Fever-and-Intoxication Syndrome

A febrile-intoxication syndrome is a symptom complex that characterizes the nonspecific adaptive response of a macroorganism to microbial aggression. The degree of severity of febrile-intoxication syndrome is a universal criterion for assessing the severity of the course of the infection process. The term "febrile-intoxication syndrome" includes fever, myasthenia gravis, symptoms of CNS damage and autonomic nervous, cardiovascular system.

The concept of "febrile-intoxication syndrome" does not include manifestations of intoxication due to organ damage and organ failure (renal, hepatic, cardiac), and symptoms caused by the specific action of microbial toxins, in particular myasthenia gravis in botulism, tetanus convulsions, cholera diarrhea, edema of cellulose in diphtheria. The febrile-intoxication syndrome is classified according to the degree of severity of its individual components. The degree of severity is determined by the most pronounced symptoms.

The presented classification allows assessing the severity of the patient's condition, but does not exclude the options for the condition of the individual patient, which does not fit into this scheme.

If the patient with a criterion corresponding to a slight degree of intoxication, there is a retardation or severe arterial hypotension, then intoxication and the patient's condition should be considered as severe.

If the individual criteria for intoxication do not correspond to the others, the appropriate organ pathology should be excluded, for example: an intense headache with nausea and vomiting, mental disorders, cramps make it possible to think about neuroinfections, tachycardia, arterial hypotension - heart damage, nausea, vomiting, anorexia - digestive tract, high fever with a slight degree of intoxication requires the elimination of non-infectious etiology of the disease. The severity of the febrile-intoxication syndrome is significantly different in certain infectious diseases. With brucellosis, high fever often occurs without significant intoxication and patients can maintain their ability to work at body temperature of 39.0 ° C and above. In severe infectious mononucleosis, severe myasthenia gravis dominates with a mild manifestation of other manifestations of intoxication.

Classification of febrile-intoxication syndrome

	Degree of expression
Main symptoms	Light	Medium	Heavy	Very heavy
Fever	Up to 38,0 ° С	38.1-39.0 ° C	39.1-40.0 ° С	Over 40.0 ° С
Weakness (myasthenia gravis)	Fatigability	Mobility limitation	Reclining position	Lying position. Difficulty in active movements
Algia (pain in the muscles, joints, bones)	Weak, absent	Moderate	Strong	Strong, may be absent
Chills	-	Chilliness, cognition	Expressed	Stunning
Headache	Weak	Moderate	Strong	Strong, may be absent
Nausea	-	Possible	Often	Possible
Vomiting	-	-	Possible	Often
Meningeal syndrome	-	-	Available	Often
Disorders of consciousness	-	-	Stupor, sopor	Sopor, coma
Convulsions	-	-	Possible	Possible
Delirium, delirium	-	-	Possible	Often
Heart rate, in minutes	Up to 80	81-90	91-110	Over 110 (bradycardia possible)
Blood pressure, mmHg.	Norm	The lower limit of the norm	80 / 50-90 / 60	Less than 80/50
Decreased appetite	Maybe	Constantly	Anorexia	Anorexia
Sleep disturbance	Maybe	Often	Insomnia, drowsiness	Insomnia. Drowsiness

The main manifestation of a febrile-intoxication syndrome is fever. In infectious diseases, it is caused by the effect on the hypothalamic centers of the thermoregulation of exogenous (microbial) and endogenous pyrogenes formed by granulocytes and macrophages or accumulating in inflammatory foci. The fever is assessed according to the following parameters: acuity of development of febrile reaction, height of body temperature rise, duration of fever, rate of decrease in body temperature, type of temperature curve.

When the body temperature rises within 1-2 days to the maximum values, its increase is regarded as acute, within 3-5 days - subacute, more than 5 days - gradual. Fever up to 38 ° C is considered subfebrile (to 37.5 ° C - low subfebrile condition, 37.6-38.0 ° C - high subfebrile condition). Fever in the range from 38.1 to 41.0 ° C is designated as febrile (up to 39.0 ° C - moderate, from 39.1 to 41.0 ° C - high), over 41.0 ° C - hyperpyretic. The fever lasting up to 5 days is considered short-term, 6-15 days - long, more than 15 days - prolonged. Decrease in body temperature from febrile or hyperpyretic level to normal within 24 hours is designated as critical, or crisis, during 48-72 hours - as accelerated lysis, more gradual - as lysis.

Depending on the diurnal fluctuations and the form of the temperature curve, several types of temperature curves are distinguished.

Curve of a constant type with daily fluctuations within 1 ° С; the body temperature level exceeds 39 ° С. Typical for severe forms of typhoid and typhus.

The remitting ( relieving ) fever is characterized by daily fluctuations from 1.0 to 3.0 ° C. It is observed in many infectious diseases.

With hectigree fever daily fluctuations in body temperature are 3.0-5.0 ° C. As a rule, an increase in temperature is accompanied by chills, and a decrease - with profuse perspiration. It is observed in sepsis, severe purulent inflammatory processes.

Intermittent fever is characterized by feverish attacks that last for up to 24 hours and alternate with febrile days. Typical for malaria.

With recurrent fever, periods of fever last for several days and are followed by several days of normal temperature, after which the fever again resumes. It is observed with recurrent typhus. In many infections, a second increase in temperature is due to the development of complications (influenza) or relapse (typhoid fever).

With prolonged flow of infectious diseases, a wave-like fever is observed , when the periods of body temperature rise are replaced by periods of subfebrile condition. Currently, infectious diseases are rare. In bacterial infections, a repeated wave of fever may be associated with the ineffectiveness of etiotropic therapy.

A fever of the wrong type is widespread when the temperature curve has an unordered appearance. In severe septic processes, a perverted fever is possible , in which the morning temperature exceeds the evening temperature.

[1], [2], [3], [4], [5], [6],

Causes of febrile-intoxication syndrome

Fever, accompanied by intoxication, is typical for most bacterial, viral and protozoal infectious diseases, generalized mycoses. It is possible in helminthic invasions (opisthorchiasis, trichinosis, schistosomiasis). Feverish-intoxication syndrome is not typical for cholera, botulism, hepatitis B virus and viral hepatitis C, uncomplicated amoebiasis. Cutaneous leishmaniasis, giardiasis, localized mycoses and many helminthic invasions.

The level of fever reflects the severity of the course of the disease as a whole. Fever may be absent or be subfebrile in the presence of many diarrheal and acute respiratory infections.

What causes a febrile-intoxication syndrome?

[7], [8], [9]

Treatment of febrile-intoxication syndrome

The treatment is aimed at detoxification and reducing the excessive temperature response. With mild intoxication and subfebrile fever, the home regime is shown, the exclusion of spicy seasonings, fried foods, smoked foods, canned food, plentiful drink (tea, juices, mors, mineral water, broth of dogrose, compote - up to 3 liters per day).

With intoxication of moderate severity and moderate fever, there is a bed rest, hospitalization according to individual indications in individual cases (fever over 5 days, burdened premorbid background), the same diet as with slight intoxication with the exception of refractory fats, plentiful drink with the inclusion of sweatshops - honey, raspberry, cowberries, ascorbic acid. With poor subjective tolerance of fever - antipyretics: acetylsalicylic acid, paracetamol, metamizole sodium, cold on the forehead.

Treatment of febrile-intoxication syndrome