Fever

1.  Fever = Temperature โ‰ฅ100.6ยฐ F (โ‰ฅ38.0ยฐ C).  Fever itself does no harm; it’s the disease causing the fever that may / may not be dangerous.

Covid-19 During Pandemic:  Every setting has its own way to address โ€œfeverโ€ without letting patients mingle inside, & doing a Covid test.  But we can’t send a patient off for this if they might die.

1a.  We send patient to E.R. by ambulance if we have concern for:

  • Septic Shock  —  low blood pressure, very rapid pulse, clammy skin
  • Meningitis —  fever + severe headache & stiff neck, or simply confused
  • Cyanosis  —  fingers look bluish; worse if lips or face
  • Short of Breath  —  oxygen saturation โ‰ค90%, breathing 30 times / min., respiratory retractions (skin sucks in with each breath: over collarbones, bottom of trachea, or between ribs)

1b.  If none-of-above, but patient looks / feels very ill, we give high-dose acetaminophen (Tylenolยฎ): 1300 mg for adults, 10 mg/lb. for children.  If 45 min. later, maybe fever declines but patient looks / feels the same, we send to E.R.  Most patients look & feel lots better, helping our diagnosis.

2.  Fever for 3 Days or Less  (and patient looks OK in general)  —

2a.  If localizing symptom (e.g. sore throat, ear pain, kidney pain, etc.), infection there is the likely cause. We examine it / do standard tests (e.g. urinalysis for kidney pain, etc.).

2b.  If there are no specific symptoms except feeling lousy, generalized achiness, maybe a headache (especially when the fever goes up), we diagnose โ€œInfluenza” / “Virus, unless thereโ€™s reason to wonder about uncommon, often life-threatening, illnesses:

  • Malaria — foreign travel in rural tropics during the last 40 days
  • Rocky Mountain Spotted Fever — fever + headache, April to Sept., in southeastern US
  • Meningococcemia — new spotty rash, esp. if don’t briefly lose color if pressed upon (petechiae)
  • Endocarditis — injects drugs, artificial or abnormal heart valve, history of Endocarditis
  • Measles, Mumps, Chickenpox — foreign travel; recent outbreak / exposure (not life-threatening; and are nowadays rare)
  • Diabetic Ketoacidosis — very thirsty; drinking & urinating lots; deep rapid breathing beyond what’s expected with fever  (diagnosed by simple urine test)
  • AIDS — known HIV+ and not on medicine; OR risk factors without recent HIV test
  • Stevens-Johnson / Toxic Epidermal Necrolysis / Toxic Shock — skin pain, muscle pain stronger than common viral aches; scattered blisters or โ€œsunburn,โ€ esp. if inside mouth / eyes / vagina
  • Acute (Primary) HIV — if risk for having been infected in the past month (not life-threatening)
  • Peritonitis — fever plus new abdominal pain that’s getting worse
  • Persons with weak immune systems — elderly, alcoholics, serious chronic illnesses, etc.

For the above possibilities, we do the tests necessary (see links to the diseases)

Covid-19 — Everyone with a fever gets a Covid test. We can’t say “just a virus” otherwise

  • If negative, but other symptoms like body aches  โ†’ isolate and repeat test in 2 days

3.  Fever โ‰ฅ4 Days  (without starting to feel any better at all) — we order tests

4.  Fever >1-2 Weeks  (very rare)

  • All tests as above in #3
  • Blood cultures for Endocarditis (heart infection)
  • CT Scan of abdomen & pelvis (for deep abscesses, cancer)
  • Think about non-infectious diseases that can cause fever (cancer, blood clots, certain inflammatory diseases like arthritis etc.)
  • Consult an Infectious Disease specialist

See also Fever — Full Text for more in-depth explanations and discussions.

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