High fever in an adult with symptoms and without

Our body can adapt to the influence of various adverse factors, including compensatory mechanisms, one of which is raising the body temperature to febrile (from 38 to 39 ℃) and hectic (above 39 ℃) values. This process is controlled by the center of thermoregulation in the hypothalamus - a small part of the diencephalon.

The high temperature of most people and, not without reason, consider a dangerous symptom. And the reaction to this symptom is unambiguous - to knock down. However, before you find out what is dangerous for a person's high temperature, you need to find out what values are high, because everyone has their own opinion on this.

The hectic body temperature is considered safe for a healthy adult and has a positive effect until it exceeds 40 ℃. Temperature values in the range from 39 ℃ to 41 ℃ are called still pyretic. With such values, the fight against infectious agents is as intense as possible, however, it is not easy for the body to withstand such pressure for a long time. The benefit of high temperature is that when it rises, the metabolic rate, circulation, and endogenous interferon production increases. In such conditions, the organism intensively suppresses foreign microorganisms and repairs the injuries. However, a significant increase in body temperature should not be long-term.

For adults, constant or increasing temperatures above 39 ℃ are considered dangerous, with no episodic decrease, registering for 72 hours or more. If the thermometer column shows a value between 40 and 41 ℃, then this situation is dangerous regardless of its duration.

The danger of hyperthermia is also associated with the acceleration of metabolism and the increased demand for all organs in oxygen, since they operate in an overload mode, and their energy supply is rapidly depleted. First of all, hypertension undergoes heart muscle overload, it pumps much larger volumes of blood to provide the organs with the oxygen they need. This is expressed in the rapidity of the pulse and respiratory cycles (inhalation-exhalation). Nevertheless, the need for a heart in oxygen is very high and even intense breathing can not satisfy it. The brain and, accordingly, the central nervous system suffers, which is expressed by convulsions, disconnection of consciousness. Violated water-salt balance, which is also fraught with complications. Temperature values above 41 ℃ are called hyperpyretic, raising to such values is very dangerous, so it is undesirable to admit it altogether, even for a short time.

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

The causes of high temperature in an adult

Up to febrile and higher values, body temperature rises for a variety of reasons. This is a common symptom, inherent, probably, most diseases. High body temperature (we will consider values above 38 ℃ in this context), unlike subfebrile, is never a variant of the norm, and its increase indicates that the body is forced to incorporate protection mechanisms from something - be it an infection or heat stroke . And in two different people, the same cause can cause a rise in temperature in different degrees, as in the same person in different periods of his life.

Most often, the reason for the high temperature in an adult is the infection of the respiratory organs with airborne pathogens and the acute diseases that cause them. A temperature exceeding 38 ℃, in most cases, manifest the viral and bacterial infections of the respiratory organs: influenza, angina, bronchitis, pneumonia, infectious mononucleosis, combined lesions.

Infections transmitted by the oral-fecal route, with contaminated water and food-viral hepatitis A, yersiniosis, brucellosis, poliomyelitis, leptospirosis, and many others also often start with a sudden rise in temperature to pyretic values. High indicators of the mercury column of the thermometer are observed with inflammation of the membranes of the brain and spinal cord (meningitis, encephalitis, meningoencephalitis) of various origins, Charcot's disease, malaria, typhoid, and sometimes in tuberculosis.

Acute nephritis, diseases of the genitourinary organs, pancreatitis, appendicitis, cholecystitis are often accompanied by high fever.

Post-traumatic and postoperative purulent complications (abscess, phlegmon, sepsis); alcohol and drug intoxication; acute allergic or postvaccinal reaction; damage to the endocardium, myocardium, pericardium as a complication of infectious diseases can occur with increasing temperature to febrile values.

Risk factors for sudden temperature increase - collagenoses (systemic lupus erythematosus, rheumatoid arthritis, thyrotoxicosis and others); vegetovascular dystonia; hypothalamic syndrome; malignant diseases of the hematopoietic organs; mental disorders; chronic infections; myocardial infarction and brainstroke. The terminal stage of cancer of any localization is almost always accompanied by a high fever, and a long subfebrile condition may be one of the signs, sometimes the only, of a developing tumor.

A sudden jump in temperature, up to febrile values, can happen as a result of overheating (heat stroke), exorbitant physical stress, and also their combination; frostbite; strong stress.

Pathogenesis

The mechanism of body temperature rise is triggered when the balance between the production of heat energy and its recoil is disturbed, when the rate of heat production exceeds the rate of heat transfer to the environment.

Hyperthermia develops in quite healthy people at an air temperature of more than 37 ° C and its humidity approaching absolute (100%). In such conditions, heat transfer in the form of sweating and its evaporation becomes impossible, and with prolonged stay in such conditions, plus also showing physical activity, the organism is subjected to the so-called "heat shock".

Hyperthermia as a protective reaction to the entry into the body of pathogenic microbes or cell changes developed in mammals in the process of evolution. Exogenous pyrogens, whose role is performed by pathogenic microorganisms, stimulate the center of thermoregulation to raise the temperature of the body. In response to the appearance of "strangers", the body produces proinflammatory mediators: interleukins 1 and 6, tumor necrosis factor, α-interferon and others that act as endogenous pyrogens, and acting on the cells of the anterior hypothalamus region, set the "fixing point" for thermoregulation above normal. The balance is broken and the center of thermoregulation begins to "work" to achieve a new balance at a higher reference temperature of the "set point".

Mechanisms that regulate the heat exchange of the organism, constantly interact with effectors that regulate other homeostatic functions. Such interaction occurs, first of all, in the anterior part of the hypothalamus, the cells of which react not only to heat exchange but are sensitive to changes in pressure in physiological fluids and arterial channels, concentrations of hydrogen ions, sodium, calcium, carbon dioxide and glucose. Neurons of the hypothalamus preoptic region react with a change in bioelectrical activity and are in constant interaction with other coordination centers of physiological processes.

Symptoms of diseases accompanied by high fever

The so-called "heat stroke" is not a disease in the conventional sense of the word. However, in this case, the dynamic balance of physiological processes in the body is violated and the human condition deteriorates right up to the collapse. Increases body temperature to febrile values. Skin blushes due to the expansion of peripheral vessels, sweating ceases, symptoms of impaired central nervous system functions (dizziness, nausea, impaired coordination, delirium, cramps, headache, loss of consciousness). Heat shock in a mild form proceeds as a heat faint - consciousness is disconnected as a result of a sharp hypotension, which occurred due to the widening of the lumen of the peripheral vessels of the skin.

Symptoms of high temperature in adults are always quite pronounced. If the subfebrile temperature can be detected by chance, then raising the temperature to febrile values in itself is accompanied by a characteristic symptomatology. The first signs of malaise - chills, weakness, dizziness, sometimes headache, muscle or joint pain, accelerated heartbeat. In most cases, the so-called "red" hyperthermia develops. The patient dilates the vessels, the skin turns red.

A more dangerous condition is considered to be "white" hyperthermia, which says that the vessels did not expand, and their narrowing occurred. Symptoms of this condition are as follows: skin pale or marble-cyanotic; cold hands and feet; strong palpitations; dyspnea; the patient is nervous, can rave, convulsions may begin.

But other symptoms indicating which disease, developing, caused a rise in temperature may not be, at least initially. Sometimes they appear on the second or third day, for example, the flu or angina begins with hyperthermia, and signs of defeat of respiratory organs appear later.

In addition to these, a fairly long series of diseases can cause hyperthermia without additional symptoms suggesting the cause of such a condition. The high temperature without symptoms in the adult is an incorrect definition. Asymptomatic flow suggests the absence of any signs of malaise, the usual state of health. At a high temperature this does not happen, even subfebrile values adults usually feel. After all, something makes us put a thermometer and measure the temperature.

With the rise in temperature, many infectious diseases can start: meningitis, encephalitis, leptospirosis, infectious mononucleosis, typhoid, septic endocarditis, osteomyelitis, atypical pneumonia, measles, parotitis. Even chickenpox or rubella, which in children often carry very easily and without fever, adults often cause hyperthermia, and specific symptoms manifest later and atypical. Temperature fluctuations during the day are characteristic for tuberculosis or abscess of internal organs. From tours to hot countries it is possible to bring malaria, which also manifests a high temperature. Specific symptoms of these diseases appear later, after a day or two.

Inflammation of the meninges (meningitis) is caused by various infectious agents, begins with a sharp rise in temperature, accompanied by the corresponding symptoms. In addition to a severe headache, which can be attributed to high fever, the patient is very weak, constantly asleep, sometimes loses consciousness. Typical intolerance of bright light, loud sounds, enslave the occipital muscles (can not touch the chest with the chin, the turn of the head is accompanied by pain). The patient has no appetite, which is natural at high temperature, there may be nausea and vomiting, convulsions. In addition, the patient can detect rashes, in principle, any localization (typical - the feet, palms, buttocks) and resemble small subcutaneous hemorrhage. Meningitis is not very common. For its development requires the presence of immune deficiency and / or defects of the nervous system. However, this disease is very dangerous and does not pass by itself, therefore, a high temperature accompanied by an unbearable headache (the main diagnostic markers) should be the reason for seeking emergency help.

Encephalitis is a group of etiologically diverse inflammations of the brain. It can begin with a high fever and a corresponding symptomatology, and depending on which part of the brain has been affected, there are more specific symptoms from the nervous system. Sometimes the meningeal membranes (meningoencephalitis) are involved in the inflammatory process and the symptoms of meningitis additionally join.

Leptospirosis (infectious jaundice, water fever) - suddenly an acute fever starts, the temperature rises to 39-40 ℃, with a headache that prevents sleep. Diagnostic marker - severe pain in the muscles of the lower leg, sometimes the muscles of the thighs and skin are involved. In severe cases, the patient can not stand on his feet. Infected more often in the summer when swimming in stagnant water, contaminated with excrement of sick animals, in the presence of any wounds on the skin (abrasions, scratches, cuts). Through the entire skin, the pathogen does not penetrate. The incubation period ranges from four days to two weeks. The disease can pass and independently, but severe forms, accompanied by jaundice, can end fatal.

Endocarditis (infectious, septic) occurs frequently, develops as a complication of acute (angina, influenza) and chronic (tonsillitis, stomatitis) diseases. Its pathogens can be more than a hundred microorganisms. Manifestes a high (more than 39 ℃) temperature, later dyspnea, heart cough, chest pain and other symptoms join.

In addition to various infectious diseases, a febrile condition may be accompanied by exacerbations of rheumatoid arthritis, systemic lupus erythematosus, thyrotoxicosis and other connective tissue diseases.

High temperature without cause in adults does not happen, just this reason does not always lie on the surface. Sometimes the temperature lasts a long time and the reasons for this state are not determined. It is believed that idiopathic hyperthermia can be caused by hypothalamic dysfunction. This condition is called the hypothalamic syndrome, it is diagnosed by excluding other causes.

In addition, a high and high temperature, which can not be knocked down, may be the only symptom of oncopathology. Often, it affects the blood and lymphatic tissue (acute leukemia, lymphoma, lymphogranulomatosis), but there may be tumors and other localizations. Subfebrile temperature, sometimes skipping, is characteristic for the onset of neoplasm development, and high mercury column numbers more often speak of tumor disintegration, lesions with metastases of many organs and terminal stage of the disease.

High fever, diarrhea, abdominal pain in an adult are not specific symptoms and require a doctor to make a thorough diagnosis. The presence of diarrhea in most cases indicates intestinal infections (food poisoning). The occurrence of such symptoms is usually associated with the ingestion of pathogenic microorganisms - bacteria, viruses, parasites, causing inflammation of its mucous membrane in some area - the stomach, duodenum, small or large intestine, into the digestive canal. Additional signs indicating intestinal infection are weakness, headache, rumbling in the area below the navel, bloating. When intestinal infections are usually observed and vomiting, which brings the patient a temporary relief. Its appearance usually precedes diarrhea, or these symptoms appear simultaneously.

It is the presence of diarrhea that suggests infection of the intestine. There are about thirty common intestinal infections, many of them show severe symptoms with signs of general intoxication - a decline in strength, a headache, a fever with a high fever (39-40 ℃), and abdominal pain and diarrhea in combination with nausea and vomiting.

The presence of the above symptoms can not be excluded even with acute appendicitis, diverticulitis, pancreatitis, hepatitis, inflammation of other digestive organs and the genitourinary system. Although diarrhea in this case - not a typical symptom. For inflammatory diseases, high temperature, nausea, vomiting and abdominal pain are more typical. And the leading sign is pain, and nausea and vomiting, especially at the initial stages of the disease, appear due to severe pain syndrome.

Cough and high fever in an adult can be symptoms of an acute respiratory viral infection, with the flu usually starting with sudden hyperthermia, and coughing and sneezing begins later. The defeat of other viruses manifests itself first respiratory symptoms with a gradual increase in temperature.

Acute inflammation of the upper and lower respiratory tract - tracheitis, laryngitis, bronchitis, pneumonia usually manifested by intense cough and rising temperature, often - to febrile indices.

High fever and cough can be observed with such infectious diseases as measles and whooping cough. In measles, there are specific eruptions and photophobia, for whooping cough are characterized by bouts of choking cough, inhaling with whistling and escaping mucus after an attack (sometimes even vomiting).

Hyperthermia and cough are observed in the symptomatic complex of endocarditis, some gastrointestinal pathologies - in viral, parasitic, bacterial invasions, peptic ulcer and gastritis.

High temperature and vomiting in an adult is observed both as a result of food poisoning, intestinal infection, and with exacerbation of gastritis or cholecystitis. A significant increase in body temperature, vomiting, sweating and trembling of the limbs may be manifestations of extreme weakness due to intoxication or severe pain, for example, when the ovary or fallopian tube is ruptured with an ectopic pregnancy. The same manifestations can be hysterical, manifest as the effects of severe stress or overwork.

The sudden appearance of such symptoms may be a sign of acute pancreatitis, small intestinal obturation, acute appendicitis and hepatitis, and damage to the central nervous system. In peritonitis, hyperthermia and vomiting of bile are also observed.

Rashes and high fever in adults can be symptoms of childhood infections - measles, rubella, chickenpox, scarlet fever, adult infection - syphilis. Meningitis occurs with hyperthermia and rashes. If a patient with infectious mononucleosis has taken a drug belonging to semisynthetic penicillins (ampicillin, ampiox, amoxyl), he will have red spots all over his body. Rash in combination with hyperthermia is observed with typhus, herpes, systemic lupus erythematosus, allergic reactions and toxic infections. There is a large group of diseases, the symptomatic complex of which includes rash and hyperthermia, so with such manifestations, specialist consultation is necessary.

High fever and sore throat, a runny nose in an adult, first of all, suggests infection with a virus, banal ARVI. Viruses, ready to hit our respiratory system, a great many. Basically, they are transmitted by airborne droplets - coughing and coughing in a shop, minibus, a cold-caught employee came to work ... And now the next day or day after three or four swells began to flow, the throat got sick, and by the evening - the temperature rose.

Most often we encounter rhinoviruses, this lesion is characterized by a pronounced catarrhal symptomatology - a runny nose, catarrhal phenomena in the throat, cough. High fever with rhinovirus infection is rare, usually the body quickly copes with an unstable pathogen and intoxication is not significant. However, it is impossible to exclude hyperthermia, much depends on the state of immunity and nervous system, the presence of chronic diseases.

Adenoviruses - have greater stability in the external environment. They are transmitted not only through the air when coughing and sneezing, but through objects and food, cause about a tenth of all SARS. Manifest the coryza and sore throat, hyperthermia, affect the mucous eye and cause inflammation of the conjunctiva, which is distinguished by adenovirus damage. Sometimes the lymphoid tissue is involved in the process - the tonsils and cervical lymph nodes increase. Adenovirus infection is fraught with complications - tonsillitis, otitis, sinusitis, myocarditis.

Paramixoviruses (measles, parotitis, rubella, respiratory syncytial infection, parainfluenza, etc.) - infection occurs through the respiratory system, the disease begins with respiratory symptoms and a rise in temperature, some infections (childhood diseases) have additional specific signs. Dangerous not so much in themselves, as their ability to give complications.

"Intestinal flu" or reovirus infection also begins with a runny nose and a sore throat, a cough, then symptoms of a lesion of the gastrointestinal tract - vomiting and diarrhea - are added. High fever is not typical, more often subfebrile, but can not be excluded. Adult people by the age of 25 usually already have immunity to reoviruses, but there are no rules without exception.

The onset of the disease - the headache, bone aches, chills and high fever in the adult, with the time the rhinitis joins and the pain in the throat gives reason to suspect infection with the influenza virus. The acute period lasts about five days. The disease is contagious and if the bed rest is not complied with, it is fraught with complications.

However, with a sharp and strong temperature jump, many of the diseases described above, meningitis, infectious mononucleosis, leptospirosis, typhoid and malaria, begin (they can be brought from the tour to hot countries).

Often, viral hepatitis A manifests, and the specific symptoms that make it possible to recognize the disease appear later, in two or three days. Therefore, a high temperature in an adult signals the need to visit a doctor or call him at home (depending on the patient's condition).

Especially dangerous is hyperthermia in a brain accident. A more favorable prognostic sign is hypothermia. Such patients usually do not have a significant neurological deficit, recover faster and are more likely to recover.

High fever in adults leads to a rapid spread of the ischemic injury zone and speaks of serious complications: the development of extensive brain edema, the recurrence of latent chronic infections, the damage to the hypothalamus, the development of pneumonia, or the response to medication.

In any case, when the temperature rises to febrile indices in the adult and lasts for several days, it is necessary to consult a doctor and establish the cause of this condition.

Diagnostics

High fever is just one of the symptoms of the disease. In order to establish its cause, it is necessary to consult a specialist who, on the basis of examining and questioning the patient, and conducting the necessary laboratory and instrumental studies, will be able to establish a diagnosis and prescribe adequate treatment.

Almost always, patients are assigned clinical blood and urine tests. To diagnose many diseases, there may be enough of them. For example, with infectious mononucleosis, specific bodies appear in the blood - mononuclear cells, which a healthy person should not have.

If there is a suspicion of thyrotoxicosis, a blood test for thyroid hormones is done, to exclude syphilis from rashes in an adult, an analysis of Wasserman's reaction.

With angina, scarlet fever, bacteriological examination of the smear from the tonsils is done, the only way to exclude (confirm) meningitis or encephalitis is a puncture of the cerebrospinal fluid, which allows not only to establish a diagnosis, but also to identify the pathogen.

Leptospirosis at the onset of the disease (before intensive antibiotic therapy) is determined by microscopic examination of blood in a dark field, a week after the onset of the disease - microscopy of urine is done.

Suspicion of lymphogranulomatosis confirms a biopsy of the lymph node with microscopic examination of the lymphoid tissue.

Assignable studies depend on the symptoms of the disease, indicating its origin.

Also, in order to establish the correct diagnosis, the necessary instrumental diagnostics is appointed depending on the alleged disease - radiography, ultrasound, computer or magnetic resonance imaging, fibrogastroduodenoscopy and others.

Based on the results of the examinations, differential diagnosis is made, the type of pathogen in infectious diseases is determined and appropriate treatment is prescribed.

[7], [8], [9],

Is it necessary to bring down the heat in an adult?

The actions of the patient and his relatives depend on many factors. First of all, one must be guided by the state of a person with temperature and its values, and also by the duration of hyperthermia. The patient should be in a cool (≈20 ℃), but not a cold, periodically ventilated room. It is good to switch on the humidifier. The patient should be dressed in light linen made of natural tissue and covered so as to ensure heat emission. Linen should be dry, if strong sweating - change clothes and rest the bed. If the patient is shivering, cover warmer, warm and rub the limbs when there is no chill, you can cover it with an easy sheet (the patient should be comfortable - not hot, but not cold).

Many are interested in the question of whether it is necessary to bring down the heat from an adult. If a person does not have and never had seizures at high temperature and the condition is satisfactory, then in the first day it can not be knocked down even at the indices from 39 to 40 ℃. It is necessary to observe the patient's condition, providing him with peace and an abundant warm drink, the temperature of which is approximately equal to the temperature of the patient's body. The next day the patient must call a doctor.

Consequences and complications

Prolonged hyperthermia without a periodic drop in temperature can have negative consequences for the body, although an increase in temperature is in most cases a compensatory process. At a temperature above 38 ℃, most of the pathogenic microorganisms and even modified cells of tissues die in the tumor process. Nevertheless, if the temperature does not fall more than three days, the tissues of our body may suffer from hypohydration and a lack of oxygen.

For example, when the temperature rises, the vessels expand sharply. This is necessary to maintain systemic blood flow, but at the same time is fraught with a drop in pressure and the onset of collapse. Of course, this does not happen in the first hours, however, the higher the temperature and the longer it does not fall, the greater the likelihood of negative consequences.

With loss of fluid in the process of increased sweat secretion, the volume of blood circulating in the body decreases, and its osmotic pressure increases, which leads to a disruption of the water exchange between the blood and tissues. The organism aspires to normalize water exchange, reducing sweating and raising body temperature. In a patient, this is expressed in a decrease in the amount of urine and unquenchable thirst.

Increasing respiratory cycles and intense sweating also lead to increased release of carbon dioxide and demineralization of the body, there may be shifts in the acid-base state. With increasing temperature, tissue respiration worsens, and metabolic acidosis develops. Even rapid breathing is not able to meet the increased needs of the heart muscle in oxygen. As a result, myocardial hypoxia develops, which can lead to vascular dystonia and extensive myocardial infarction. The prolonged high temperature in an adult leads to the depression of the central nervous system, the disturbance of homeostasis, and the hypoxia of the internal organs.

It must be remembered that if the febrile values of the mercury column are observed for more than three days, such a temperature must necessarily be knocked down. And to establish the reason for this state is needed even earlier.

It happens that the heat does not get lost in the adult. In such cases, you need to see a doctor. If the thermometer does not exceed 39 ℃, you can contact the local therapist, and if the temperature approaches 40 ℃ and the antipyretics do not help, you need to call an ambulance.

Seizures at high temperature in an adult develop due to the fact that high temperature disrupts the regulation processes in the structures of the brain. Reflex muscle contractions occur with different readings of the thermometer. For people with central nervous system diseases, it is sometimes sufficient to raise the mercury column to 37.5 ℃, although, of course, most seizures occur at temperatures above 40 ℃. Seizures can be clonic, when muscle spasms quickly turn into relaxation, and tonic, when the tone persists long enough. Spasms can cover a particular muscle group or the entire musculature of the body. Spasmodic contractions of the muscles usually occur with a sudden rise in temperature or with a drop in blood pressure. The patient with convulsions can not be left unattended, it is necessary to seek emergency medical care, since in such a state, respiratory failure may occur, collapse on the background of a sharp drop in pressure in the arteries.

Even without the development of seizures, prolonged hyperthermia without periods of decrease in temperature indices can lead to depletion of the energy reserve, intravascular coagulation, edema of the brain - terminal states with a fatal outcome.

A rash after high fever in an adult can most often be caused by drug intoxication by antipyretic agents. Basically, for all infections (measles, scarlet fever, typhoid, meningitis and others), the rash appears when the temperature has not yet fallen. Although the causes of rashes may be many, including secondary syphilis. In addition, children's infections such as rubella and chickenpox in adults often occur atypically, so rashes after high fever that have appeared in an adult should be shown to the doctor.

[10], [11], [12], [13], [14]

Prevention

To warn a fever means never to be ill. This is unrealistic, especially since an increase in temperature is a protective reaction, and with a high temperature, healthy people with good immunity usually get sick. Usually such diseases end faster than a long-term subfebrile condition with unexpressed symptoms.

To easily tolerate heat, it is necessary to eat fully, move a lot, walk in the fresh air, dress in the weather and in time to sanitize the foci of chronic infection.

If the temperature rises in a person suffering from diseases of the central nervous system or blood vessels and heart, it is necessary to prevent its uncontrolled recovery and promptly seek medical help.

It is also desirable to avoid hyperthermia due to overheating, overloads and significant nervous tension. In hot weather, try to drink more pure water, wear a hat and do not stay long in the open sun.

In addition, you should always have in your home medicine cabinet a suitable remedy for the heat for yourself and your loved ones, take it with you on hikes and trips.

Forecast

In the main, each of us repeatedly suffered from diseases accompanied by high fever. The vast majority of such states have a favorable outlook.

People at risk, suffering from convulsions and diseases that lower the temperature threshold, must take timely measures, knocking down the temperature by suitable means and methods, which will also help them avoid complications.

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