

We tend to fear fevers. However, a fever generally means your immune system is doing its job by fighting off infection. A fever is a stimulation of the immune system and is the immune system’s attempt to gain advantage over bacteria or a virus. 

What qualifies as a fever?

Normal body temperature for adults is about 98.6 degrees Fahrenheit but given that body temperature varies, the normal range is broad. It is very normal for body temperature to range between 98.6-99.9 and these temperatures (even if they are high for you) are less likely to be a true sign of illness.  

Regular body temperatures generally do not exceed 99.9 degrees Fahrenheit. Therefore, a true fever is when body temperature reaches 100.4 F (38 deg C). 

Parents, it’s easy to panic when your young child spikes a fever but first, take a deep breath. Keep in mind that kids usually spike fevers faster than adults and the temperatures tend to be higher as well; this is because children have an inexperienced immune system. 

At-home fever remedies

Fortunately, for low-grade fevers, there are a few steps you can take to make yourself more comfortable at home.

Rest

Your body needs lots of rest to give your immune system a chance to recover. Keep your body cool by sleeping with light clothing.

Fluids

Fluids are essential since fevers can cause fluid loss and dehydration. For children younger than 1 year old, use oral rehydration products.  

OTC medication

Fever treatment for adults usually depends on the temperature. If the temperature is below 102 degrees and there is minimal discomfort, simple over the counter ibuprofen, naproxen, acetaminophen or aspirin should be adequate.  

OTC medications should be used for children based on age and weight. Acetaminophen or ibuprofen can help reduce aches and pains, but parents should follow the directions and dose very carefully. Talk to your pediatrician about any medication questions.

When to call your doctor

If your fever reaches higher than 104 degrees Fahrenheit, come in to see your doctor. Also see your doctor if you have additional symptoms such as:

• Seizures
• Loss of consciousness
• Stiff neck
• Trouble breathing
• Severe pain
• Swelling or inflammation in the body
• Pain with urination
• Any malodorous vaginal discharge

If your child is less than 3 months old and has a fever, seek care immediately. For children older than 3 months old, seek medical care if their fever reaches 102 degrees Fahrenheit or higher. 

Fever with any of the following symptoms can also be a cause for concern in children:

• Non-blanching dark rashes
• Extreme irritability or lethargy
• Severe pain
• Difficulty moving a part of the body (most importantly the neck)
• Trouble breathing or quick/forceful breathing
• Poor appetite or fluid intake with decreased urine output

If ever in doubt, please reach out to your primary care physician. We can help you evaluate your symptoms and guide you in the right direction so you or your child can get the care you need.

Worried about a fever? Find a doctor near you or schedule a virtual visit today.

Fevers 101: How to treat them, and when to get help

 
A fever is your immune system’s way of changing the battleground to help itself fight. When your body recognizes an invader (like bacteria or a virus), your immune system raises your body temperature as a defense. Your immune system works much better in hotter temperatures, while invaders do worse. Fevers may feel terrible to you, but they help your body destroy invaders and get back to its healthy self.

Fevers defined

Normal body temperatures sit between 97 to 99° F. A fever is a temperature of 100.4° F or higher. There are low-grade fevers and more serious fevers, depending on the sick person’s age.

A serious fever is hotter than:

•    100.4° F in infants younger than one month – go to the ER if this happens
•    102° F in infants older than one month on up to children
•    103° F in adults

For infants one month and younger, a temperature of 100. 4° F or higher requires immediate medical attention. From one month of age and older, most fevers – even serious fevers – do not require immediate medical attention. If your feverish child is making eye contact, responding to your voice, drinking fluids and voiding normally, there’s no need to worry.

When to get medical attention

Most fevers don’t require medical attention. However, any of these symptoms in children or adults, along with a fever, means it’s time to see a doctor. Download the new Nebraska Medicine mobile app to make an appointment, or call 800.922.000.
 

In general, fevers don’t cause harm. Even febrile seizures – convulsion in a child caused by a spike in body temperature – rarely cause any lasting damage. However, the infection triggering the fever certainly can cause long-lasting damage. For example, meningitis can cause very sudden high fevers. Meningitis can cause brain injuries or even death. That’s why it’s important to monitor the symptoms associated with the fever to see if you need medical help.

Which thermometer reading is best

• Mouth: The best choice for home use. Oral readings are accurate and easy to take. Placing an oral thermometer in the armpit is less accurate (and will be about 1 degree lower than a mouth reading) 
• Rectal: Highly accurate, but there’s a risk of injury, especially with infants. Best to leave rectal thermometers to health care professionals
• Forehead: Used for their convenience and speed, no-touch forehead thermometers are the least accurate

Home treatments for fevers

You don’t have to treat a fever, especially if it’s lower than the more serious fevers (listed above in Fevers defined).

A fever is part of your normal immune response. Lowering your body temperature with medication can limit your immune system’s fighting power. However, if you or your child’s symptoms are intolerable, these medications effectively treat a fever:

• Children one to six months old: acetaminophen
• Children six months or older: acetaminophen or ibuprofen
• Adults: acetaminophen, ibuprofen and any other over-the-counter NSAID medications

Other at-home remedies can make you feel more comfortable and help with accompanying symptoms:

• Decreasing ambient room temperature
• Using a fan
• Fewer blankets on bed
• Soothing honey or lemon teas
• Cold beverages for sore throat
• Humidifier for cough

Above all, stay hydrated and get plenty of rest. A fever is one of the symptoms of COVID-19. Be sure to get tested for COVID-19 before returning to work or other public places.

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Rheumatic fever – online presentation

1. RHEUMATIC FEVER

Systemic inflammatory disease
of the connective tissue with
predominant localization of the pathological process in the cardiovascular system
developing in
predisposed persons, predominantly of young age due to 9 0005 with pharyngeal infection,
due to group A streptococcus

2. RHEUMATIC FEVER

Epidemiology:
In developing countries, value
RL is huge. Recent estimates
show that 15,600,000 people worldwide have 90,005 rheumatic heart disease and that 470,000 new 90,005 cases of LC (approximately 60% of which 90,005 will develop into 90,005 rheumatic heart disease) occur annually, 90,005 with 230,005 deaths as a result of it
complications.

3. RHEUMATIC FEVER

IKB – 10
100 – Rheumatic fever without
mention of involvement of the heart;
101 – Rheumatic fever since
involvement of the heart;
102 – Rheumatic chorea.
Rheumatic fever
acute
rheumatic fever

–
not
infectious disease (unlike influenza,
intestinal
infections
and
others).
The difference between
is that streptococcus itself does not
affect the joints and heart. As a result of
infection
the functioning of the
immune system is disrupted (it is believed that some proteins of
streptococcus are similar in structure to
proteins of joints, heart valves;
as a result of an immune response to streptococcus, the organism
mistakenly “attacks” its own tissues
, in which inflammation develops,
which becomes the cause of the disease.
Rheumatic fever
Etiology
Rheumatogenous strains of b-hemolytic
streptococcus: A-3, 5, 18, 19, 24
A special role is assigned to the M-protein, which is part of the
streptococcus cell wall. Of the 90,005 more than 80 known varieties of Mprotein, the so-called rheumatogenic
consider M-5, M-6, M-18 and M-24. At the same time, a stable hyperimmune response
to various streptococcal antigens is determined
with the formation of antibodies – antistreptolysin
O (ASL-O), antistreptohyaluronidase (ASH),
antideoxyribonuclease, etc.
Rheumatic fever
Etiology
Genetic factor
frequent occurrence of Dr5–Dr7 , Cw2–Cw3 and a number of
others in patients with various forms of LC.
Genetic marker for this disease according to
Opinion
of a number of
researchers,
is
alloantigen of B-lymphocytes, determined with
using monoclonal antibodies D8 / 17, with
a high frequency found both in
patients with LC and in their closest relatives
.
With
he
bind
hyperimmune response to streptococcal
antigen.
Rheumatic fever
Pathogenesis
direct or indirect damaging
effect of streptococcus components,
its toxins on the body with development
immune inflammation. For selective
damage to the valves of the heart and myocardium with the development of
immune
aseptic
inflammation

antistreptococcal
antibodies are responsible,
cross-reacting with heart tissues
(molecular mimicry).

8. RHEUMATIC FEVER Pathogenesis

Genetic
predisposition
enzymes
arr. Am
Streptococcal
infection
toxins
sample IR
myocardial injury, conn. tissues
according to the type of GNT
exposure of antigenic structures tissues
Immune inflammation by the type of HRT with
formation of
granulomas and sclerosis
Clinical manifestations of RL
Department of Faculty Therapy No. 1 MMA named after. I.M. Sechenova
PATHOGENESIS OF RHEUMATISM
STREPTOCOCCAL INFECTION
formation of antistreptococcal antibodies
enzymes toxins
formation of immune complexes
damage to myocardium, connective tissue
GNT type (with “exposure” of the antigenic structure)
formation of autoantibodies to the myocardium,
connective tissue
long-term immune inflammation of the HRT type
with the formation of granulomas and sclerosis
CLINICAL MANIFESTATIONS OF THE DISEASE

10.

RHEUMA TYC FEVER Pathogenesis

Streptolysin S (not forms Ar)
cardio- and membrane toxic
(binds to membrane phospholipids)
Destabilization of the lysosomal apparatus

11. RHEUMATIC FEVER Pathogenesis

Ab + C
Ag Str.
Ag of thymic epithelium
Ag of myocardial sarcolemma
Ag of valve glycoproteins
Ag of SMC of vessels
Ag of certain CNS elements

12. RHEUMATIC FEVER WHO Issue 764, Geneva 1988

Acute disease, chronic and relapsing course
not considered.
Genetic marker – alloAg
B-lymphocytes
Autoimmune nature of obstruction:
cross-division of Ag components
streptococcus wall and membrane and
myocardium and valve glycoproteins
hearts.
Rheumatic fever
Valvulitis
Typical
organic
systolic
murmur,
combination
with
myocarditis
and/or
pericarditis.
Auscultatory:
prolonged
blowing

systolic murmur associated with the I tone, best heard in the
region of the apex of the heart, carried out in the left

axillary
region.
Noise
variable,
especially
early

stages, and does not change significantly
when changing the position of the body and
breathing.
Rheumatic fever
Valvulitis
On (FCG) register a decrease
in the amplitude of the I tone at the apex, an increase in the amplitude
of the III and IV tones. With myocarditis, at
FCG, a systolic murmur is determined, not
associated with the I tone, variable in different
cardiac
cycles,
having a medium-amplitude
,
mid-frequency
character.
Mitral valve valvulitis is manifested by
high frequency
pansystolic
or
protosystolic
noise
of different amplitude
.
Rheumatic fever
atypical manifestations of articular syndrome
monoarthritis, lesions of small joints

hands
and
feet,
asymptomatic
sacroiliitis;
reactive
arthritis,
which
persists
to
for
more than
prolonged
time,
than
with typical

ARF,
and
insufficient
responds optimally to therapy with
anti-inflammatory drugs.
Rheumatic fever
Sydenham’s chorea
Frequency: 6-30%, predominantly in children, rarely in adolescents.
Clinical manifestations:
pentad of syndromes
choreic
hyperkinesias, muscular hypotonia
up to
up to
flabbiness
muscles
with
imitation
paralysis,
stato-coordination
disorders,
vascular
dystonia,
psychopathological phenomena.
Rheumatic fever
Annular erythema
Incidence: 4-17%;
pale pink
annular
varying
in
sizes
rashes,
localized

trunk
and
proximal 5 face!).
Is
transient
migratory in nature, is not accompanied by itching or induration and
turns pale when pressed.

18. RHEUMATIC FEVER Classification

Acute disease, chronic and
relapsing course are not considered.
Genetic marker – alloAg
B-lymphocytes
Autoimmune nature of obstruction:
cross-division of Ag components
of the wall and membrane of streptococcus and
myocardium and glycoproteins of valves
of the heart.

19. RHEUMATIC FEVER Diagnosis

Jones criteria, amended by ARA in 1992
Major criteria
Minor criteria
Carditis
Migratory polyarthritis
Sydenham’s chorea
Subcutaneous nodules
Annular erythema
Clinical
Fever
Arthralgia
Laboratory findings
Acute phase r-tion
Increased PQ int.
The diagnosis is supported by the active participation of streptococcus: culture +, rapid growth of Ag strept. and Ab to it.
Ab to cardio-reactive Ag.

20. RHEUMATIC FEVER Treatment:

In the acute period:
Penicillini – 500 mg x 2 r. 10 days or
Erythromycin – 250 mg x 4 r. daily
or Penicillini benzathini G 1.2 million units 1 time
Prednisolone – 40 mg / day for up to 10 days.
Aspirin up to 3-5 g/d
Ascorbic acid up to 3 g/d.

21. RHEUMATIC FEVER Diagnosis examples:

22. RHEUMATIC FEVER Treatment:

In the acute period:
Penicillini – 500 mg x 2 r. 10 days or
Erythromycin – 250 mg x 4 r. daily
or Penicillini benzathini G 1.2 million units 1 time
Prednisolone – 40 mg / day up to 6 days, NSAIDs up to
1 month.
Aspirin up to 3-5 g/d
Ascorbic acid up to 3 g/d.

23. Treatment of RL

1. benzylpenicillin 1,500,000–4,000,000 IU/day for 10 90,005 days, then the Durant form of the drug (benzathine
benzylpenicillin – 2,400,000 IU/m once every 3 weeks).
A 10-day course of treatment with oral
penicillins is possible.
2. amoxicillin at a dose of 1-1.5 g per day for 10
days. In case of intolerance to β-lactam antibiotics,
it is advisable to prescribe macrolides:
spiramycin (rovamycin) 6–9 million IU in 2–3 doses,
course duration 5–8 days; azithromycin;
roxithromycin; clarithromycin; (cephalexin, cefaclor, cefixime).
a new means of prevention and
etiotropic treatment of streptococcal infection recommended
tomicide. The drug is a
antagonistic substance, the main
the active principle of which is
a bacteriocin-like substance (a mixture of lysates of
bacteria), which has an inhibitory effect on
many microorganisms, including streptococci.
imudon (tablets), which is a
polyvalent complex, which includes
substances that act on microorganisms, most
often causing inflammation in the
oral cavity. Active ingredient
of the preparation is a mixture of bacterial lysates: 50 mg
dry matter for local use. Imudon
activates phagocytosis, increases
the content of lysozyme and secretory IgA in saliva, and
also immunocompetent cells. The drug is indicated
for acute and chronic pharyngitis, chronic
tonsillitis, stomatitis, before and after tonsillectomy,
for tooth extraction. The daily dose of the drug is 8
tablets, which dissolve in the mouth from
The average duration of
treatment is 10 days.
interval
2-3 hours
Immunization against group A streptococcus
is being carried out. A vaccine has been synthesized that will contain
epitopes of M-proteins of “rheumatogenic”
strains of streptococci that do not cross-react with tissue antigens
of the human heart. The use of such a vaccine as part of
primary prevention of LC is expedient,
in the first turn, in persons with genetic markers
indicating a predisposition to
the disease.
Rheumatic fever
The second stage
achieving complete remission and
restoring the functional
ability of the cardiovascular system in children with PD. In
, the sanatoriums continue the therapy started in the
hospital, sanitize the foci of chronic infection
, carry out the appropriate
health-improving regimen with differentiated
motor activity,
physical therapy, tempering
procedures.
Rheumatic fever
Primary prevention
Timely diagnosis and
adequate therapy of active A –
streptococcal pharyngitis,
tonsillitis.
In acute A-streptoccal
tonsillopharyngitis in young people
with risk factors
for the development of ARF, a 5-day
treatment with benzylpenicillin in
daily doses of 1,500,000 – 4,000 90,005,000 million units is indicated, followed by a single injection
Rheumatic fever
Primary prevention
Timely diagnosis and
adequate treatment of active A –
streptococcal pharyngitis,
tonsillitis.
Amoxiclav – Tablets 375 and 625
mg, suspension 156 and 312 mg / 5 ml –
per os;

30. RHEUMATIC FEVER Prevention:

Penicillini benzathini G 1.2 million IU once every 4
weeks for 3 months.
Aspirin up to 3-5 g/d
Ascorbic acid up to 3 g/d.

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