What temperature is considered a dangerous fever. How to recognize signs of a severe fever in adults and children. When should you contact a doctor for a fever. What are the potential complications of high fevers.

What Constitutes a Normal Body Temperature?

Body temperature fluctuates naturally throughout the day and can vary between individuals. For adults, the normal range typically falls between 97°F (36.1°C) and 99°F (37.2°C). However, several factors can influence this baseline:

• Time of day (lower in the morning, higher in the evening)
• Physical activity
• Menstrual cycle in women
• Individual variations

While slight elevations above this range don’t necessarily indicate illness, it’s crucial to understand when a fever becomes concerning.

Recognizing Dangerous Fever Symptoms in Adults

A fever alone isn’t always cause for alarm, but certain accompanying symptoms can signal a more serious condition. Adults should seek medical attention if a fever is accompanied by:

• Severe throat pain or swelling
• Rapidly worsening skin rash
• Intense headache
• Sudden light sensitivity
• Neck stiffness
• Mental confusion
• Persistent vomiting
• Difficulty breathing or chest pain
• Severe abdominal pain
• Pain during urination
• Any unusual or unexplained symptoms

As a general guideline, adults should consult a healthcare provider if their temperature exceeds 103°F (39.4°C) and persists for more than three days.

Fever in Children: When to Be Concerned

Children, especially infants, are more susceptible to complications from high fevers. Parents should be vigilant and seek medical care under the following circumstances:

• Any fever in babies under 3 months old
• Fever above 101°F (38.3°C) in older infants and children
• Fever accompanied by refusal to eat or drink
• Unusual irritability or lethargy
• Signs of dehydration
• Presence of other concerning symptoms (rash, earache, etc.)

It’s important to note that fever-induced seizures, while frightening, are rarely harmful and typically last less than five minutes. However, parents should still seek medical evaluation if a seizure occurs.

Understanding the Purpose of Fever

Contrary to popular belief, fever itself is not inherently dangerous. In fact, it serves as a crucial defense mechanism against infections. Here’s why:

• Many pathogens struggle to survive at higher temperatures
• The immune system may function more effectively at elevated temperatures
• Fever acts as a signal that the body is actively fighting an infection

While reducing fever can provide comfort, it’s essential to understand that this doesn’t address the underlying cause. Most fevers related to infections rarely exceed 106.2°F (41.3°C). Temperatures above this are more commonly associated with other serious conditions like heatstroke or severe reactions.

Fever Management: When to Treat and When to Wait

Not every fever requires immediate intervention. In many cases, allowing the body to fight the infection naturally can be beneficial. Consider these approaches:

• Rest and hydration
• Consuming foods rich in vitamin C
• Ensuring proper ventilation
• Gentle exercise (if feeling up to it)

Over-the-counter fever reducers can provide relief but may slow the body’s natural healing process. If a fever persists beyond three days without improvement, consult a healthcare provider, even in the absence of other symptoms.

Potential Complications of Untreated High Fevers

While most fevers are benign, prolonged high temperatures can lead to complications if left unchecked. These may include:

• Dehydration
• Exhaustion
• Cognitive impairment
• In extreme cases, organ damage

It’s worth noting that brain damage from fever alone is extremely rare and would require temperatures exceeding 107.6°F (42°C), which is not typical of infection-related fevers.

Fever in Special Populations: Unique Considerations

Certain groups may require more careful monitoring and different thresholds for seeking medical attention:

Elderly Individuals

Older adults may not exhibit typical fever symptoms and could have a blunted temperature response. Be alert for:

• Confusion or changes in mental status
• Weakness or falls
• Loss of appetite
• Rapid breathing

Immunocompromised Patients

Those with weakened immune systems should seek medical attention for any fever, as their bodies may struggle to fight infections effectively.

Pregnant Women

Persistent high fevers during pregnancy can potentially harm fetal development. Pregnant women should consult their healthcare provider for any fever lasting more than 24 hours.

How Does Fever Affect Sleep and Recovery?

Fever can significantly impact sleep quality, which in turn affects the body’s ability to recover. Consider these factors:

• Increased metabolism can lead to restlessness and difficulty staying asleep
• Night sweats may cause discomfort and dehydration
• Pain or other symptoms associated with the underlying illness can disrupt sleep

To promote better rest during a fever:

1. Keep the room cool but comfortable
2. Use lightweight, breathable bedding
3. Stay hydrated throughout the night
4. Consider using a humidifier to ease respiratory symptoms

Adequate sleep is crucial for the immune system to function optimally, so prioritizing rest can aid in recovery.

The Role of Nutrition in Supporting Fever Recovery

Proper nutrition plays a vital role in supporting the body’s immune response during a fever. Focus on these dietary strategies:

• Increase fluid intake to prevent dehydration
• Consume easily digestible, nutrient-dense foods
• Incorporate foods rich in vitamins C, D, and zinc
• Consider bone broth or chicken soup for hydration and nutrients

While appetite may be reduced during a fever, maintaining adequate nutrition can help the body fight infection more effectively.

Understanding Fever Patterns and Their Significance

Different fever patterns can provide clues about the underlying cause. Common patterns include:

Continuous Fever

Temperature remains elevated with little fluctuation. Often seen in:

• Pneumonia
• Urinary tract infections
• Typhoid fever

Intermittent Fever

Temperature alternates between normal and elevated. May indicate:

• Malaria
• Sepsis
• Lymphoma

Remittent Fever

Temperature fluctuates but never returns to normal. Associated with:

• Viral infections
• Infective endocarditis

Recognizing these patterns can help healthcare providers determine the most appropriate course of treatment.

The Impact of Fever on Chronic Health Conditions

For individuals with pre-existing health issues, fever can present additional challenges:

Cardiovascular Diseases

Fever increases heart rate and metabolic demands, potentially straining the cardiovascular system. Patients with heart conditions should monitor fever closely and consult their doctor if it persists.

Diabetes

Fever can affect blood sugar levels and insulin requirements. Diabetic patients should:

• Check blood glucose more frequently during illness
• Stay hydrated to prevent complications
• Consult their healthcare provider about adjusting medication if needed

Respiratory Conditions

Individuals with asthma or COPD may experience exacerbated symptoms during a fever. They should:

• Monitor breathing closely
• Use prescribed inhalers as directed
• Seek medical attention if respiratory symptoms worsen significantly

Understanding how fever interacts with chronic conditions can help patients manage their health more effectively during illness.

Fever Prevention: Boosting Immune Health

While not all fevers can be prevented, strengthening the immune system can help reduce the frequency and severity of infections. Consider these strategies:

• Maintain a balanced diet rich in fruits, vegetables, and lean proteins
• Engage in regular physical activity
• Prioritize quality sleep
• Manage stress through relaxation techniques or mindfulness practices
• Stay up-to-date on vaccinations
• Practice good hygiene, including frequent handwashing

By focusing on overall health and wellness, individuals can build a more robust defense against infections that lead to fevers.

The Future of Fever Management: Emerging Technologies

Advancements in medical technology are shaping the future of fever detection and management:

Wearable Temperature Monitors

Continuous temperature tracking devices can provide early warning of fever onset and help monitor patterns over time.

Smart Thermometers

Connected devices can log temperature data, track symptoms, and even suggest when to seek medical attention based on personalized health profiles.

Artificial Intelligence in Diagnosis

AI-powered systems are being developed to analyze fever patterns and associated symptoms, potentially improving early detection of serious conditions.

These innovations hold promise for more precise and timely fever management, especially for vulnerable populations or those with chronic health conditions.

Cultural Perspectives on Fever and Its Treatment

Attitudes towards fever and its management vary across cultures and can influence treatment approaches:

Western Medicine

Often focuses on symptomatic relief and fever reduction, with a lower threshold for seeking medical intervention.

Traditional Chinese Medicine

May view fever as a sign of imbalance in the body’s energy and use herbal remedies or acupuncture to restore harmony.

Ayurvedic Medicine

Considers fever a purification process and may recommend dietary changes or natural therapies to support the body’s healing.

Understanding these diverse perspectives can help healthcare providers offer more culturally sensitive care and improve patient compliance with treatment plans.

Fever in the Context of Global Health Challenges

Fever remains a significant concern in global health, particularly in developing regions:

Tropical Diseases

Conditions like malaria, dengue, and yellow fever present unique challenges in fever management and prevention.

Antibiotic Resistance

The rise of antibiotic-resistant infections complicates treatment of fever-inducing bacterial illnesses.

Climate Change

Changing global temperatures may affect the spread of fever-causing pathogens and alter human susceptibility to certain infections.

Addressing these challenges requires coordinated efforts in research, public health initiatives, and international cooperation to improve fever management and reduce disease burden worldwide.

When Is A Fever Dangerous?

When we feel that our body is burning with fever, the first thought is to get rid of it. It is especially difficult to be relaxed about fever when it attacks our kids. We are ready with pills, cold showers, compresses, cold drinks, anything to bring the temperature down. But, fever or increased body temperature is an important part of our body’s defense against infections. When we are attacked by an invader, our body reacts by rising the temperature. Most viruses and bacteria that cause infections thrive at 98.6 °F There is also a theory that our immune system works best at higher than normal body temperature. It does not mean that we can ignore fever when it hits us and keep going on like it is all normal. It is important to distinguish fevers that require urgent trip to the doctor, and others that are better left alone, to do the job of fighting infection, with a little help of rest, hot soup and some vitamin C.

What is normal?

Our normal body temperature changes during the day, throughout the month, and is very much dependent on the activity we do. Normal temperature in adults varies from 97 F (36.1 C) to 99 F (37.2 C). It is lower when we wake up in the morning and higher later in the day. It can be a few degrees higher after an exercise. Body temperature in women changes depending on their menstrual cycle. Some people naturally have higher body temperature than others. But, we know when our increased temperature is due to an infection, because it comes with other symptoms:

• Very sore throat and throat swelling
• Skin rash that is rapidly getting worse
• Severe headache
• Sudden sensitivity to brightness
• Stiff neck
• Confusion
• Prolonged vomiting
• Difficulty breathing
• Chest pain
• Irritability and listlessness
• Sharp stomach pain
• Pain when urinating
• Any strange unexplained symptoms

Any of these symptoms together with a fever require a trip to the doctor. As a rule of thumb, see your doctor any time your temperature is higher than 103 F (39. 4 C) and lasts longer than three days. Doctor can determine the cause of high fever and prescribe proper treatment or medication depending on the cause.

Children and Fever

Babies are much more sensitive to high body temperature and fever has to be taken very seriously. See your pediatrician immediately if your baby is younger than three months and has even slightly elevated temperature. For older babies and kids, see a doctor if a fever is higher than 101 F (38.3 C), if a child has a fever and refuses water and food or is more irritable than normal and keeps crying.  Children that are feverish and are lethargic may be suffering from meningitis, so see a doctor right away.

Call your doctor right away if your child has a fever and:

• Looks very sick
• Is drowsy or very fussy
• Has a weakened immune system or other medical problems
• Has a seizure
• Has other symptoms such as  rash,  sore throat,  headache,  stiff neck, or  earache

Parents are often afraid of seizures that sometimes occur as a consequence of high body temperature. These types of seizures are very seldom harmful to children and last less than five minutes. Seizures are most often resulting from sudden increase of body temperature, not from high temperature.

Fevers that happen as body’s response to an infection rarely go over 106.2 (41.3 C). Such high temperatures are most commonly due to head trauma, heatstroke, poisoning or side effect of anesthesia.

It is important to remember that fever in general is NOT dangerous. To damage the brain, our temperature would have to go over 107.6 F (42 C). Use the fever as a sign your body is sending you that some infection is going on and see if you can do something about it. Rest, nutrition high in vitamin C, fresh air, and light exercise can help your body”s immune system to fight infection before it becomes serious. Lowering your temperature with pills will make you feel more comfortable, but will not help you fight the infection. If your own immune system cannot fight the infection and the fever lasts longer than three days, see your doctor even if you have no other symptoms.

Your Action Steps:

• 1Check with your doctor if you, your child and especially your baby are having a high fever.
• 2Enroll in our Doctor on Demand program to get 24/7 access to a licensed US physician (US residents only)
• 3Get a high quality Dual Mode Thermometer to take temperatures more accurately.

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The fever paradox

Abstract

Fever can be deadly, but in moderation it could have some surprising upsides, as Linda Geddes discovers

AS NEWS about coronavirus spread around the world, paracetamol soon began to disappear from shop shelves as people stocked up at home. In some places, the price of the drug shot up. That probably comes as little surprise given that one of the key symptoms of the infection is a fever.

We tend to routinely use drugs such as paracetamol or ibuprofen to try to bring down a high temperature, believing fever to be, at best, a passive and unwelcome bystander to infection and, at worst, a direct contributor to our illness. Yet mounting evidence suggests that fever may, in fact, be a strategy the body uses to ramp up its defences. This new understanding of what is going on when we are burning up could help us come up with better approaches to fighting infection altogether.

Normal body temperature is generally thought of as 37°C, although anything between 36.5°C and 37.5°C is considered normal (see “Highs and lows
”, overleaf). However, once your temperature hits 38°C, you have officially got a fever.

Highs and Lows

Although 37°C is often cited as normal body temperature, it varies throughout the day, with thermometer readings some 0.8°C to 1°C lower first thing in the morning compared with the evening.

Body temperature also tends to be higher in women than in men – and even within women, it is approximately 0.4°C higher during the second half of the menstrual cycle compared with the first. Younger people also tend to have higher body temperatures than older people.

There is even evidence that our body temperatures may be falling over time – possibly because we are exposed to fewer pathogens in the modern world, meaning our immune systems are less active and our bodies less inflamed. One recent study found that, on average, body temperature in the US has fallen by around 0. 03°C per decade since the early 19th century. Men born then were 0.59°C hotter than men today, while women’s body temperature appears to have dropped about 0.32°C since the 1890s. The average body temperature for 21st-century humans is about 36.6°C – not 37°C as widely thought.

The most common cause of this is infection. “When immune cells recognise the telltale signs of a germ in the body – and often this can be quite early on in an infection – they release secretions which act on a brain area called the hypothalamus,” says Daniel Davis, an immunologist at the University of Manchester, UK, and author of The Beautiful Cure: Harnessing your body’s natural defences. The hypothalamus is responsible, among other things, for controlling body temperature, and it responds to these signals by releasing hormones that cause various heat-boosting responses. Blood vessels in our skin constrict so less heat is lost at the body’s surface. Fat cells start burning energy and our muscles rapidly contract, causing shivering – both of which warm us up. As a result, the body’s temperature starts to rise.

If it rises too far, that can be fatal. Our cells begin to die, releasing proteins into the blood that can damage the kidneys and other organs, resulting in their failure. The exact temperature this happens at probably depends on the source of a person’s fever, as well as other factors such as how hydrated they are. “The number 40 [degrees] scares a lot of doctors,” says Mark Peters at the UCL Great Ormond Street Institute of Child Health in London.

Even so, many hospital doctors will routinely give fever-reducing drugs as soon as a patient’s temperature hits 38°C. Even a mild fever comes at a great cost: raising your body temperature by just 1°C requires a 10 per cent increase in energy expenditure. Fever is associated with a higher pulse and breathing rate, placing additional strain on the heart and lungs that could be risky in seriously ill people.

So if fever can kill us, why does it happen? Fever-like responses are observed in many organisms, suggesting fever’s evolutionary origins may stretch back hundreds of millions of years. Even some plants have been shown to increase their leaf temperature in response to fungal infections, while cold-blooded creatures will deliberately raise their body temperature if they have an infection, by sitting on a hot rock, for instance. In the case of the desert iguana, not being allowed to do so was seen to cause a 75 per cent reduction in survival rates.

That suggests fever might not be all bad. “Things that have a very high metabolic cost would not be preserved throughout evolutionary history unless they came with a clear survival advantage,” says Peters.

The idea that fever might actually have medical benefits goes way back. The ancient Greek physician Hippocrates claimed that “those who cannot be cured by [medicine or] surgery can be cured by heat; and those who cannot be cured by heat are to be considered incurable”. In 1927, the Nobel prize for medicine was awarded to the Austrian physician Julius Wagner-Jauregg for his discovery that triggering a high and persistent fever by inoculating people with malaria could treat their syphilis; the malaria was later treated with quinine.

Fever reliever

Modern medicine has moved on considerably, and so has the way we think about fever. It is easy to see it as the thing that is making us ill, not a symptom along with other things like a runny nose or sore throat. “People often equate fever with the cause of the fever – even many doctors struggle to get their heads around that separation of fever being the response to a problem, and not necessarily the problem itself,” says Peters.

Fever can also feel unpleasant, and many of us feel glad when our temperature drops after taking some medication. From all these perspectives, it makes sense to want to bring temperatures down as quickly as possible. That’s certainly how the medical profession views things, says Peters. “Correcting fever has become a routine part of intensive-care practice, almost to the point where it’s not discussed.”

But there are hints we might be missing something. Take the common viral infection chickenpox. In a study of 72 children, those who weren’t given drugs known to reduce fever recovered faster. Likewise, a study of 56 people infected with one of the viruses that causes the common cold found that those who took certain fever-reducing drugs remained infectious for longer.

Similarly, people who are admitted to intensive care units with infections and a slightly raised temperature tend to fare better than those who have a normal temperature, or one higher than 40°C. One reason for this may be that bacteria and viruses find it easier to replicate and infect cells at temperatures below 37°C. “By increasing your body temperature, you may be slowing down the ability of a virus to multiply,” says Davis.

By increasing your body temperature, you may be slowing the ability of a virus to multiply

It also seems that the immune system works more efficiently when the body gets hotter. Immune cells that act as first responders to infection, such as dendritic cells, macrophages and neutrophils, have been shown to arrive at the scene faster, and have an improved capacity to engulf and destroy infectious agents at 38°C to 40°C. Fever also seems to make these cells better at recruiting and activating T-cells, which coordinate longer-term “adaptive” immune responses, such as antibody production. And T-cells and antibody-producing B-cells also better respond to instructions from the immune system at these temperatures.

Recent studies are providing new insights into how this happens. One published last year suggested that running a temperature of 40°C may help T-cells crawl out of the blood towards sites of infection, by producing proteins that allow them to anchor to the blood vessel wall.

Raising body temperature by just a few degrees also speeds up a cellular “clock” that controls the switching on of a set of inflammation-promoting genes, according to recent work by Mike White at the University of Manchester and his colleagues. “You see a dramatic change in the timing of this system, where pretty much every degree makes a difference,” he says.

This is unusual in biological systems: even the circadian clock, which generates roughly 24-hour rhythms in our physiology, is insensitive to temperature. That implies fever may be a deliberate strategy to bolster our immune defences in the face of infection. “It suggests that the immediate immune response is that bit faster at higher temperatures,” says White, which may explain the speedier resolution of some illnesses.

All of this raises the question of when – and how – fever should be treated. Peters recently conducted a trial in 100 children who were critically ill with suspected infections. He wanted to explore whether it was feasible to let their temperatures rise as high as 39.5°C before administering fever-reducing drugs, instead of 38°C, which is the current practice in most UK hospitals. The children continued to receive other treatment. The trial showed that there were no adverse outcomes from treating at higher temperatures, but it wasn’t designed to test if this resulted in faster recovery.

Meanwhile, a recent meta-analysis combined the results of various trials assessing the impact of treating mild fever in hospitalised adults. It concluded that there was no difference in survival between those who received more active management of their fever and those who received less. So far then, the results suggest there isn’t a lot in it, although it is still early days.

It might be that we are focusing on the wrong problem, however. The question isn’t whether we should treat fever, but in which patients we should do it, says Edward Walter, an intensive care doctor at Royal Surrey County Hospital in Guildford, UK, who recently reviewed the medical literature on fever. Rather than seeing it as a single thing, he says that running a high temperature can be a response to various problems. In addition to infection, these include brain injury, heatstroke and taking certain drugs such as ecstasy, so our response to it might need to be more nuanced, he says.

Another good question to ask is whether we have the means to treat the underlying cause of the fever. “If you’re going to get an advantage from fever, it will probably be in populations where you cannot easily achieve control of the infection by existing means,” says Peters. With pneumonia triggered by a bacterial infection, for instance, antibiotics will often treat the pneumonia, in which case there may be limited benefit to letting a fever run.

However, we currently have no effective drugs for pneumonia triggered by the new coronavirus, and so Peters speculates that mild fever could be helpful in such a situation.

Not everyone agrees. “You cannot really say fever is good, period, or fever is bad, period,” says Andrej Romanovsky at the University of Arizona, who edits the journal Temperature. “The only practical way to answer how we should treat fever is to run clinical trials in specific populations suffering from a specific disease and using specific [fever-reducing] drugs.”

In the case of covid-19, such trials may be years away. In the meantime, the UK’s National Institute for Health and Care Excellence (NICE) is reviewing evidence on ibuprofen to try to clarify whether it is safe for treating the symptoms of covid-19 infections, after French health officials controversially urged people with symptoms to avoid the drug. The current advice from the World Health Organization is that either paracetamol or ibuprofen can be used to treat symptoms of the illness. In the UK, the advice from the National Health Service is to take paracetamol – although it doesn’t say whether that is for fever or for other symptoms such as a sore throat.

“Fever is probably helpful in a very limited way, in those situations where we have light infections, but we should also consider how a person is sleeping and how they feel,” says Romanovsky. “For mild cases, it probably doesn’t matter whether you take a drug to take the fever down.”

And most health services advise that a mild fever of up to 38.9°C, in the absence of more worrying symptoms, will probably get better with rest and fluids. So if your fever is mild, and you aren’t in great discomfort, you might want to remember what is going on inside. “Permitting a fever in the viral condition is likely to allow your immune system to do its job – as it has been designed by millions of years of evolution – better,” says Peters.

Why Are Fevers So Scary?

For most of human history, an unusually high body temperature was a sign of the supernatural. Fevers were sinister but common, unnatural but real. And without a theoretical underpinning by which to understand them, fevers long seemed to be as nebulous as they were deadly.

Ancient Romans had at least three temples dedicated to worshipping a god of fever. According to a 1918 issue of The Classical Weekly, Romans would leave amulets in these structures of febris, hoping to placate the deities who made them sick.

In the Middle Ages, fever treatments included incantations, elixirs, charms, and exorcisms. Avicenna, the influential Persian scholar, described the condition as “extraneous heat, kindled in the heart, from which it is diffused to the whole body through the arteries and veins.” In the centuries that followed, fevers retained an air of mysticism.

“It was generally agreed by sixteenth-century writers on fever, as by their predecessors, that the nature of fever lay in the ‘heat contrary to nature,’ or preternatural heat experienced by the patient,” wrote Iain Lonie in a 1981 paper for the Wellcome Trust. “Almost all of them regarded this heat as a distinct kind or genus of heat, contrasted with other kinds.”

What, then, is the evolutionary purpose of a fever?

A fever, then, wasn’t seen as an extension of a person’s body heat, but as something else entirely. Fevers were mysterious largely because people didn’t understand they were a symptom rather than a disease in their own right—but also because of their seemingly paradoxical qualities. A person who is febrile feels hot to the touch, but experiences bouts of shivering cold. Someone with a very high temperature can get well without intervention, whereas the condition of a person with milder fever can seem to suddenly deteriorate. “Fever is a mighty engine which nature brings into the world to the conquest of her enemies,” wrote the English physician Thomas Sydenham in the 1660s.

Today, fevers are common as ever, but often linked to less serious diseases. In many parts of the world, vaccination has eradicated some of the deadliest illnesses that can cause fevers. In an otherwise healthy person, a fever runs its course in a few days and then a person gets better. We have widely available medicines, like Tylenol, to treat discomfort associated with fevers. And yet they have retained much of their peculiar power.

* * *

“People don’t like fever,” said Howard Markel, the director of the Center for the History of Medicine and a professor of pediatrics and communicable diseases at the University of Michigan. “They just don’t, and for good reason.”

A person with a fever, after all, can feel very sick—can actually be very sick. But the larger attitude toward fevers is one that Markel says is socially and culturally mediated through generations of misinformation and actual suffering. “We’re culturally raised to be wary of fever based on older information—some of it very pertinent to this day, some of it not so pertinent,” he said. “I don’t want to call them all urban legends or myths, but these are cultural practices that spread just as widely as the infectious diseases that are behind them. ”

The phenomenon known as “fever phobia,” an exaggerated fear of fever, is found among parents of all socioeconomic classes. One study found the majority of parents are unduly worried about low-grade fevers; another reported that most caregivers were “very worried” about the potential harm of fever in their children.

This fear is, in some ways, understandable. A fever—a temperature at or above 100.4 degrees Fahrenheit—in an newborn’s first month of life is a medical emergency. Infants that young are rushed to the emergency room for spinal taps and urine cultures to rule out bacterial infection that can be deadly. They are hospitalized and given IV antibiotics even before doctors can determine whether a baby is gravely ill. Hospitalization for this reason is quite common; serious problems are not. Babies can also suffer from febrile seizures, convulsions and loss of consciousness prompted by high body temperature. Such episodes affect one in 25 children, according to the National Institute of Neurological Disorders and Stroke. Although most kids outgrow febrile seizures without any lasting health problems, they can be frightening for caregivers.  

Fevers aren’t always a sign of a passing virus or some other benign illness. Among the the more perplexing conditions for doctors are persistent fevers that seem to have no cause, or fevers of unknown origin. Startlingly, many physicians still don’t have a clear understanding of how to manage fevers, despite them being among the most common health problems. A 2001 study found a significant number of doctors demonstrated a “serious lack of knowledge” of the nature, dangers, and management of fever in children.

Avicenna, it should be pointed out, did not have it right about fevers, either. Physiologically, they are not “kindled in the heart,” but triggered by a reaction in the hypothalamus, a bundle of tiny nuclei about the weight of a penny that sits just above the brainstem. “Going back to Hippocrates, people—doctors and their patients—had the conception that fever was the disease itself rather than, say, caused by salmonella, or influenza, or some microbial organism,” Markel told me. “Nobody knew about microbes, so fever was considered a disease.”

In those days, most people weren’t as concerned with where a fever came from as they were with what might happen to you if you got one. “Very often you tended to have infectious diseases that killed you,” Markel said. “That’s one reason why fever would be terrifying.”

“If you have a high fever and it’s before the era of antibiotics, you’ll be sick as hell,” he continued. “With pneumonia, which was extremely common, you could have a really high fever of 104 or 105. People died of it. That’s scary stuff. And your body either fights it off or it doesn’t. Sometimes, with diseases like bacterial pneumonia, you’d be sweating, your fever would be high, and you’d either resolve it or you’d die. These were very dramatic moments.”

Evidence of these moments was everywhere, culturally. In the 18th and 19th centuries, newspaper pages were cluttered with ads for tonics promising to “cure fever.” And because “fever” was a euphemism for a number of serious illnesses, stories of people who “died from fever” were all over obituary pages.

“Back then, people said, ‘Fever came to town,’ and ‘This year’s fever had a lot of red rash.’ We now know that meant measles,” said David Morens, a senior scientific advisor at the National Institute of Allergy and Infectious Diseases. “When they said, ‘Last year fever came to town and it had a lot of vesicular rash,’ we now know that was smallpox. They didn’t understand fever in its different forms as indicating any distinct disease that was different from any other disease.”

Which is why generations of doctors tried to treat fevers themselves, not their underlying causes, often with gruesome outcomes. “Particularly with febrile diseases, one of the ideas was that you had unbalanced humors,” Morens said. “The idea was that bad humors were causing the disease, or at least the fever, and you had to get rid of the poison.” In the 1700s, patients with febrile diseases were bled, sometimes to death, in an attempt to get rid of toxicity. Other treatments included medicines that made a person vomit, sweat, or have diarrhea.

“The idea was the fever will go away if you get out all these bad things through all the various pores and orifices,” Morens said. “At the same time, people still believed that fever was caused by the pounding of the heart generating heat—which was viewed as a substance, not a property. They observed that when you had a disease, your heart rate goes up, but they had it backwards.”

The Italian physician Francisco Torti’s drawing of a fever tree, an attempt to connect various febrile illnesses, first published in 1712. (Wellcome Images)

Even into the 20th century, as people began to understand that fever was the symptom and not the disease, fever was explicitly connected to how illnesses were described: yellow fever, typhoid fever, scarlet fever.

Fever remained the focal point. It was a cause of death, right there in the name of the most terrible diseases you could get.

* * *

The technology still used to assess a fever, the thermometer, reinforces a view of febrile illnesses that isn’t right. Thermometers allow for a level of precision—the difference between, say, 101.2 degrees and 101.7 degrees—that does little to actually illuminate how sick a person is. At the same time, thermometers have become an icon of modern medicine by being among the most common medical tools in a person’s home. Which means one of the key devices people associate with differentiating between sickness and wellness is ultimately misleading.

“A thermometer is, by its very nature, a crude measurement,” Morens said. “Temperature measurement is affected by the ambient temperature outside, it’s affected by daily variations. Different people have different ranges they go through at different times. It’s an imprecise measurement. I don’t think anybody who is a medical person or a scientist has ever had the idea that there’s any precision in measuring a temperature.”

This hasn’t stopped the baby-industrial complex from capitalizing on fever phobia. Devices like TempTraq, a wearable thermometer that transmits a baby’s temperature to a parent’s smartphone via a wireless signal, promises to monitor a child’s temperature continuously. There’s also, as Markel put it, a pharmaceutical industry that “makes a fortune” off fever reducers.

Today, doctors don’t treat fevers as much as they attempt to treat a fever’s underlying cause. “We understand that if you get rid of the bug you get rid of the fever,” Morens said. “We see fever as a sign of an illness but treating the fever is largely meaningless. There are thousands and thousands of infectious diseases that, under some circumstances at least, cause fevers. That’s what we know now.”

But philosophies on fevers are evolving. Doctors still debate the proper treatment for newborns with fevers—should a 3-month-old get the same aggressive workup, including lumbar puncture and IV antibiotics, as a 3-day-old? The answer, as with so many questions in medicine is: It depends.

As recently as the 1970s, doctors still wondered if inciting fever might help kill off an actual infection. There’s little scientific evidence that a fever can stop a virus, but that idea has persisted—sort of like the bromide “feed a cold, starve a fever,” which is also without scientific proof.

When Morens was in medical school, he remembers a patient, a 10-year-old boy, who had a rare and devastating neurological disease. The child’s doctors knew he wouldn’t survive. “As the kid got to the point of being ready to die, he was put on the ward. He was never going to get out and go home,” Morens said. “The head of our infectious disease team got permission to infect this kid with malaria to try to get his temperature up to 107, in hopes that it would kill the virus.”

It didn’t work. But the fact that fever as a treatment was even attempted in recent decades highlights the sometimes bizarre manifestations of fever’s cultural standing. “He knew almost certainly it wouldn’t have worked but he wanted to try to do it, even [as recently as] 1972,” Morens said. “I’m not aware that any disease can be killed by a fever. Although it’s said that one of the reasons we have fevers at all is that it potentially kills microorganisms—I think in general that’s not true.”

What, then, is the evolutionary purpose of a fever?

It may simply be a way for humans to know that they’re sick—which is useful not just for the person suffering, but for the community around that person. Consider, for example, what happened during the catastrophic measles epidemic in Fiji in 1875. “These people had never seen an epidemic fever—not ever,” Morens said. “This is a group of people who lived for over 1,000 years on a group of islands. There had never been an epidemic febrile disease there.” And yet they knew how to protect themselves right away.

“First of all, they were terrified—all of the sudden their bodies were turning hot and cold,” Morens said. “They didn’t know what it was or why. They thought they’d been bewitched by spirits… But they immediately undersotod the concept of contagion and they started isolating themselves. They’d never seen a fever before but they immediately recognized it was contagious. Groups of people ran to the highlands and hid until the epidemic went away. In some cases, where people were sick, they locked them up in a village and burned them down and killed them.

“There are many example of that,” Morens told me. “We think of contagion as a sophisticated concept but, in fact, primitive people who have never seen a contagious disease before immediately understand it. That’s been shown again and again and again in history.”

Over time, Western medicine has promoted more pragmatic understanding of fever. Doctors now know that, with the exception of ultra-high fevers of 105 or more, a higher temperature does not necessarily mean a person is sicker. Most cultures have abandoned theologic interpretations—like the idea that a fever was a sign of the gods striking you down, as ancient Egyptians believed. But a deep-rooted fear of fevers remains, passed down from generations of people who lived with a different understanding of their bodies and their vulnerabilities.

“The idea that fever was a big deal has been around for thousands of years,” Morens said. “Fever was a real disease to people, and we carry that legacy forward.”

Deadly virus’s pathway to infect cells identified – Washington University School of Medicine in St. Louis

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Mosquito-borne Rift Valley fever virus slips into cells via protein linked to cholesterol metabolism

CDC/Abbigail Tumpey

Goats shelter inside a pen during an investigation into a Rift Valley fever outbreak in Saudi Arabia in 2000. Researchers at Washington University School of Medicine in St. Louis and the University of Pittsburgh have discovered how Rift Valley fever virus enters cells, pointing the way to new therapies to treat the deadly disease.

Rift Valley fever virus causes economically devastating outbreaks of hemorrhagic fever in livestock such as sheep, goats and cattle. These mosquito-borne outbreaks lead to infection in people working with dead or dying animals, sometimes causing hundreds of human cases and dozens of deaths.

Rift Valley fever, for which there is no specific treatment, has been limited to Africa and the Arabian Peninsula. But mosquitoes capable of transmitting the virus can be found all over the world, necessitating a need to understand and control the virus.

Researchers at Washington University School of Medicine in St. Louis and the University of Pittsburgh Center for Vaccine Research and School of Public Health have discovered that the virus gets inside cells by taking advantage of a protein normally involved in taking up low-density lipoproteins (LDL, the carriers of so-called bad cholesterol) from the blood. The discovery, published Sept. 23 in the journal Cell, could lead to therapies that prevent Rift Valley fever or reduce its impact by interfering with the ability of the virus to get into cells.

“For people in areas where Rift Valley fever is endemic, an outbreak threatens not only their livelihood but their health,” said co-senior author Gaya K. Amarasinghe, PhD, a professor of pathology & immunology and of biochemistry & molecular biophysics at Washington University. “People have a 1% to 2% chance of death if they get infected with this virus, which doesn’t sound like much, but it’s about the same as COVID-19. The disease is much more severe in domesticated animals, especially young animals, which get very ill and die in large numbers. This virus has been flying under the radar, but given that it’s transmitted by mosquitoes that are found everywhere, it could spread into other parts of the world and become a serious issue.”

The World Health Organization has listed Rift Valley fever as a prioritized disease likely to cause epidemics in the near future. The virus spreads easily among domesticated animals via mosquito bite. People also can be infected by mosquito bite, but most people who become infected are workers exposed to infected animal body fluids as they care for sick animals or dispose of their remains.

To find out how the virus invades cells, first author Safder Ganaie, PhD, a postdoctoral researcher who works with Amarasinghe, grew the virus on mouse cells in a dish. By systematically disrupting normal mouse genes, Ganaie and colleagues found that the virus failed to infect mouse cells that lacked certain genes, notably the gene for LDL receptor-related protein 1 (Lrp1). Further experiments showed that the virus needs LRP1 to infect mouse, hamster, cow, monkey and human cells, indicating that the virus uses the same protein across distantly related species.

The finding constitutes an opportunity. If the virus needs LRP1 to infect cells, then temporarily taking LRP1 out of commission may limit its ability to spread in the body, thereby reducing disease. The researchers used a protein that effectively does this. Called RAP, the protein attaches to LRP1 and fends off anything else that tries to attach.

The researchers infected a group of mice with the virus and simultaneously treated them with RAP. A second group of mice also was infected but was left untreated for comparison. Most of the treated mice survived, while all of the untreated mice died. Further, the treated mice had lower levels of virus throughout their bodies on the third day after infection compared with the untreated mice.

RAP itself is not a good prospect for drug development, since it’s a normal mammalian protein that plays a role in many important biological processes. But the results suggest that targeting LRP1 may lead to therapeutics for Rift Valley fever.

“This finding is the key to understanding how Rift Valley fever virus spreads not only throughout the human body but also how it is able to infect mosquitoes and different species of mammals. Knowing how the virus spreads will help us develop targeted therapies, which currently do not exist for Rift Valley fever,” said co-senior author Amy Hartman, PhD, an associate professor of infectious diseases & microbiology at the University of Pittsburgh. “This discovery opens up new opportunities to study virus-host interactions at the cellular and organismal level and enriches our understanding of the basic biology of mosquito-transmitted emerging viruses.”

The discovery that Rift Valley fever virus uses LRP1 to get inside cells is interesting because the protein is better known for its role in cholesterol metabolism. It also is thought to play a role in Alzheimer’s disease and possibly in infections by the intestinal bacterium C. difficile. It’s not clear why these disparate biological processes are linked, but Amarasinghe, Hartman and their collaborators already have several projects underway to explore these connections.

Ganaie SS, Schwarz MM, McMillen CM, Price DA, Feng A,  Albe JR, Wang W, Miersch S Orvedahl A, Cole AR, Sentmanat MF, Mishra N, Boyles DA, Koenig ZT, Kujawa MR, Demers MA, Hoehl RM, Moyle A, Wagner N, Stubbs SH, Cardarelli L, Teyra J, McElroy AK, Gross ML, Whelan SJP, Doench JG, Cui X, BrettT, Sidhu SS, Virgin HW, Egawa T, Leung DW, Amarasinghe GK, Hartman AL.  Lrp1 is a host entry factor for Rift Valley Fever Virus. Cell. Sept. 23, 2021. DOI: 10.1016/j.cell.2021.09.001

This research was supported by the National Institutes of Health (NIH), grant numbers R01NS101100, P01AI120943, R01AI123926, R01AI107056, U19AI142784, U19AI10972505, R01AI130152, T32AI060525, T32AI106688, 1K08AI144033; the Burroughs Wellcome Fund, award number 1013362.02; the Pediatric Infectious Diseases Society; St. Jude Children’s Research Hospital; Society for Pediatric Research; Alzheimer’s Association, grant number AARG-16-441560; and The Leukemia and Lymphoma Society.

Washington University School of Medicine’s 1,700 faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is a leader in medical research, teaching and patient care, consistently ranking among the top medical schools in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.

Health workers scramble to contain deadly rat-borne fever in Nigeria | Science

By early January, it was clear something “really, really extraordinary” was going on in Nigeria, says Lorenzo Pomarico of the Alliance for International Medical Action (ALIMA). Cases of Lassa fever, a rare viral hemorrhagic disease, were skyrocketing across the country—more were recorded in the first 2 months of this year than in all of 2017. Unprepared for a disease that has no vaccines or drugs for treatment and kills 20% to 30% of those it sickens, eight health care workers were infected early on and three died. “Something was going very wrong with the outbreak,” Pomarico says.

Since then, the situation has only gotten worse. The rodent-borne disease is endemic in Nigeria and several other West African countries, fluctuating with the seasons and usually causing “a trickle” of cases a year, says Chikwe Ihekweazu, who heads the Nigeria Centre for Disease Control in Abuja. But as of 4 March, 353 cases had been confirmed across 18 states, with about 700 suspected cases, and 110 deaths. Ihekweazu says the record-setting figures are sure to be underestimates, because the disease is maddeningly hard to diagnose, and many cases go unreported.

Already, Nigeria’s fragile health care system is overwhelmed. The one dedicated Lassa fever ward in the country at Irrua Specialist Teaching Hospital has just 24 beds. Without access to proper training, health care workers continue to become infected—by now 16 cases have been reported, with one additional death.

As the government and its international partners scramble to set up isolation wards to stem the outbreak and deliver protective gear to health workers, researchers on three continents are racing to figure out what is driving the unprecedented outbreak. Is it simply better disease surveillance in the wake of Ebola, the similar but more deadly disease that began its rampage across West Africa in 2014? Has the virus changed in some way, are there more of the rats that carry it, or is a higher proportion of them infected? Or is another rodent capable of spreading the virus as well?

“There are lots of possible explanations,” says Stephan Günther of the Bernhard Nocht Institute of Tropical Medicine in Hamburg, Germany, whose team has worked in Nigeria for years. Considering how lethal Lassa fever is, shockingly little is known about it, he says. “We don’t know why people die. We don’t know about the pathophysiology of the disease. We don’t know the point of no return.”

That could be beginning to change. In 2016, the World Health Organization added Lassa fever to its list of priority pathogens of epidemic potential, calling for more research. And last week, the recently created Coalition for Epidemic Preparedness Innovations awarded its first grant for development of a Lassa fever vaccine to Themis Bioscience, a biotech in Vienna.

Lassa fever was discovered in 1969, when two missionary nurses died of a mysterious disease in the remote town of Lassa in Borno state in northeastern Nigeria. When a third nurse fell ill, she was evacuated to a hospital in New York City—along with a thermos full of blood and other samples from all three nurses bound for Yale University’s then-new Arbovirus Research Unit. There, a team led by Jordi Casals-Ariet isolated a novel virus from the samples. (He, too, almost died in the process, saved only by an infusion of antibody-rich plasma from the third nurse, who recovered.)

The cause is now known to be an arenavirus, one of a class of rodent-borne pathogens, and its natural reservoir is a multimammate rat, so-called for its rows of mammary glands, that is ubiquitous across West Africa. Cases peak in the dry season, when farmers burn the bushes in preparation for spring planting and rats scurry into houses in search of food. The rodents shed the virus in their urine and droppings, and people contract it by touching contaminated surfaces, inhaling viral particles, or eating contaminated food (including the rats themselves). Like Ebola, the virus can also be spread through contact with bodily fluids of an infected person. Such human-to-human transmission is thought to be rare for Lassa, unlike Ebola, except in hospital settings without proper infection control. But “the real rate of human-to-human transmission is unknown,” says Augustin Augier, secretary general of ALIMA in Paris, which has just launched a Lassa fever research program with the French medical institution INSERM.

No one knows the true incidence of the disease. “Most cases we have found are in places where there are hospitals and labs,” Günther says. “There is good reason to assume there are cases that are being overlooked.” And because the rat vector lives across a broad swath of the continent, the disease might also be endemic, but unrecognized, outside of West Africa, where it could be responsible for undiagnosed fevers.

Initial symptoms are easily mistaken for malaria or typhoid fever—body aches, sore throat, fever, nausea, diarrhea—before the disease progresses to organ failure, shock, and sometimes internal hemorrhaging. By the time doctors suspect Lassa fever, it’s often too late to save the patient. There is no rapid test; accurately diagnosing the disease requires a real-time polymerase chain reaction technique, but only three labs in Nigeria have that capability.

For now, the only treatment is a nonspecific antiviral drug, ribavirin. If it’s administered during the first 6 days of the illness, it seems to improve a patient’s prognosis, but “no one arrives before day 7,” Augier says. Nor is everyone convinced that ribavirin works in Lassa fever, as the only data come from the 1980s, Augier says.

Several potential drugs are on the horizon, in addition to the vaccine. Christian Happi at Redeemer’s University in Ede, Nigeria, and the Irrua Specialist Teaching Hospital is developing a rapid diagnostic test with colleagues at Tulane University in New Orleans, Louisiana; the Broad Institute in Cambridge, Massachusetts; and Zalgen, a company in Germantown, Maryland. Happi’s group and its international partners are also sequencing the virus “around the clock,” he says, and trying to figure out whether the genetic changes they have seen in the virus could have made it more transmissible or virulent.

For Happi, who diagnosed the first case of Ebola in Sierra Leone, the new attention to Lassa hasn’t come a moment too soon. “I used to scream and scream that Lassa is important, but no one listened,” he says. “I wrote so many grants” that were turned down. “Lassa fever is a disease of the poor … it is confined to a part of West Africa, and it is not viewed as a global threat. “

Meanwhile, the government and its partners are focusing on training health care workers and providing the basics needed for infection control, as well as educating a frightened public.

ALIMA’s Pomarico, who is leading ALIMA’s emergency response to the outbreak in the two hardest hit states of Edo and Ondo, hopes cases will subside with the rains and cooler weather, as they usually do. “But this year is different. “We are bracing for worst and preparing for the worst.”

Ebola Virus: Symptoms, Treatment, and Prevention

Ebola is a rare but deadly virus that causes fever, body aches, and diarrhea, and sometimes bleeding inside and outside the body.

As the virus spreads through the body, it damages the immune system and organs. Ultimately, it causes levels of blood-clotting cells to drop. This leads to severe, uncontrollable bleeding.

The disease was known as Ebola hemorrhagic fever but is now referred to as Ebola virus.

It kills up to 90% of people who are infected.

How Do You Get Ebola?

Ebola isn’t as contagious as more common viruses like colds, influenza, or measles. It spreads to people by contact with the skin or bodily fluids of an infected animal, like a monkey, chimp, or fruit bat. Then it moves from person to person the same way. Those who care for a sick person or bury someone who has died from the disease often get it.

Other ways to get Ebola include touching contaminated needles or surfaces.

You can’t get Ebola from air, water, or food. A person who has Ebola but has no symptoms can’t spread the disease, either.

What Are the Symptoms of Ebola?

Early on, Ebola can feel like the flu or other illnesses. Symptoms show up 2 to 21 days after infection and usually include:

As the disease gets worse, it causes bleeding inside the body, as well as from the eyes, ears, and nose. Some people will vomit or cough up blood, have bloody diarrhea, and get a rash.

How Is Ebola Diagnosed?

Sometimes it’s hard to tell if a person has Ebola from the symptoms alone. Doctors may test to rule out other diseases like cholera or malaria.

Tests of blood and tissues also can diagnose Ebola.

If you have Ebola, you’ll be isolated from the public immediately to prevent the spread.

How Is Ebola Treated?

There’s no cure for Ebola, though researchers are working on it. There are two drug treatments which have been approved for treating Ebola. Inmazeb is a mixture of three monoclonal antibodies (atoltivimab, maftivimab, and odesivimab-ebgn). Ansuvimab-zykl (Ebanga) is a monoclonal antibody given as an injection. It helps block the virus from the cell receptor, preventing its entry into the cell.

Doctors manage the symptoms of Ebola with:

How Can You Prevent Ebola?

There’s a vaccine to prevent Ebola, but rVSV-ZEBOV (Ervebo) only treats the Zaire strain of the virus. The best way to avoid catching the disease is by not traveling to areas where the virus is found. 

If you are in areas where Ebola is present, avoid contact with bats, monkeys, chimpanzees, and gorillas since these animals spread Ebola to people. You may be able to get the vaccine from the World Health Organization.

Health care workers can prevent infection by wearing masks, gloves, and goggles whenever they come into contact with people who may have Ebola.

Ebola Facts

There are five types of Ebola virus. Four of them cause the disease in humans.

The Ebola virus first appeared during two 1976 outbreaks in Africa.

Ebola gets its name from the Ebola River, which is near one of the villages in the Democratic Republic of Congo where the disease first appeared.

A Child’s Fever Turns Into a Rare, Deadly Disease

A Fever That Would Not Quit

It started out as a fever during flu season in January. My teenage son, Tim, complained of aches and pains — nothing out of the ordinary for the flu.

After four days with no change, we made an appointment to see his primary care doctor at the local clinic. Two days later, with all his respiratory viral tests returned negative, his fever continued.

By day seven his mom and I began to worry that he might have a serious bacterial infection, since he showed no flu symptoms. The three of us drove to the urgent care clinic in Sacramento, California, where the doctor directed us to take him directly to the emergency room at the UC Davis Medical Center.

Biopsies, Tests, and Scans

The emergency room doctors quickly realized they didn’t have the resources to diagnose or treat Tim. The ER doctor, in consultation with the on-call pediatric team, admitted him to the hospital.

His fever continued over the next 10 days, despite continual full doses of acetaminophen every four to six hours. During that time he underwent numerous tests, biopsies, and scans, which showed lesions and nodules in his liver, right lung, and skin. His spleen and liver were swollen, and his blood counts were erratic.

We hit a particularly rough patch as Tim prepared for an ultrasound-guided liver biopsy. He couldn’t have any food or fluid by mouth after midnight. What was supposed to be an early morning procedure didn’t happen until midafternoon. By then Tim’s fever had spiked to over 105 degrees.

He looked pale and despondent, desperately parched. His mom and I soaked towels in ice water in an attempt to cool him down. Finally, the surgical team rolled him to the operating area and gave him anesthesia and a dose of acetaminophen through his intravenous line. I heaved a sigh of relief once they took him in for the procedure at last.

It didn’t take a doctor to know that something was terribly wrong — but what?

Cancer, Infection, or Autoimmune Disorder?

Various teams of doctors — including specialists in infectious disease, dermatology, general pediatrics, and immunology — made their rounds. The pediatric hematology and oncology team took the lead. We were asked questions about sudden child deaths in the family, travel to foreign countries, or possible exposure to harmful substances or diseases.

Every “no” answer led to more questions and confusion. One morning they informed us that Tim either had cancer, a systemic infection, or an autoimmune disorder. A thick fog fell over our family as we contemplated the seriousness of his condition.

During the entire hospitalization, my wife, Lori, stayed with Tim. My asthma, psoriasis, and eczema only worsened in the dry, heated, sterile air of the hospital. The stress of Tim’s care, lack of sleep, and the 30-minute drive from home to hospital took a toll as well.

RELATED: Overcoming a Psoriasis Flare

I asked for two weeks off from work. My full-time job became taking care of my two daughters, helping out at the hospital, and transporting clothes, food, and other things my son had requested. Friends from our church helped with meals and shopping. We were in full crisis mode.

The doctors eventually eliminated cancer as a possible diagnosis, which was a huge relief. But they could not rule out a systemic fungal infection. Meanwhile, they sent vials of Tim’s blood to Cincinnati Children’s Hospital for tests. Liver biopsy slides went to UCLA Medical Center. And an immunologist from the UC San Francisco Medical Center was consulted. Tim got antifungal infusions every night for good measure.

A Frightening Diagnosis: HLH

Almost three weeks after Tim’s fever started, an immunologist told us the multidisciplinary team had made a tentative diagnosis: hemophagocytic lymphohistiocytosis, or HLH. He told my wife to Google HLH and look at the more reputable medical websites. One of the first pages we visited was for Cincinnati Children’s Hospital’s HLH Center of Excellence. We read: “Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder of the immune system causing uncontrolled inflammation that damages organs of the body leading to rapid death. A cure is possible but an accurate and quick diagnosis needs to be made.”

Some of the other articles I read on HLH did not inspire confidence. Words like “life-threatening” and “fatal” rang in my head. Parents who lost children to HLH spoke of how they were told cancer is more treatable than HLH.

Fortunately, our doctors told us that Tim had a relatively mild acquired case, which most likely was triggered by a viral infection. I began to believe them when, two days after Tim started a high-dose systemic steroid treatment, his fever finally broke.

After 18 days in the hospital, Tim received his discharge paperwork. The day before, he’d received his first chemotherapy infusion and a list of medications. The plan was for a home healthcare nurse to come to our house twice a week to draw blood. We would also need to drive Tim to the pediatric cancer center at UC Davis Medical Center for infusions every Tuesday, and to follow-up appointments with his pediatric hematologist oncologist every two weeks.

‘One Day, One Step at a Time’

Tim’s journey was far from finished. His blood counts were slowly normalizing, thanks to a number of blood transfusions along the way. A CT scan showed amazing shrinkage of the nodules in his right lung. But I couldn’t help but wonder, what was next? What were the chances of HLH recurring? Would Tim develop leukemia or lymphoma from the treatments or the disease?

Our family settled into a new routine. We freely used medical jargon and terms such as “fibrinogen” and “ANC” (absolute neutrophil count). Then there was the twice-daily medication regimen. We watched to see if side effects such as tremors, bruising, low blood counts, hair loss, and weight gain would improve or worsen. We considered whether life would ever be the same: Including Tim’s illness, four out of five members of our family now had either a chronic or serious medical condition.

I’ll never forget what Tim’s pediatric nurse told me as I peppered her with questions: “One day, one step at a time, Mr. Chang.” Every parent on that floor no doubt needed to hear that.

Those words remain with me. If today is what God gives me with my son, then that is what I will cherish while I pray for many more days to come.

You can read more about my experiences in my blog for Everyday Health and on my website.

90,000 In India, the probable cause of an unknown fatal fever has been revealed: Society: World: Lenta. ru

An unknown disease that has led to the deaths of dozens of Indians may be caused by dengue fever. This was stated by the deputy chief secretary of the state of Uttar Pradesh for health issues Amit Mohan Prasad in an interview with local media, RIA Novosti reports.

According to him, the cause of the outbreak is still being investigated, but the symptoms are similar precisely to dengue fever. Prasad noted that the state has already notified the state health authorities.It is noted that the majority of patients with an unknown fever suffer from high fever, dehydration and a drop in the level of platelets in the blood. Some patients had symptoms such as severe headache, muscle pain, nausea, and swollen lymph nodes.

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Mutation is inevitable.

There are more and more variants of the coronavirus. Where will its further evolution lead?

Earlier, Rospotrebnadzor estimated the chances of getting an unknown viral fever from India to Russia. According to the service, the two countries do not have a common border, and measures for the sanitary protection of the territory of the Russian Federation at the moment make it possible to minimize the importation of infectious diseases into the country from India. The risk of the spread of an unknown disease in Russia is practically absent, Rospotrebnadzor summed up.

On August 30, it was reported that in India the death toll from an unknown viral fever was about 68 people, of which 40 were children. In one day, the virus killed 12 children.According to the source, referring to the Indian leadership, this number of victims is only approximate, since the health authorities keep count of the deaths in state medical institutions. The main focus of the disease was the western regions of the state of Uttar Pradesh in northern India. Among the main reasons for the occurrence of an unknown fever, non-compliance by residents of sanitary and hygienic standards, as well as carriers of the virus – mosquitoes that breed in swampy reservoirs, are voiced.

Similar to Ebola.Another deadly virus appeared in Guinea

10 August 2021

Photo author, Getty Images

Photo caption,

The Marburg virus was first detected in the city of Marburg in Germany in 1967

World Health Service and Government Guinea has officially confirmed the first death from Marburg disease. It is caused by a virus similar in properties to the Ebola virus. Just like the coronavirus that causes Covid-19, it spreads from animals to humans.

An unnamed man fell ill on 25 July and died on 2 August in a village near the town of Gukedu at the junction of the borders of Guinea, Liberia and Sierra Leone. He was treated for malaria and tested negative for the Ebola virus. Posthumous examination of tissue samples confirmed the presence of the Marburg virus in his body.

Marburg disease was first discovered in the German city of Marburg in 1967. Green monkeys imported for experiments from Africa became the source of infection. There were 31 cases of the disease and seven deaths.

Subsequent outbreaks of Marburg disease have been reported in Sudan, Kenya, Angola, Uganda, South Africa and the Democratic Republic of the Congo. The current case is the first in West Africa.

The mortality rate from it ranged from 24 to 88 percent. The virus infects the digestive organs and the central nervous system, treatment is difficult. The first symptoms are high fever, severe headache, and weakness.

Bats are considered the main vectors of this rather rare infection.Infection often occurs after visiting caves or abandoned mines, where there are colonies of these animals.

From person to person, the Marburg virus is transmitted by airborne droplets, through body secretions and physical contact with the patient or surfaces to which he touched.

It is not yet known whether “patient zero” managed to infect someone else. The risk is exacerbated by the fact that a large bazaar is held in Gukeda every Sunday.

WHO on Monday rated the hazard as high for West Africa and low for the rest of the world.

The disturbing news came just two months after the organization announced the end of another outbreak of Ebola in Guinea, which has claimed 12 lives since February this year.

“The potential for spreading of the Marburg virus requires stopping it at the outset,” said Machidiso Moeti, WHO Regional Director for Africa.

“We welcome the high level of readiness and responsiveness of the Guinean medics. We are working with them based on their experience in dealing with Ebola, which is spreading in a similar way,” he added.

Ten WHO epidemiologists are already in Guinea. Three family members of the deceased and his doctor are under constant supervision. Searching for his other contacts.

A vaccine against Marburg disease has not yet been developed.

On vacation in Thailand, there is a risk of catching a deadly fever – Rossiyskaya Gazeta

There are no vaccines for dengue fever, so no one will give an injection from it.

Going on November holidays to the countries of Southeast Asia, just stock up on repellents and take with you as many closed clothes as possible.Although in Thailand there will be about 40 degrees of heat, but health is more important.

What is dengue fever

It is an acute and dangerous viral infection that can be obtained after being bitten by mosquitoes of the Aedes aegypti family. The incubation period after infection is up to 14 days.

Symptoms include fever, nausea, rash, headache and back pain. Hemorrhagic fever is the most dangerous – it is accompanied by severe internal bleeding caused by collapse of blood vessels.

Mosquitoes, the vectors of the virus, most often breed and live in earthen vessels, metal barrels and concrete tanks used by people in tropical countries to store household water supplies.

Where is fever most common

After World War II, dengue became a global problem. Now it is found in 128 countries, including Southeast Asia, Oceania, the Western Pacific, Africa, America, including the Caribbean.The WHO estimates that about 2.5 billion people are at risk of contracting dengue fever.

Since the beginning of 2019, more than 2.6 million cases of this fever have been reported in 46 countries of the Americas, of which more than 1.1 million have been fatal. The most unfavorable situation is in Brazil (over 2 million cases of virus infection), as well as in Mexico, Nicaragua, Colombia and Honduras.

From the regions of South and Southeast Asia, residents of the Philippines are most often affected by fever.Since July 2019, the Philippine Ministry of Health has even announced an emergency due to the spread of the disease.

In Sri Lanka, where Russian tourists like to go on vacation, you need to be especially careful with mosquitoes in areas such as Colombo, Gampaha and Galle. Thailand, a favorite vacation spot for Russians, has had over 100,000 cases of fever since the beginning of the year. Over 100 cases have died.

If there is no vaccine, then what to do

As Rospotrebnadzor warns, while on vacation in countries with a tropical climate, it is necessary to use window mosquito nets, bedspreads, long-sleeved clothing, insecticide-treated materials, and repellents.And upon returning home, visit a therapist and, if necessary, take tests for the presence of infections.

Especially you need to be on the lookout if the temperature rises sharply after a vacation. Fever is mainly treated with antibiotics, and you need to drink plenty of fluids.

In the most severe forms, blood transfusions may be required when a person is bitten by a mosquito carrying several serotypes of the virus.

90,000 Russians are threatened by dangerous mosquitoes, carriers of deadly fevers

Russians are threatened by deadly viruses carried by mosquitoes from the tropics that have populated the Black Sea coast. One injured tourist is enough for an epidemic, scientists warn.

The deadly viruses of Chikungunya, Zika and dengue, carried by mosquitoes of the species Aedes aegypti and Aedes albopictus, may threaten the inhabitants of Russia, according to Izvestia citing Moscow State Medical University, Institute of General Genetics and Moscow State University.

As scientists have established, populations of mosquitoes carrying dangerous tropical fevers have spread to the Black Sea coast of the Krasnodar Territory.As Aleksandr Lukashev, a leading researcher at the Laboratory of Molecular Biology and Biochemistry at the Martsinovsky Institute, explains, the species found came to Russia from Egypt and Southeast Asia due to global warming.

“It is a worldwide problem when vectors of tropical diseases, which in principle should not appear in the north, migrate to areas with suitable temperature conditions,

– he says. – A similar picture is observed in Europe. Scientists predict that by 2050, these mosquitoes will spread even in Sweden.Here they multiplied in the south, and now they are moving to Central Russia.

The main vectors of tropical diseases are mosquitoes of two species: Aedes aegypti and Aedes albopictus. They are distinguished by their characteristic white stripes on the legs. Insects that have become widespread in the Crimea and along the entire Black Sea coast of the Krasnodar Territory periodically cause epidemic outbreaks of Dengue, Chikungunya, Zika, etc. The species Aedes aegypti is also the main carrier of the yellow fever virus.

Dengue fever occurs with severe pain in muscles and joints, fever, intoxication, swollen lymph nodes, insomnia, anorexia. In some of its variants, hemorrhagic syndrome develops. The condition lasts 2-7 days. Fever can become severe hemorrhagic, in which bleeding begins and platelet counts drop, and dengue shock syndrome can develop, in which pressure drops to life-threatening levels.

There is no treatment for fever – you can only improve the patient’s condition with the help of pain relievers and antihistamines, vitamins, coagulants, in especially severe cases – glucocorticoids.It is categorically impossible to use aspirin, ibuprofen, diclofenac – they increase bleeding.

With the disease of the classic form of dengue fever, the prognosis is favorable, and with the hemorrhagic form, the mortality rate is about 50%.

Complications are also possible, from pneumonia to encephalitis.

Chikugunya proceeds in a similar way. Pain after it can drag on for months or even years. For older people, the disease can be fatal. There is no vaccine against the causative agent of Chikugunya; all treatment is reduced to relieving pain.

In the last five years alone, outbreaks of chikugunya have been reported in the United States, Colombia, Italy, Brazil.

The course of yellow fever varies in severity from mild fever to severe hepatitis with hemorrhagic fever. Typical symptoms are high fever, chills, headache, muscle pain, nausea, and vomiting. Due to liver damage, the patient’s skin turns yellow. The face turns red, edema appears. After a short relief, shock, hemorrhagic syndrome with the development of acute renal failure may occur, and acute liver failure develops.With lightning-fast development of the disease, the patient dies in 3-4 days.

The lethality of the disease is 5-20%, and during epidemic outbreaks – up to 50-60%.

“If a mosquito carrying any of these fevers bites only one tourist, this will be enough for an epidemic to sweep the entire region,” says Lukashev.

Also, both types of mosquitoes are capable of carrying the larvae of filamentous worms of the genus Dirofilaria, which cause serious damage to internal organs in humans and animals.

In the first half of the twentieth century, mosquitoes were already fought on the Black Sea coast, albeit malaria. The bogs were drained, plants protecting from mosquitoes (mainly eucalyptus trees) appeared, the mosquito fish ate the larvae.

Researchers note that it is almost impossible to prevent the spread of dangerous insects at the state level – mosquitoes move to the north due to natural reasons. However, local residents themselves are able to stop the growth of the population of deadly mosquitoes.Scientists recommend reducing areas that are especially suitable for breeding mosquitoes – loose debris and containers in which water accumulates, such as tires and tanks.

90,000 Ebola: Deadly Virus on the African Continent – Society

The Ebola virus belongs to the filovirus family. During the existence of the infection, five subtypes have been identified – Sudanese, Zairian, Ivory Coast, Reston, Bundibugio. In the photo: Doctors of the DR Congo Red Cross working with victims of Ebola in the city of Kikwit, 1995

© AP Photo / Jean-Marc Bouju

There is still no specific treatment for Ebola hemorrhagic fever or a vaccine against it.None of the major pharmaceutical companies have invested in the development of an Ebola vaccine. In the photo: residents of the city of Kikwit near a pharmacy, DR Congo, 1995

© AP Photo / Jean-Marc Bouju

Up to 90% of cases are fatal. In the photo: Doctors of the DR Congo Red Cross transport the bodies of those killed from Ebola in the city of Kikwit, 1995

© AP Photo / David Guttenfelder

Ebola disease is a severe acute viral infection, accompanied by hemorrhagic fever, weakness, muscle pain, sore throat, vomiting , diarrhea and bleeding.In the photo: an infected patient in a hospital in the city of Kikwit, DR Congo, 1995

© AP Photo / Jean-Marc Bouju

The incubation period varies from 2 to 21 days. The final diagnosis of Ebola virus infection is made only in laboratory conditions. In the photo: patients in a hospital in the city of Gulu, Uganda, 2000

© AP Photo / Sayyid Azim

The virus is transmitted from person to person through close contact, through lesions on the skin or mucous membrane, with blood, secretions or other body fluids infected of people.In the photo: the work of doctors with the consequences of the Ebola virus in Gabon, 2001

© AP Photo / Christine Nesbitt

Cases of human infection as a result of handling infected chimpanzees, gorillas, bats have also been confirmed. In the photo: a Red Cross doctor tells villagers in Uganda about how the fever spreads, 2000

© AP Photo / Sayyid Azim

Over the past 20 years, the deadliest outbreaks have occurred in 1995, 2000 and 2003. A new outbreak of fever was recorded in February this year in western Africa.In the photo: a resident of the capital of Liberia Monrovia reads the headlines about a new outbreak of the epidemic

© EPA / AHMED JALLANZO

Announcement of the first case of Ebola in 2014 in Liberia in January

© AP Photo / Jonathan Paye-Layleh

In July 2014 World Organization Healthcare announced the launch of a massive $ 100 million program to combat the Ebola outbreak. In the photo: doctors-virologists examine bats while studying the Ebola virus

© AP Photo / Peirre Rollin, CDC Atlanta

Image of the Ebola virus obtained using transmission electron microscopy

© ITAR-TASS / EPA / CYNTHIA GOLDSMITH

According to WHO, Since 1976, 1,648 people have died from Ebola haemorrhagic fever in Africa.In the photo: doctors with a patient infected with the Ebola virus, in a hospital in Liberia, 2014

© AP Photo / Samaritan’s Purse

West African countries where Ebola is rampant – Sierra Leone, Liberia, Guinea – isolate the centers of the outbreak. Photo: street in the capital of Liberia Monrovia

© EPA / AHMED JALLANZ

An outbreak of hemorrhagic fever in 2014 in the west of the African continent threatens to be the longest and deadliest in African history. In the photo: campaign to prevent infection with Ebola in Guinea-Bissau

© EPA / TIAGO PETINGA

Since the beginning of 2014, more than 800 people have died from Ebola in western Africa, almost 1,500 have contracted the virus

© AP Photo / Abbas Dulleh

Deadly fever in Volgograd region – Newspaper Kommersant No. 110 (1995) from 21.06.2000

& nbsp Deadly fever in the Volgograd region
In the south of the Volgograd region, an outbreak of the Crimean-Congo hemorrhagic fever was registered – the same one that killed twelve people from the village of Oblivskaya Rostov region last summer. In the Volgograd region, only one person has died so far.

The hotbed of the spread of the viral infection was the Kotelnikovsky district, located along the border with the Rostov region.The forty thousand population of this area is now in panic. Many parents send their children to relatives, in Volgograd and other parts of the region, away from the damned place. Some adults flee the area with their children.
Buses from the Kotelnikovsky district to Volgograd are overcrowded. Those who have no money for a ticket leave on foot. The authorities of the district, which consists of 36 farms and the city of Kotelnikov, in the first days of the outbreak, found themselves alone with the disease, are trying to maintain order in the territory, calling on citizens to discipline and calmness.Calls help badly, people run anyway. Calm reigns only in the military town and at the training airfield of the Armavir Military Pilot School, located on the outskirts of the city.
According to official data, as of June 20, seven people have already been hospitalized with suspected hemorrhagic fever. The first of the sick, a 63-year-old resident of the city of Kotelnikov, died on June 9. Taught by the bitter experience of last year’s outbreak in the neighboring Rostov region, the Kotelnikov doctors did not hesitate to diagnose hemorrhagic fever.
An emergency headquarters for the fight against fever was set up in the district administration. However, the leadership of the Volgograd region reacted more than calmly to the message about the appearance of a terrible disease. For five whole days, sanitary doctors, epidemiologists or doctors from the regional center did not appear in the Kotelnikovsky district. While working with patients due to the lack of special protective equipment, a nurse contracted hemorrhagic fever.
First aid from the regional center arrived only on June 15.Scientists from the Volgograd Medical Academy, headed by Professor Vladimir Petrov, one of the largest Russian infectious disease specialists, who over the years of his work took part in the elimination of all outbreaks of hemorrhagic fevers in the CIS, arrived in the Kotelnikovsky district.
Scientists confirmed the conclusion of local physicians, and only after that help began to arrive in the region with specialists, equipment, equipment, and drugs. By order of the chief sanitary doctor of the Volgograd region, Alexander Zhukov, the Kotelnikovsky district was declared an infection zone.There is no ban on movement within the zone, entry and exit from it.
To blame for the epidemic are murine rodents, the natural reservoir of the arbovirus, which causes fever. A terrible drought forced them, in search of water, to come closer to a man’s dwelling. Ticks carry the virus from rodents to humans. The largest reservoir in the region is the Volgograd reservoir. The deceased pensioner fished there three days before his death and was bitten by a tick. After last year’s epidemic in the Rostov region, epidemiologists have established that this type of hemorrhagic fever is transmitted both by drip (like a runny nose or flu) and by getting the patient’s blood onto the mucous membrane of a healthy person.So the epidemic can become widespread.
To avoid this, a large-scale medical check is carried out in Kotelnikovsky and adjacent areas. For example, in those farms where residents are hospitalized with a diagnosis of hemorrhagic fever, paramedics measure the temperature of the entire population on a daily basis.
Crimean-Congo fever has a mortality rate of up to 50%. Our medicine recognizes that it cannot cure this disease. But in Kotelnikovo they hope not only for medicine.Last year, the icon of the Mother of God from the church in the village of Oblivskaya received wide recognition. Relatives of the dying villagers prayed all night long, kneeling before the icon. Residents of the village believe that their prayers were heard and only thanks to the intercession of the Mother of God, only 12 people died, and not hundreds. And when trouble struck in Kotelnikovo, the local residents remembered the icon and turned to the villagers of Oblivskaya with a request to transfer their icon to the temple of the city of Kotelnikovo for a while. But the believers of Oblivskaya did not give the icon away, fearing that it might be useful to them again.

MIKHAIL Kommersant-SERENKO, Volgograd 90,000 Invasions of mosquitoes carrying a fatal disease await in the Kuban

Photo: pixabay.com

Invasions of mosquitoes carrying a deadly disease await in the Kuban

In autumn, including in the Krasnodar Territory, mosquitoes that carry West Nile fever may breed.This was reported on September 6 at the All-Russian Research Institute for Civil Defense and Emergencies of the Russian Emergencies Ministry.

Background

Events prior to this news

Acting head of the research institute Vladimir Moshkov said that in the south of the European part of Russia in September and October there may be a significant increase in the population of mosquitoes carrying West Nile fever.

Insect breeding is facilitated by warm and damp weather in several regions of the south of the country. Moshkov recalled that an infectious disease can be accompanied by damage to the human nervous system.

With a severe course of the disease, Moshkov added, there is a risk of death. The mortality rate is up to 14%. In 2010, he recalled the acting. director of the research institute, in the Volgograd region there was an outbreak of morbidity. 413 people were infected with fever.

In regions prone to the spread of West Nile fever, Moshkov explained, it is necessary to carry out prevention to preserve the health of the population.What exactly needs to be done, he did not specify.

UTYUG reported that the so-called tiger mosquitoes bred in Anapa. Because of this, there was a shortage of insect sprays in stores. A significant increase in the number of mosquitoes is also observed in Yeisk. The improvement of the situation can only be expected by winter, suggested Vladimir Gladun, associate professor of the Department of Zoology of the Kuban State University.