Vomiting and fever

When a symptom is associated with one specific disease, it is defined as specific. But symptoms such as vomiting and fever are nonspecific because they occur in a wide range of diseases and pathologic conditions.

Causes of the vomiting and fever

Vomiting occurs as the body's defense response, most often to endo- and exotoxins, and an increase in body temperature (fever) indicates its immune response to the infection, and a combination of these symptoms is very common.

The list of causes of vomiting and fever can be quite long, so here are the most common and some of the less obvious ones. The presence and/or absence of accompanying symptoms should be taken into account: nausea, diarrhea (diarrhea), pain - epigastric or abdominal, as we say, "abdominal pain"), and others.

The classic combination of symptoms such as vomiting, nausea, diarrhea and fever or the triad of diarrhea, vomiting and fever causes food poisoning (usually provoked by eating food that is contaminated with staphylococcal enterotoxins, [1] bacteria Escherichia coli, Salmonella enterica, Shigella dysenteriae, etc.).). [2]

Read more:

• Causes and agents of food poisoning
• Types of intestinal infections

Next is intestinal influenza, which is more properly called viral or infectious gastroenteritis. It is caused by Rotavirus of the family Reoviridae - rotavirus infection, [3], [4] Norwalk virus - norovirus of the family Caliciviridae [5] and several serotypes of ECHO viruses of the family Picornaviridae. [6]

Vomiting, diarrhea, and fever in a child are especially common with viral gastroenteritis. For more information, see. - Rotavirus infection in children

By the way, water vomiting and fever of varying intensity and duration occur not only in norovirus infection: they are possible in concussion of the brain, as well as cyclic vomiting syndrome. [7]

Cough, fever and vomiting or chills, vomiting and fever are symptoms of infection with influenza A virus [8] and parainfluenza in children. [9]

And in streptococcal tonsillitis (sore throat) and meningeal syndrome there is vomiting and fever in a child without diarrhea.

Patients with acute gastrointestinal yersiniosis, the causative agent of which is Enterobacteriaceae of the family Yersiniaceae, have vomiting, liquid stools, and fever above +38°C (with pain in the abdominal region). [10]

When there is abdominal pain, vomiting and fever, depending on the localization of the pain, there should be suspicion of:

• development of the initial stage of viral hepatitis A;
• chronic hepatitis B;
• inflammation of the gallbladder (cholecystitis) in acute form;
• Acute inflammation of the appendix - appendicitis, and the formation of an appendicular abscess;
• The presence of an acute gastroduodenal form of granulomatous enteritis, an idiopathic inflammatory disease of the GI tract known as Crohn's disease.

In cases of pelvic peritonitis with bacterial inflammation of the inner wall of the abdominal cavity, and sepsis there is nausea, vomiting, and fever with increased pulse rate.

In addition to infectious gastroenteritis and other causes listed above, vomiting and fever in an adult may be due to fibrosis of the liver parenchyma - cirrhosis, as well as due to the accumulation of metabolic products (ketone bodies or ketones) formed in the liver in the blood - alcoholic ketoacidosis.

Vomiting, fever and weakness may be signs:

• acute cholecystitis;
• acetonemic syndrome - elevated levels of ketone bodies in the blood;
• lack of hormones produced by the adrenal cortex - chronic adrenal insufficiency;
• GI malignancies.

And in the presence of headaches, these symptoms are present in the clinical picture of an inflammatory process of the brain membranes - meningitis.

Among other symptoms vomiting bile and fever are observed by pediatricians in repeated strong vomiting when the stomach is already empty - in the same poisoning and viral gastroenteritis, and by gastroenterologists - in cases of bile duct obstruction, esophageal hernia, exacerbation of reflux esophagitis (gastroesophageal reflux disease), diffuse peritonitis or the presence of retroperitoneal tumors.

In acute gastritis, particularly ulcerative gastritis; exacerbation of peptic ulcer disease of the stomach and duodenum; erosion or peptic ulcer of the esophagus; bleeding with esophageal varices; [11] stomach cancer and cirrhosis of the liver, fever and vomiting with blood (hematemesis) are among other symptoms. [12]

Vomiting without fever or diarrhea

When can vomiting occur without fever or diarrhea? In the absence of diarrhea, subfebrile or high fever, vomiting occurs in cases:

• functional gastric disorder;
• Gastroparesis - lazy stomach syndrome, which slows the rate of digestion;
• migraines; [13]
• intracranial hypertension (increased intracranial pressure);
• autonomic crises;
• excessive or insufficient production of parathormone (PGT) - hyper- or hypoparathyroidism, respectively;
• high blood urea levels - uremia (resulting from chronic kidney failure).

Abdominal pain and vomiting without fever when patients have:

• Digestive Disorders - dyspepsia; [14]
• Inflammation of the inner mucous membrane of the stomach - gastritis;
• a cystic mass in the pancreas;
• ectopic pregnancy;
• neurotic or anxiety personality disorder, and elevated stress levels, of which gastroenterologic manifestation is gastric neurosis.

Pathogenesis

The mechanism of vomiting - a protective reflex of our body - is caused by activation of the vomiting center of the medulla oblongata when the receptors of its trigger zone are irritated by impulses of dopamine, serotonin, acetylcholine and other receptors of nerve endings of the sympathetic nervous system of the GI tract (enteric nervous system). The response to these impulses is a multiple increase in contractions of smooth muscles of the digestive tract, resulting in the expulsion of contents from the stomach to the outside. [15]

The thermoregulation center located in the hypothalamus is responsible for the increase in body temperature, which raises the so-called set thermostatic point under the influence of interleukins IL-1 and IL-6. These cytokines are synthesized by activated immune cells - B- and T-lymphocytes, mononuclear phagocytes, etc. - in response to viral or bacterial infections. - in response to viral or bacterial toxins. And the body, in order to strengthen immune defense, begins to produce more heat, which promotes the production of protective proteins - interferons. [16]

Diagnostics of the vomiting and fever

To identify the causes of vomiting and fever, it is necessary to diagnose the etiologically related disease. Here, the patient history and clinical evaluation play a crucial role.

While in cases of, for example, viral gastroenteritis, diagnosis is most often based on symptoms, a clinically sound diagnosis of other diseases may require various laboratory tests, including blood tests (general and biochemical, sedimentation, leukocytes, pH, serologic tests for bacteria, antibodies, ACTH, cortisol, parathormone, etc.).), urine tests (for adrenal cortex hormones, ketone bodies, etc.), stool analysis (with bacterial culture), cerebrospinal fluid analysis.

In gastroenterologic diseases, instrumental diagnosis includes endoscopic examination of the stomach, X-ray of the stomach and duodenum, ultrasound of the gallbladder or liver, ultrasound and CT of the abdomen.

If parathormone problems are suspected, parathyroid gland x-rays are resorted to, MRI of the brain is needed to detect meningitis, etc.

Differential diagnosis is performed to make a definitive diagnosis.

Also read:

• Rotavirus infection - Diagnosis
• Diagnosis of food intoxication
• Diagnosis of functional dyspepsia

Treatment of the vomiting and fever

How to treat fever and vomiting? Treatment - except perhaps for intestinal flu and parainfluenza - is aimed not so much at eliminating these symptoms as at their causes.

Meningitis is treated differently from cirrhosis, and cholecystitis is treated differently from hyperparathyroidism, so both the overall therapeutic strategy and the choice of a specific drug are conditioned by the diagnosis.

Read more in the publications:

• Treatment of food poisoning
• Rotavirus infection - Treatment
• Treatment of intestinal infection
• Antibiotics for intestinal infection
• Medications for vomiting and diarrhea
• Treatment of dyspepsia
• Treatment of vomiting and abdominal pain in adults and children