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Approach to Fever

Definitions and terminology of fever

Approach to Fever

Term	Definition and characteristics
Fever	Elevated core body temperature above daily range for an individual regulated by hypothalamus Usually due to increased prostaglandin E2 (PGE2) Mediated by cytokines (eg, IL-1, IL-6, TNF) and the enzyme cyclooxygenase Temperature > 38.3o C (101o F)
Hyperthermia	Elevated body temperature rising in an uncontrolled manner that overrides the body’s ability to lose heat Can be due to exogenous heat exposure (eg, heat exhaustion) or endogenous heat production (eg, malignant hyperthermia)
Hyperpyrexia	Extraordinarily high fever (> 41.5o C) Can be due to severe infections or CNS hemorrhage
Pyrogens	Any substance that causes fever *Exogenous pyrogen* Derived from outside of the host Includes microbes or their toxins Example includes lipopolysaccharide endotoxin from gram-negative bacteria *Pyrogenic cytokines* Small proteins that regulate immune, inflammatory, and hematopoietic processes Examples include IL-1, IL-6, and TNF
Fever of Unknown Origin (FUO)	Fever > 38.3 O on several occasions for > 3 weeks in non-hospital setting Duration of fever > 1 week in hospitalized setting
Neutropenic fever	Single temperature > 38.3O C or sustained temperature > 38O C (100.4o F) *Neutropenia* Absolute Neutrophil Count (ANC) < 1500 cells/L Severe neutropenia is ANC < 500 cells/L

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