1. Section III Common Symptoms (fever) Dr. Zhuoren Lu First Hospital Xian Jiaotong University

2. Concepts  symptoms: subjective disturbances, for instance headache, chest pain, abdominal pain, dyspnea, cough, palpitation, nausea, vomiting, and so on.  physical signs: objective marks, for example fever, edema, cyanosis, jaundice, diarrhea, confusion, coma, skin eruption, scar, murmur and so on.  In a board sense, both subjective and objective abnormal could be called as symptoms.

3. A. Fever (pyrexia) 1. Definition: Fever represents a disturbance in which there is upward shift of the body ’ s temperature. The normal body temperature taken in the mouth, is closed to 37 ℃ (36.3  37.2 ℃ ). Oral temperature recordings is approximately equal to simultaneous rectal temperature reading.  The temperature of the skin of the axilla is slight lower(0.2  0.4 ℃ ) than that in the mouth.

4. 2. Physiology: An individual ’ s baseline temperature varies (less than 1 ℃ ) (lowest in the morning), activity (exercise), physiological events (ovulation), and habit (smoking).  Eldly has lower baseline temperature and often produce less fever response.

5. 3. Clinical classification  low fever: 37.4  38 ℃  middle fever: 38.1  39 ℃  high fever: 39.1  41 ℃  excessively high temperature (hyperpyrexia): above 41 ℃

6. 4. Type of fever (1) Continus (persistent) fevers: Fever curve shows the high temperature from 39  40 ℃ may continue for days or weeks with fluctuation less than 1 ℃ between morning and evening (typhoid)

7. (2) Remittent fevers: It is similar to continuous fever, but the swing of temperature is greater than 2 ℃ and the temperature does not fall to normal (rheumatic fever).

8. (3) Intermittent (periodic) fevers: The temperature rises every second or third day at approximately the same time. The temperature rises abruptly to about 40 ℃ for a few hours only and then falls abruptly to normal or below(malaria).

9. (4) Undulant fevers: The temperature chart shows rises up to 39  40 ℃, lasting for 7  14 days, falling to normal for about the same period but recurring over many weeks or months.

10. (5) Relapsing (recurrent) fevers: The temperature rises abruptly to 39 ℃ or above for a few days and then falls abruptly to normal (Hodgkin’s disease).

11. (6) Irregular fevers: The fever curve is irregular (bronchopneumonia).

12. 5. Etiology (1) Infections by various infectious agents (bacteria, viruses, fungi):the most common causes (2) Fever frequently occurs in many noninfectious illness (most of the cases with low fever), including connective tissue disorders, hypersensitive reaction, neoplastic diseases, hemorrhage, and thromboembolic diseases.

13. 6. Symptoms and signs of fever (1) Rigor or shivering attack is common at the beginning of many fevers. (2) Rash, especially in childhood and infectious diseases. Also, the various special rashes are very important in differential diagnosis. (3) Tachycardia: In typhoid fever the pulses rarely above 110 beats/min in the second week, when the temperature may average 40 ℃.