Non-infectious fever

Introduction Non-infectious fever refers to non-infectious diseases, aseptic substances or various inflammatory effects on the body temperature regulation center, body temperature central dysfunction or excessive heat production caused by various causes, reduced heat dissipation, resulting in elevated body temperature Exceeding the normal range. The cause is fever caused by biological agents or drug reactions: mainly seen in heterologous protein fever, such as injection of horse serum. Drug fever, such as sulfonamides, barbiturates, penicillin, iodine and other drug allergies, pyrogen reaction of blood transfusion or infusion, and various vaccinations.

Cause

(1) Aseptic tissue damage and necrotic product fever: such as mechanical and physical damage after major surgery, fracture, extensive burn, X-ray irradiation; heart, liver caused by spleen rupture, gastrointestinal bleeding, vascular occlusion , spleen and other visceral infarction or limb necrosis; hemolytic anemia, reticuloendothelial hyperplasia, leukemia, aplastic anemia and tissue necrosis caused by various malignant tumors.

(2) Fever caused by biological agents or drug reactions: mainly found in heterologous protein fever, such as injection of horse serum. Drug fever, such as sulfonamides, barbiturates, penicillin, iodine and other drugs are allergic. Pyrogen reaction of blood transfusion or infusion, as well as various vaccinations.

(3) Abnormal heat production and heat dissipation: excessive heat production due to hyperthyroidism, convulsions, and status epilepticus, due to extensive scarring, extensive dermatitis, congenital sweat gland deficiency, scales or excessive coverage ( More common in small infants caused by heat dissipation and a large number of blood loss, dehydration caused by water loss.

(4) Central fever: such as heat stroke, sleeping pills poisoning, cerebral hemorrhage, skull fracture, concussion and other damage to the body temperature regulation center, some of the autonomic dysfunction caused by low fever, as well as infant position central regulation dysfunction.

(5) Pyrogenic steroid fever: such as cycle fever, adrenal cancer, chronic hepatitis, cirrhosis, and fever of the original cholesteryl ketone in the treatment of tumors.

(6) Others: such as immune diseases, lupus erythematosus, rheumatic fever, rheumatoid arthritis, nodular arteritis, dermatomyositis can cause fever. Some rare diseases such as ocular genital panniculitis and granulomatous diseases can cause fever.

an examination

Related inspection

Body temperature measurement, regression, thermocoil (BR), tuberculin intradermal test

Non-infectious fever has the following characteristics:

1. The heat course is longer than 2 months, and the longer the heat stroke, the greater the possibility.

2, long-term fever is generally good, no obvious symptoms of poisoning.

3, anemia, painless multi-site lymphadenopathy, hepatosplenomegaly.

Combine the patient's medical history and disease characteristics, and develop appropriate examination items for examination and diagnosis.

Differential diagnosis

1. Infectious fever: various infectious diseases such as bacteria, viruses, fungi, spirochetes, and malaria parasites act on the body temperature regulation center, body temperature center dysfunction or excessive heat production caused by various causes, and heat dissipation is reduced, resulting in an increase in body temperature. Exceeding the normal range. The white blood cell count is higher than 1.2x109/L or lower than 0.5109/L.

2, unexplained fever: the concept of generalized unexplained fever refers to all unexplained fever. However, in the clinic, the narrow concept of fever is also adopted, that is, fever of unknown cause. The fever lasted for more than 3 weeks, the body temperature was above 38.5 °C, and the diagnosis was not confirmed by detailed medical history, physical examination and routine laboratory tests.

3, central fever: refers to the fever caused by central nervous system disorders caused by abnormal body temperature regulation. The fever caused by systemic or local inflammation should be strictly excluded before diagnosis, and other causes of fever should be excluded. Most cases of intracranial disease with fever are critical cases, most of which are caused by intracranial inflammation, intrapulmonary infection, and urinary tract infection. For the unexplained increase in moderate body temperature, the source of infection or the cause of infection cannot be found at one time, and it cannot be easily considered as central fever. The cause of systemic or local infection should be repeatedly searched for, and attention should be paid to the cause of drug fever and other fevers.

4. Persistent fever: When the mouth temperature is higher than 37.3 °C or the anus temperature is higher than 37.6 °C, the change in one day exceeds 1.2 °C, which is called fever. According to the level of fever, it can be divided into the following clinical classifications: low heat 37.4 ° C ~ 38 ° C, moderate heat 38.1 ° C ~ 39 ° C, high heat 39.1 ° C ~ 41 ° C, ultra high heat 41 ° C or more, lasting more than 4 weeks, for Sustained fever.

5. Relaxation heat: The body temperature continues to be above 39 degrees, and the fluctuation range is large. The body temperature fluctuation range exceeds 2 degrees within 24 hours, but both are above the normal level.

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