Repeated high fever

Introduction High Fever is clinically critical. The body temperature repeatedly reached 39.1 to 40 °C. Hyperthermia is divided into acute hyperthermia and long-term hyperthermia. Acute hyperthermia is more common in infectious and allergic inductive diseases, while long-term hyperthermia can be seen in sepsis, Salmonella infection, tuberculosis, rheumatic fever, and juvenile rheumatism.

Cause

(1) Acute high fever

Infectious disease

Early acute infectious diseases, acute infectious diseases of various systems.

2. Non-infectious diseases

Heat syndrome, neonatal dehydration fever, intracranial injury, convulsions and epileptic seizures.

3. Allergic reaction

Allergies, allogeneic serum, vaccination response, infusion, transfusion reactions, etc.

(2) Long-term high fever

Common disease

Sepsis, Salmonella infection, tuberculosis, rheumatic fever, juvenile rheumatism, etc.

2. Rare disease

Malignant tumors (leukemia, malignant lymphoma, malignant histiocytosis), connective tissue disease.

an examination

Related inspection

Arterial injection pigment comparison test

First, comprehensive and careful physical examination

1, the examination should be detailed and comprehensive, combined with medical history and symptoms, and then in-depth examination.

2, oral in many fever patients, there are common pathological changes. Such as tonsillitis can be seen tonsils redness or purulent secretion, herpetic pharyngitis can be seen in the pharynx and other areas of herpes and ulcers, measles in the early buccal mucosa with Coriolis spots, diphtheria visible pharyngeal and tonsil with white pseudomembrane.

3. Pay attention to the distribution and morphology of the rash. Allococcal sepsis, streptococcal infections are common with scarlet fever-like rashes, blood diseases, epidemic cerebrospinal meningitis, epidemic hemorrhagic fever and other skin may have bleeding points, rheumatic fever can be seen in ring erythema, viral infection, connective tissue disease, sepsis Bacterial endocarditis, histiocytosis X, mucocutaneous lymph node syndrome and many drugs can cause rash, but their morphology and appearance are different.

4, when the mental state is good in high fever, often mild infection. Such as lethargy, apathetic, unconscious, with meningeal irritation, suggesting intracranial infection. In the early stage of infant intracranial infection, meningeal irritation is often not obvious, but the performance is apathy, lethargy, irritability, nervous or full of sputum, etc., must be alert to intracranial infection.

5, hepatosplenomegaly is common in leukemia, connective tissue disease, inflammation of the hepatobiliary system, typhoid fever, sepsis, malaria, tumors and so on. Lymph node enlargement can be seen in blood diseases, infectious mononucleosis, mycoplasma infection, lymph node syndrome of the skin and mucous membranes. Local lymphadenopathy, tenderness, should pay attention to find adjacent areas with or without inflammatory lesions.

Second, laboratory inspection

First check the general, according to the general screening results, and then decide to further check the project, try to avoid the purposeless "casting" type inspection.

Common tests for blood, urine, and feces are preferred items for screening. The total number of white blood cells and neutrophils are increased, and more are considered bacterial infections; those with reduced weight are more viral or bacilli infections. If you suspect sepsis, intestinal and urinary tract infections, you need to send blood, feces, and urine separately. In addition to routine examinations, various puncture fluids are sometimes sent for culture or smear examination. For example, meningococcal smear and cerebrospinal fluid smear in patients with epidemic cerebrospinal meningitis can find meningococcal bacteria, blood smears for malaria can find malaria parasites, and diphtheria pseudomembrane smears to check diphtheria bacilli.

If necessary, check the fatda reaction, the external Fischer reaction, the heterophilic agglutination test, the condensation set test, etc., to help the differential diagnosis. Rheumatoid fever or rheumatoid disease was examined for anti-streptolysin O or rheumatoid factor, respectively. Patients with suspected viral infections may have early rapid diagnostic tests for immunological aspects. Patients with repeated infections caused by immunodeficiency disease can be used for serum immunoglobulin and cellular immunity and complement determination. Blood diseases should be checked for bone marrow. Suspected tuberculosis requires a tuberculin test. Patients with suspected biliary tract infections are often examined and cultured for duodenal drainage, and often have meaningful results. In short, the relevant examinations can be carried out according to the condition of the disease, but it is necessary to pay attention to the analysis of the results of the examination, to eliminate false positives or false negatives caused by errors and pollutions such as sampling or operation.

Third, X-ray and other inspections

Chest X-rays help diagnose lung and chest diseases. Others, such as malignant tumors, can be selected for CT, nuclear magnetic resonance, angiography, radioisotope, B-mode ultrasound, and living tissue according to the site, which is also necessary.

Differential diagnosis

1, high fever does not return: If the patient measured the temperature of the temperature for a long time up to 39.1 ~ 40 ° C is called high fever. There was no skin trauma and sputum history within 2 to 3 weeks before fever. There was no history of infectious disease in the infected area within 1 to 3 weeks, and there was no history of contact with schistosomiasis in 1 month. Skin trauma and paralysis are clues to the diagnosis of sepsis. Have a history of infectious disease epidemic areas, consider acute infectious diseases, abdominal surgery after fever should consider abdominal cavity, pelvic infections such as underarm abscess, intestinal gap abscess, hollow organs and so on.

2, continuous fever: 41 ° C or more, lasting more than 4 weeks, for continuous fever. There is no diagnostic value for the diagnosis of most patients with fever. In view of clinical treatment problems, for patients with unknown causes of long-term fever, diagnostic treatment can be performed in addition to tumors. However, it is necessary to take a cautious attitude and choose drugs with specific specific effects and minimal side effects, such as nitrous acid to treat amebic liver disease and antimalarial drugs for malaria. Most of them are used for diagnostic treatments such as antibiotics, anti-protozoal anti-rheumatic drugs, etc. These drugs have side effects (such as drug fever, rash liver function damage, hematopoietic organ damage, etc.), such as improper application, but delay the disease. It should be noted that this method has its limitations, and the results of special effects treatment in terms of diagnosis are generally more negative than the diagnosis. If the suspected malaria patients are not treated with regular treatment with chlorsulfone, the possibility of malaria is considered to be small.

3, irregular heat refers to fever without a certain law, duration is not necessarily. Can be seen in a variety of lung diseases, heart pleurisy. The body temperature curve of fever has no regularity.

4. Intermittent heat: After the body temperature rises to a peak for several hours, it quickly drops to the normal level. The no-heat period (intermittent period) can last from one day to several days, so that the high heat period alternates with no heat. Common in malaria, acute pyelonephritis and so on.

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