What is considered a high grade fever in adults. How to accurately measure body temperature. When should you worry about a fever. What are the common causes of high fever in adults. How does fever help fight infections. Can fully vaccinated individuals get breakthrough COVID-19 with fever. When to seek immediate medical attention for a fever.

Understanding Fever: Definition and Purpose

Fever is a common physiological response that plays a crucial role in our body’s defense mechanisms. But what exactly constitutes a fever, and why does our body initiate this process?

A fever is defined as an elevated body temperature of 100.4°F (38°C) or higher. It’s our body’s natural way of combating infections by raising the internal temperature to create an environment less favorable for pathogens. This elevation in temperature can enhance immune function and inhibit the growth of certain microorganisms.

Is fever always a cause for concern? Not necessarily. In most cases, fever is actually considered beneficial, as it indicates that your immune system is actively fighting an infection. However, the severity and duration of the fever, along with accompanying symptoms, can help determine when medical attention might be necessary.

High Grade Fever in Adults: What You Need to Know

When it comes to fevers in adults, it’s important to understand what constitutes a high grade fever and when it might be a cause for concern.

What is considered a high grade fever in adults? A high grade fever in adults is typically defined as a temperature of 103°F (39.4°C) or higher. While lower-grade fevers can often be managed at home, high grade fevers may require medical attention, especially if they persist or are accompanied by other concerning symptoms.

Can adults develop a fever without other symptoms? Yes, it’s entirely possible for adults to experience a fever without any other noticeable symptoms. In such cases, the underlying cause may be a viral infection that the body is fighting off silently. Common culprits include:

• COVID-19
• Common cold or flu
• Bronchitis
• Gastroenteritis (stomach bug)

It’s worth noting that in many cases, especially with viral infections, the exact cause of the fever may remain unidentified, and the condition often resolves on its own within a few days.

Measuring Body Temperature: Debunking the 98.6°F Myth

For years, 98.6°F (37°C) has been considered the “normal” body temperature. However, recent research suggests that this long-held belief may not be entirely accurate.

Is 98.6°F still considered the average body temperature? Not exactly. Modern studies indicate that there’s a wider range of normal body temperatures, typically between 97°F to 99°F (36.1°C to 37.2°C). This shift in understanding has led to a reevaluation of what constitutes a fever.

Why has the concept of “normal” body temperature changed? Several factors contribute to this shift:

1. Improved accuracy of modern thermometers
2. Lower metabolic rates in the general population
3. Reduced rates of chronic infections

How can you accurately measure your body temperature? Oral temperature measurement remains the most reliable method for adults. To ensure accuracy:

• Wait at least 30 minutes after eating or drinking hot/cold beverages
• Keep the thermometer under your tongue for the recommended time
• Avoid physical activity before taking your temperature

Fever in Vaccinated Individuals: Understanding Breakthrough Cases

With the widespread administration of COVID-19 vaccines, questions have arisen about the possibility of fever in vaccinated individuals.

Can fully vaccinated people experience fever due to COVID-19? While rare, breakthrough cases of COVID-19 can occur in fully vaccinated individuals, potentially causing fever. However, it’s important to note that symptoms in these cases tend to be milder compared to those in unvaccinated individuals.

Does a high fever in a vaccinated person automatically indicate COVID-19? Not necessarily. While COVID-19 should be considered, especially in areas with high transmission rates, other causes of fever should also be explored. It’s always best to consult with a healthcare provider for proper diagnosis and guidance.

When to Seek Medical Attention for a Fever

While most fevers are not cause for immediate concern, certain circumstances warrant medical attention. Here are some situations where you should consider seeking medical help:

High or Persistent Fever

If your temperature remains high (103°F or above) and doesn’t respond to over-the-counter fever reducers like acetaminophen or ibuprofen, it’s time to consult a doctor. Similarly, if the fever persists for several days or keeps recurring, medical evaluation is recommended.

Underlying Health Conditions

Individuals with certain health conditions should be more cautious about fevers. Seek medical attention if you have a fever and any of the following conditions:

• Diabetes
• Heart disease
• Cancer
• Lupus
• Sickle cell anemia

Special Circumstances

Certain situations require extra caution when dealing with a fever:

• Pregnancy
• Recent overseas travel
• Frequent infections
• Ongoing chemotherapy (seek immediate attention if fever lasts more than an hour)
• Recent tick bites

Common Causes of Fever in Adults

Fevers can be triggered by various factors, ranging from infections to non-infectious causes. Understanding these potential triggers can help in identifying the underlying issue and determining the appropriate course of action.

Infectious Causes

Infections are the most common cause of fevers in adults. These can include:

• Viral infections (e.g., influenza, COVID-19, common cold)
• Bacterial infections (e.g., strep throat, urinary tract infections)
• Fungal infections
• Parasitic infections

Non-Infectious Causes

While less common, non-infectious conditions can also lead to fevers:

• Autoimmune disorders (e.g., rheumatoid arthritis, lupus)
• Certain medications
• Heat exhaustion or heat stroke
• Some cancers, particularly blood cancers
• Thyroid storm (a rare but serious condition related to hyperthyroidism)

It’s important to note that in some cases, especially with brief, low-grade fevers, the exact cause may remain unidentified. These fevers often resolve on their own without specific treatment.

Managing Fever at Home: Do’s and Don’ts

While high-grade or persistent fevers may require medical attention, many low-grade fevers can be managed effectively at home. Here are some guidelines for managing fever:

Do’s:

• Stay hydrated by drinking plenty of fluids
• Rest and avoid overexertion
• Use over-the-counter fever reducers like acetaminophen or ibuprofen as directed
• Dress in light, breathable clothing
• Keep the room temperature comfortable, not too hot or cold

Don’ts:

• Don’t bundle up excessively, as this can trap heat and raise body temperature further
• Avoid alcohol and caffeine, which can contribute to dehydration
• Don’t use ice baths or alcohol rubs, as these can be counterproductive and potentially harmful
• Don’t ignore persistent or high-grade fevers, especially if accompanied by other concerning symptoms

Remember, while these measures can help manage fever symptoms, they don’t address the underlying cause. If your fever persists or worsens despite home care, it’s important to seek medical advice.

The Role of Fever in Immune Response

Understanding the purpose of fever can help alleviate some of the anxiety associated with this common symptom. Fever plays a crucial role in our body’s defense mechanisms against pathogens.

How does fever help fight infections? Fever contributes to the immune response in several ways:

1. Enhancing immune cell function: Higher temperatures can increase the activity and efficiency of white blood cells.
2. Inhibiting pathogen growth: Many harmful microorganisms struggle to survive at higher temperatures.
3. Boosting metabolic rate: Increased metabolism can accelerate the body’s healing processes.
4. Triggering the release of protective proteins: Fever stimulates the production of heat-shock proteins, which can protect cells from damage.

Does this mean we should always let a fever run its course? Not necessarily. While fever serves a purpose, excessively high or prolonged fevers can be harmful. It’s about striking a balance between allowing the immune system to do its job and preventing potential complications from high temperatures.

The Concept of “Fever Phobia”

The term “fever phobia” refers to the exaggerated fear of fever, often leading to unnecessary anxiety and overtreatment. While caution is warranted with high-grade fevers, it’s important to remember that most fevers are beneficial and self-limiting.

How can we overcome fever phobia? Education is key. Understanding that fever is typically a sign of a functioning immune system can help alleviate unnecessary worry. Focus on the overall condition of the person rather than fixating solely on the temperature number.

Remember, “Don’t fear the fever” is a common saying among healthcare professionals. It emphasizes that fever itself is usually not the enemy, but rather a sign that your body is actively fighting an infection.

Special Considerations for Fever in Older Adults

Fever in older adults, typically those over 65, can present unique challenges and may require different approaches to assessment and management.

Why is fever in older adults a special concern? Older adults may not mount the same fever response as younger individuals. Their baseline temperature may be lower, and they might not develop a high fever even with serious infections. This phenomenon is known as a “blunted fever response.”

What temperature is considered a fever in older adults? Given the potential for a blunted response, healthcare providers often consider a temperature of 99°F (37.2°C) or higher as a fever in older adults, especially if accompanied by other symptoms or changes in behavior.

Key Points to Remember:

• Older adults may not exhibit classic fever symptoms
• Changes in mental status, confusion, or lethargy can be signs of infection in the elderly, even without a significant temperature elevation
• Chronic health conditions can complicate the assessment and management of fever in older adults
• Prompt medical evaluation is often warranted for fevers in this age group, given the higher risk of complications

When caring for older adults with potential fever, it’s crucial to monitor for subtle changes in behavior or overall health status, not just temperature alone.

The Impact of Environment and Lifestyle on Body Temperature

While infections are a common cause of fever, it’s important to recognize that various environmental and lifestyle factors can also influence body temperature.

Environmental Factors:

• Ambient temperature: Prolonged exposure to hot environments can raise body temperature
• Humidity: High humidity can interfere with the body’s natural cooling mechanisms
• Altitude: Higher altitudes can affect body temperature regulation

Lifestyle Factors:

• Physical activity: Intense exercise can temporarily elevate body temperature
• Clothing: Wearing heavy or non-breathable clothing can trap heat
• Diet: Spicy foods or hot beverages can cause a temporary increase in body temperature
• Stress: Emotional stress can lead to a slight elevation in body temperature

How can you differentiate between environmentally induced temperature elevation and true fever? True fevers are typically accompanied by other symptoms of illness and persist even when environmental factors are addressed. If you’re unsure, it’s always best to consult with a healthcare provider.

Fever and Its Relationship to Other Symptoms

While fever can occur in isolation, it’s often accompanied by other symptoms that can provide clues about the underlying cause.

Common Symptoms Associated with Fever:

• Chills and shivering
• Sweating
• Headache
• Muscle aches
• Loss of appetite
• Dehydration
• Fatigue

How do these associated symptoms help in diagnosis? The constellation of symptoms accompanying a fever can often point towards specific conditions. For example:

• Fever with a sore throat and swollen lymph nodes might suggest strep throat
• Fever accompanied by cough and shortness of breath could indicate a respiratory infection
• Fever with abdominal pain and diarrhea might point to a gastrointestinal infection

It’s important to note that the absence of additional symptoms doesn’t necessarily mean the fever is less serious. Always consider the overall context, including the fever’s duration and severity, when deciding whether to seek medical attention.

The Future of Fever Management: Emerging Technologies and Approaches

As medical science advances, new technologies and approaches are emerging that could revolutionize how we monitor and manage fevers.

Continuous Temperature Monitoring

Wearable devices that continuously monitor body temperature are becoming increasingly sophisticated. These devices can provide real-time data and alerts, potentially allowing for earlier detection of fever and more timely interventions.

AI-Assisted Diagnosis

Artificial intelligence algorithms are being developed to analyze patterns in temperature data along with other symptoms. This could help in predicting the likelihood of specific infections or conditions based on fever characteristics.

Targeted Fever Management

Research is ongoing into more targeted approaches to fever management. This includes exploring the potential benefits of allowing certain fevers to run their course while more aggressively treating others based on the underlying cause and individual patient factors.

Personalized Medicine

As our understanding of individual genetic and physiological variations grows, we may see more personalized approaches to fever management. This could involve tailoring temperature thresholds and treatment strategies based on an individual’s unique characteristics.

While these advancements hold promise, it’s important to remember that they are still evolving. Current best practices, including seeking medical advice for high or persistent fevers, remain crucial for ensuring proper care and treatment.

As we continue to deepen our understanding of fever and its role in health and disease, we can expect to see more nuanced and effective approaches to managing this common but complex symptom. Always stay informed about the latest guidelines and consult with healthcare professionals for personalized advice on fever management.

Fever & Temperature In Adults: When To Worry

Karen Justiniano, DO, MS, Stamford Health Medical Group

Looking for a Primary Care Physician (PCP)?

Let us help you find the right doctor for your needs.

Explore Your Options

A friend of mine whose father is 70 years old told me her story. It went something like this:

“My father never gets fevers. Out of nowhere the other day, he developed a 103 temperature with no other symptoms. He is also fully vaccinated against COVID-19. My mother brought him to the emergency room. Did she do the right thing, or would he likely have been fine if he stayed home and let the fever run its course?”

As a physician who cares for a variety of people with a variety of conditions, I have to say of course she did the right thing! When in doubt or when concerned, seeking medical attention is the smart thing to do.

But the longer answer is a little more complicated than that. It all starts with breaking down the purpose of a fever, and when you should truly worry. Please note—fevers in infants or young children are sometimes a different story—what you are about to read relates to adults only.

What is a fever and why do we get them, and sometimes with no other symptoms?

Fever is an elevated body temperature which means your temperature is 100.4 degree F or higher. A fever is the body’s way of fighting an infection by naturally raising your body’s temperature to “kill the germ.” The medical community likes to say that fever is a “good thing,” in most cases.

And yes, it’s completely possible for adults to develop a fever with no other symptoms, and for doctors to never truly find the cause. Viral Infections can commonly cause fevers, and such infections include COVID-19, cold or the flu, airway infection like bronchitis, or the classic stomach bug.

That’s why you often hear the word “viral” as an explanation because these types of infections often go away on their own after a few days.

What is considered a high fever in adults?

A high-grade fever in adults is 103 degrees F or higher.

Is it possible that a fever could be a sign of a “breakthrough case” of COVID-19 even if the person is fully vaccinated?

Yes, but not highly likely. Breakthrough cases of COVID-19 in fully vaccinated people have been reported, but symptoms tend to be milder than in non-vaccinated people, including fever.

First, make sure you are taking your temperature the right way. Taking your temperature by mouth is the most accurate method, and wait at least 30 minutes after you eat or drink anything hot or cold. Get medical attention for your fever if:

• Your temperature is high and has not gone down after taking Tylenol or Advil
• Your temperature lasts several days or keeps coming back
• You live in an area where people have COVID-19
• You have serious health conditions like diabetes, heart disease, cancer, lupus, or sickle cell anemia. (Non-infections like these can cause fever as well.)

You should also seek medial attention if you have a fever and you:

• Are pregnant
• Recently returned from travel overseas
• Get infections often
• Are on chemotherapy, in which case you should seek medical attention immediately if the fever lasts for more than one hour.
• Have recently been bitten by a tick

Is 98.6 still considered “normal” body temperature?

Yes and no. You’ve probably always heard that the average body temperature is 98.6, but the truth is there’s a much wider range—from about 97 to 99 degrees F.

So why is 98.6 suddenly a myth after all these centuries? Research suggests body temperatures are falling overall. Doctors have a few ideas about why this is, including lower metabolic rates, lower rates of infection and more advanced thermometers.

A couple of helpful reminders:

1. As the saying goes, “Don’t fear the fever.” A fever is your body’s first line of defense in fighting off an infection.
2. If you are not fully vaccinated against COVID-19, and have developed a high-grade fever, please call your doctor right away.

Characteristics, Types, and When It’s Serious

A fever is a common side effect of illness like the flu. It happens when there is a temporary rise in body temperature. A fever is usually a sign that your immune system is busy fighting an infection or other illness.

In babies and toddlers even a slight fever may be a sign of a serious illness. In adults a fever is not usually serious or life-threatening.

However, sometimes a fever in adults can be a warning signal that something is not right. A high or persistent fever might be a sign of a serious health condition.

A fever is normally a short-term rise in temperature that helps your body get rid of illness. A fever begins when your immune system makes more white blood cells to fight an infection. The increase in white blood cells triggers your brain to heat your body up.

This causes a fever. In response, your body tries to cool itself off by tightening up on blood flow to your skin and contracting muscles. This makes you shiver and may cause muscle aches.

Your normal body temperature ranges from 97°F to 99°F (36.1°C to 37.2°C). You may have a fever if your temperature rises above this.

Adults typically have a fever if their body temperature increases to 100.4°F (38°C). This is called a low grade fever. A high grade fever happens when your body temperature is 103°F (39.4°C) or above.

Most fevers usually go away by themselves after 1 to 3 days. A persistent or recurrent fever may last or keep coming back for up to 14 days.

A fever that lasts longer than normal may be serious even if it is only a slight fever. This is because a recurrent fever might be a sign of a more serious infection or health condition.

Common fever symptoms in adults include:

• sweating
• chills (shivering)
• headaches
• muscle pain
• loss of appetite
• fatigue
• weakness

Call your doctor immediately if you have a high grade fever — when your temperature is 103°F (39.4°C) or higher. Get medical help if you have any kind of fever for more than three days. Let your doctor know if your symptoms get worse or if you have any new symptoms.

Serious symptoms

A fever may be a sign of serious illness if you have:

• a severe headache
• dizziness
• sensitivity to bright light
• stiff neck or neck pain
• skin rash
• difficulty breathing
• frequent vomiting
• dehydration
• stomach pain
• muscle cramps
• confusion
• seizures

Other signs that a fever may be serious are:

• pain when urinating
• not urinating enough
• passing dark urine
• passing urine that smells bad

If you have serious fever symptoms, let your doctor know if you have recently traveled to a different country or attended an event that had lot of people. This may help your doctor find out the cause.

Common causes of a fever in adults are:

• viral infection (like the flu or a cold)
• bacterial infection
• fungal infection
• food poisoning
• heat exhaustion
• serious sunburn
• inflammation (from conditions like rheumatoid arthritis)
• a tumor
• blood clots

Some adults may have a higher risk of getting a fever. If you have a chronic health condition or have been treated for a severe illness, you may be more likely to get a serious fever.

Let your doctor know about any fever symptoms if you have:

• asthma
• rheumatoid arthritis
• diabetes
• Crohn’s disease
• heart disease
• sickle cell disease
• liver disease
• kidney disease
• chronic lung disease
• cystic fibrosis
• cerebral palsy
• stroke
• multiple sclerosis
• muscular dystrophy
• HIV or AIDS

Some medications and treatments can also lead to a serious fever, these include:

• antibiotics
• blood pressure drugs
• seizure medications
• DTaP vaccine
• pneumococcal vaccine
• steroids
• chemotherapy
• radiation treatment
• methotrexate
• azathioprine
• cyclophosphamide
• post-transplant medications

A fever is not normally harmful on its own. Most fevers go away within a few hours to days as your body defeats an infection.

Help yourself feel better with these at-home flu remedies:

• stay hydrated by drinking plenty of fluids, such as:
  • water
  • juice
  • soup
  • broth
• eat light foods that are easy on the stomach
• rest
• use a cool compress, like a damp towel
• take a warm sponge bath
• dress in light, comfortable clothing
• turn down the temperature in your room

Over-the-counter medications can help ease your fever and symptoms, like headaches and muscle pain:

• ibuprofen (Advil, Motrin)
• acetaminophen (Tylenol)
• naproxen (Aleve, Naprosyn)

You may need treatment from your doctor for more serious causes of a fever. The treatment depends on the cause. Your doctor may prescribe medications to treat serious infections:

• antibiotics
• antivirals
• antifungals

A fever may be a sign of serious illness. A high fever can also cause serious side effects.

Emergency Symptoms

Get emergency medical attention by going to the ER or calling an ambulance if you have any of these symptoms:

• seizure or convulsions
• fainting or loss of consciousness
• confusion
• hallucinations
• severe headache pain
• stiff or painful neck
• difficulty breathing
• hives or a rash
• swelling in any part of the body

A fever in adults is usually not harmful on its own. It is a sign that your body is dealing with an infection or other illness. In some cases a high or long-lasting fever can be a sign of a serious illness. You may need urgent medical treatment.

Do not ignore a fever. Get plenty of rest and fluids to help your body heal. See your doctor if you have a fever that lasts longer than 3 days or if you have other severe symptoms.

If you have a chronic condition or have been treated for a serious illness, let your doctor know if you have any kind of fever.

Temperature for oncology, what is the temperature for cancer in an adult in the early stages?

Is there a fever in cancer? Yes, an increase in body temperature in oncological diseases is a common phenomenon, and its causes are different. The temperature in cancer does not belong to the typical signs of a malignant process, only in rare cases, cancer cells are able to independently initiate a temperature reaction by releasing, as expected, active substances. One cannot but agree that an oncological patient has more reasons for an increase in body temperature, both internal and iatrogenic – arising as a result of therapeutic measures.

Causes of fever

There are several reasons for fever in a cancer patient, but most often the temperature in oncology is a consequence of some processes:

• Vital activity of tumor cells producing biological products. This leads to systemic hyperthermia, which occurs in some types of lung adenocarcinoma, when a paraneoplastic syndrome develops with debilitating fever and joint pain. After removal of the tumor, all pathological manifestations disappear.
• Existence of a cancer conglomerate in tissues. Due to a decrease in local immunity and impaired blood supply, inflammatory changes develop, for example, with lung carcinoma or lung metastases.
• Reactions of the body to the absorption of toxic substances from a decaying cancer node.
• Aggressive therapeutic measures. As a rule, these are complications of immune suppression after a course of chemotherapy. From this list, we can conclude that fever is most common in metastases, when malignant cells have spread throughout the body and the disease requires more aggressive treatment.

In all cases, it is necessary to quickly understand, without an accurate understanding of the pathogenetic mechanism of the temperature reaction, it is impossible to prescribe adequate treatment. Sometimes the identification of causal relationships requires more effort than the diagnosis of a malignant tumor.

Temperature indicators in cancer

Does the temperature always rise in oncology? A fever in an oncological patient, as well as a decrease in the thermometer below 35.5 ° C, is an abnormal condition, the body temperature in cancer should be normal, and this should be strived for when choosing a treatment.

Daily fluctuations in heat transfer are natural in healthy people, the difference between morning and evening thermometer readings can reach up to one degree. Active movements and eating, nervousness and a nightmare also change degrees, but this is imperceptible to a person.

Failure of adaptive mechanisms in a cancer patient slows down the normalization of temperature fluctuations, stretching in time. Even a slight change in heat transfer affects the work of all organs: the nervous system is depleted, the cardiovascular system reacts, immune mechanisms and reparative processes are inhibited.

The normal range is two degrees between 35.5° and 37. 4°, the rest is pathological.

Subfebrile temperature in cancer

Subfebrile body temperature in oncology is limited to 37.5°C to 38°C. This is a pre-febrile condition, but it is believed that short-term subfebrile condition does not require therapeutic intervention.

A prolonged increase – more than 5-7 days without a tendency to normalization will not be resolved without the complicity of a doctor, its cause may be inflammation and even sepsis, requiring the appointment of antibacterial drugs.

When a zone of reduced blood supply appears in the center of the cancer conglomerate with the formation of necrosis – the collapse of the tumor tissue can begin with local hyperthermia – local heating of the soft tissues above the focus, and with an increase in the volume of decay products absorbed into the general bloodstream, lead to persistent low-grade fever.

High fever in cancer

High temperature or febrile fever is detected when the thermometer is above 38°C. On the one hand, this indicates a protective reaction of the body, but the temperature after chemotherapy is usually an unfavorable consequence of a significant decrease in neutrophilic granulocytes, a subtype of leukocytes.

Fever with a decrease in immune cells in eight out of ten cases is due to a septic condition in the absence of “classic” signs of blood poisoning and requires emergency treatment.

Quite often, a prolonged fever slightly above 38°C manifests multiple liver lesions with cancer metastases with the development of liver failure.

A high temperature can manifest a malignant brain tumor located near the center of thermoregulation, or perforation into the abdominal cavity of a carcinoma of the colon or stomach.

Low temperature in cancer

Is there a temperature below normal in oncology? Yes, it happens, and it is also dangerous. A decrease in the thermometer below 36 ° C with an increase or decrease in the number of leukocytes, along with persistent tachycardia or shortness of breath, can also be a manifestation of systemic inflammation syndrome – sepsis. Moreover, low body temperature in oncology does not necessarily have to be accompanied by a pronounced decrease or increase in the number of leukocytes, less than 4 thousand or more than 12 thousand is enough, but functionally incapable of an adequate fight against infectious agents.

Temperature during chemotherapy

Chemotherapy requires a normal body temperature – a marker of the normal state of the body at a given time. Any deviations of thermoregulation from the norm can be a manifestation of sluggish inflammation or intoxication. Chemotherapy for a decaying cancer conglomerate can aggravate the pathological process and cause internal bleeding.

An increase in temperature during chemotherapy and the development of a feverish state a week after the course indicates hematological complications that are life-threatening in case of insufficient immunological protection.

Is it necessary to bring down the fever in oncology?

To begin with, let’s figure out what temperature is acceptable for oncology. Do not needlessly ask the question: “What temperature is not dangerous for cancer?” – in a malignant disease, any violations of heat transfer are unfavorable. In part, degrees above the norm are not even important, it is enough that there is a temperature in cancer when it should not be.

If the temperature rises due to oncology: what to do? You can reduce the temperature reaction by taking NSAIDs if it is hard for the patient’s body, but it is more correct to immediately consult a doctor. Primary differential diagnosis is carried out at the patient’s bed, the main thing is to exclude blood poisoning against the background of a malignant process.

The development of cancer without an increase in temperature is quite possible, but at different periods of the disease, its increase may be a complication of the treatment or progression of the tumor lesion. It is necessary to quickly figure out if the patient has a temperature with cancer, and most importantly, accurately diagnose and offer the best solution to the problem. Euroonco has all the conditions for adequate medical care for any patient and at any time of the day.

Appointment for a consultation around the clock

+7 (495) 668-82-28

References

1. Pathophysiology 4th ed. ed. Novitsky V.V., Goldberg E.D., Urazova O.I.; GOETAR-Media; 2009; v. 1.
2. Ptushkin VV/ Treatment and prevention of infections in patients with neutropenia// Mater. III Ross. oncol. conf.; 2003.
3. Sakaeva D.D., Orlova R.V., Rykov I.V., Shabaeva M.M. /Practical recommendations for the treatment of infectious complications of febrile neutropenia and the appointment of colony-stimulating factors in cancer patients // Malignant tumors: Practical recommendations RUSSCO; 2017; v. 7
4. T.S. / Violations of heat exchange. Fever: guidelines / Gomel: GoGMI, 2003.

Influenza Information – Belovskaya Ambulance Station

INFORMATION FOR EMERGENCY STAFF.

“Clinical management of patients infected with pandemic influenza virus (h2N1)”.

Influenza is an acute viral disease characterized by a short incubation period, severe general intoxication, catarrhal changes in the respiratory tract and a tendency to bacterial superinfections.

The 2009 pandemic (h2N1) influenza virus differs in its pathogenicity from seasonal influenza in two key respects: the infection affects a wider age range, especially children and young people, the virus can infect the lower respiratory tract and cause rapidly progressive pneumonia.

A wide clinical spectrum has been described ranging from non-febrile, mild upper respiratory illness, febrile influenza-like illness (ILI) to severe or even fatal complications, including rapidly progressive pneumonia. The most commonly reported symptoms include cough, fever, sore throat, muscle pain, malaise and headache. Some patients had gastrointestinal symptoms (nausea, vomiting and/or diarrhea).

Approximately 10-30% of hospitalized patients required treatment in intensive care units. Critically ill patients were defined as those with rapidly progressive lower respiratory disease, respiratory failure, and acute respiratory distress syndrome (ARDS) with persistent hypoxemia.

The risk groups include the following:

* Infants and young children, especially children under 3 years of age 9

* Persons of any age with chronic lung disease (for example: with asthma, COPD)

* ​ Persons of any age with chronic heart disease (eg, congestive heart failure)

* Persons 65 years of age and older

Uncomplicated influenza

• ​ILI symptoms include: high fever, cough, sore throat, rhinorrhea, headache, muscle pain and malaise, without shortness of breath or difficulty breathing. Patients may have some or all of these symptoms.
• Gastrointestinal disease may also be present, such as diarrhea and/or vomiting, especially in children, but without signs of dehydration.

Complicated or severe influenza

Clinical (eg, dyspnea/difficulty breathing, rapid breathing, hypoxia) and/or radiological evidence of lower respiratory disease (eg, pneumonia), central nervous system (CNS) damage (eg, encephalopathy, encephalitis), severe dehydration, or the presence of secondary complications such as renal failure, multiple organ failure, and septic shock. Other complications may include acute skeletal muscle necrosis and myocarditis.

Exacerbation of an existing chronic disease, including asthma, COPD, chronic liver or kidney failure, diabetes, or other cardiovascular disease.

Presence of any other disease or clinical manifestation requiring hospitalization for clinical treatment.

Presence of any of the signs of disease progression mentioned below.

Signs and symptoms of progressive disease

In patients who initially show symptoms of uncomplicated influenza, the disease may progress to a more severe form. Progression can be rapid (i.e., within 24 hours). The following are some of the indicators of progressive disease that will require an urgent review of patient management:

• Signs and symptoms that may indicate poor oxygen supply or cardiopulmonary failure:

– Shortness of breath (when moving or at rest), shortness of breath, cyanosis, bloody or colored sputum, chest pain and low blood pressure;

– In children: frequent or labored breathing;

– Hypoxia, determined by the readings of a pulse oximeter.

• Signs and symptoms that may indicate CNS complications:

– Altered mental state, unconsciousness, drowsiness or difficulty waking up and periodic or persistent convulsions (convulsions), confusion, severe weakness or paralysis.

Pregnant women, especially those with comorbidities, are at increased risk of complications from influenza virus infection. Influenza during pregnancy is associated with an increased risk of adverse pregnancy outcomes such as miscarriage, preterm birth, and fetal distress. Therefore, pregnant women require closer monitoring and early initiation of antiviral treatment. Paracetamol is recommended to reduce high fever and pain in pregnant women, as non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin ⁷ are associated with fetal risks and maternal bleeding and are therefore contraindicated in pregnancy.

Infants and young children (especially children under 2 years of age) have the highest rates of hospitalization, especially among children with pre-existing chronic conditions. Neonates and young children often present with less typical symptoms of ILI, such as shortness of breath, low grade fever, rapid breathing, blueness, excessive sleep, lethargy, poor appetite, and dehydration. Such symptoms are nonspecific and the diagnosis cannot be made on the basis of these features alone.

Antiviral therapy

The 2009 pandemic (h2N1) influenza virus is currently susceptible to the neuraminidase inhibitors (NAIs) oseltamivir (TAMIFLU) and zanamivir (RELENZA).

The following is a summary of treatment recommendations:

• Patients with severe or progressive clinical disease should be treated with oseltamivir. Treatment should begin as soon as possible.

This recommendation applies to all patient groups, including pregnant women and children under 2 years of age, including neonates.

In patients with severe or progressive disease who do not respond to normal treatment regimens, higher doses of oseltamivir (TAMIFLU) and longer treatment may be appropriate. In some situations for adults, a dose of 150 mg twice a day is used.

In cases where (1) oseltamivir is not available or cannot be used, or (2) if the virus is resistant to oseltamivir, patients who have severe or progressive clinical disease should be treated with zanamivir (RELENZA).

* Patients who are at increased risk of severe or complicated illness but who have uncomplicated illness due to influenza virus infection should be treated with oseltamivir or zanamivir. Treatment should begin as soon as possible after the onset of the disease.

If antiviral therapy is used, it should ideally be started early after the onset of symptoms, but it can be used at any stage of active disease.

Mothers who are breastfeeding may continue to breastfeed while sick and receiving treatment with oseltamivir or zanamivir.

Pneumonia is the most common severe complication of influenza.

There are three forms of pneumonia complicating influenza: primary viral pneumonia, viral-bacterial (secondary) pneumonia, bacterial (tertiary) pneumonia.

Primary viral pneumonia develops on 1st day from the onset of the disease. A significant proportion of lethal pneumonias may be associated not with a concomitant bacterial infection, but directly with the invasion and reproduction of the virus in the lungs. The initial symptoms of the disease are typical of influenza, but already within 12-36 hours, patients notice an increase in shortness of breath, which is often accompanied by a cough with a meager amount of sputum and streaks of blood. In rare cases, massive hemoptysis is possible. Pleural pain is rare. At the time of hospitalization most often manifest the phenomena of respiratory failure. Expressed tachypnea, tachycardia, cyanosis.

Viral-bacterial (secondary) pneumonia develops by the end of the first week from the onset of influenza. With this type of pneumonia, the interval between the onset of the first respiratory symptoms and signs and involvement in the process of the lung parenchyma can be up to 4 days, during this period even some improvement in the patient’s condition is possible. In most cases, the cough is productive with purulent or bloody sputum, accompanied by tremendous chills and pleural pain. As a rule, by the time of hospitalization, there are signs of severe respiratory failure: severe dyspnea, tachypnea, cyanosis.

Tertiary bacterial pneumonia develops in the second week from the onset of influenza. This is the most common complication that occurs due to damage to the ciliary epithelium by the virus, slowing down the mobilization of leukocytes, and impaired neutralization of bacteria by polymorphonuclear phagocytes. In most patients, the diagnosis of secondary bacterial pneumonia can be made based on the history. Usually the patient suffers a typical flu, followed by a period of apparent improvement, some patients even have time to get to work. However, 3-14 days after the first flu symptoms, the patient’s condition deteriorates rapidly: a second wave of fever with chills, pleural chest pain, cough with purulent sputum, and possibly hemoptysis. In about 2/3 of cases, the disease does not have a two-phase character, and the symptoms of pneumonia “superimpose” on the symptoms of influenza.

CONCLUSIONS:

– when working with patients with fever, a medical worker must wear a mask pulmonology departments of medical organizations

– early start of antiviral therapy is necessary, drugs with proven efficacy are TAMIFLU and RELENZA

– Paracetamol is recommended as an antipyretic for fever in pregnant women, while other drugs increase the risk of obstetric bleeding

– Mandatory hospitalization of children under 3 years of age with signs of acute respiratory disease

– obligatory pulse oximetry for patients (if a pulse oximeter is available) for early detection of respiratory disorders

Appendix

The degree of intoxication in children.

I degree. Decreased emotional tone, decreased appetite, liver enlargement by 1.0-2.0 cm, decreased muscle tone, subfebrile condition.

II degree. The child is restless or very lethargic, loses interest in others, refuses to eat, is pale, muscle hypotension, muffled heart sounds, temperature 38-39C, the liver is enlarged by 2.0-3.0 cm, there may be vomiting, regurgitation.

III degree. Sopor.

Degrees of respiratory failure in children (RD).

DN I degree. Respiratory distress with moderate exercise, breathing quickens by 10-2%. Tachycardia is moderate. HR:RR = 3:1 (normally 3.5:1). The gas composition of the blood is almost not disturbed.

DN II degree. Dyspnea and cyanosis at rest. Breathing speeded up by 20-30%. The pulse is frequent. HR:HR=2:1. Participation of auxiliary muscles in the act of breathing. In the blood, persistent hypoxia and hypercapnia. The child is restless.