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===Definition===
===Definition===
*Defined as [[Celsius Fahrenheit Temperature Conversion|temperature]] ≥38°C (100.4°F).  
*Defined as [[Celsius Fahrenheit Temperature Conversion|temperature]] ≥38°C (100.4°F).  
*Peripheral temperature is not clinically accurate and central measurements are the preferred means of determining fever.<ref>Niven DJ, Gaudet JE, Laupland KB, Mrklas KJ, Roberts DJ, Stelfox HT. Accuracy of Peripheral Thermometers for Estimating Temperature: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;163(10):768-777. doi:10.7326/M15-1150.</ref>
*Peripheral temperature is not clinically accurate and central measurements are the preferred means of determining fever.
**Rectal or oral
**Rectal temperatures should not be performed in neutropenic patients<ref>Niven DJ, Gaudet JE, Laupland KB, Mrklas KJ, Roberts DJ, Stelfox HT. Accuracy of Peripheral Thermometers for Estimating Temperature: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;163(10):768-777. doi:10.7326/M15-1150.</ref>


==Clinical Features==
==Clinical Features==
 
*Fever directly causes an increase in:<ref>Davies P, Maconochie I. The relationship between body temperature, heart rate and respiratory rate in children. Emerg Med J. 2009 Sep;26(9):641-3. doi: 10.1136/emj.2008.061598.</ref>
**Heart rate: 10 beats per minute per degree centigrade
**Respiratory rate


==Differential Diagnosis==
==Differential Diagnosis==
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===DDx by Heart Rate===
===DDx by Heart Rate===
''Every 0.55°C increase in temperature should → increase HR by ~10BPM
''Every 0.55°C increase in temperature should → increase HR by ~10BPM
#Relative bradycardia
*If patient has relative bradycardia, consider:
## Concomitant medication
**Concomitant medication
## Drug fever
**Drug fever
## [[Typhoid Fever]]
**[[Typhoid Fever]]
## Brucellosis
**Brucellosis
## [[Leptospirosis]]
**[[Leptospirosis]]
#Frank bradycardia
*If patient has frank bradycardia, consider:
## [[Rheumatic Fever]]
**[[Rheumatic Fever]]
## [[Lyme Disease]]
**[[Lyme Disease]]
## Viral Myocarditis
**Viral Myocarditis
## [[Endocarditis]]
**[[Endocarditis]]


==Diagnosis==
==Evaluation==
See individual notes for specific workup:
===General Approach===
*[[Fever and Rash]]
*History: duration, recent travel, sick contacts, immunocompromised status, medications, recent procedures/hospitalizations, indwelling devices
*[[Fever of Unknown Origin]]
*Physical exam: systematic search for source — HEENT (sinuses, pharynx, ears, dental), lungs, heart, abdomen, skin/wounds, GU, joints, spine
*[[Neutropenic Fever]]
*Not all fevers require a workup — well-appearing immunocompetent adults with clear viral URI symptoms may need only supportive care
*[[AIDS Fever of Unknown Origin]]
===Workup (when indicated)===
*[[Heat Emergencies]]
*Basic: CBC with differential, BMP, urinalysis, blood cultures (x2 if concern for bacteremia), CXR
*[[Fever in Traveler]]
*Additional based on suspicion:
**Lactate, procalcitonin — if sepsis suspected
**[[Lumbar puncture]] — if meningitis/encephalitis suspected
**CT imaging — guided by suspected source (abdomen/pelvis for abdominal source, CT chest for pulmonary, CT head if AMS)
**LFTs, lipase — if hepatobiliary or pancreatic source suspected
**Joint aspiration — if septic arthritis suspected
**Wound cultures — if skin/soft tissue infection
===Special Populations Requiring Lower Threshold for Workup===
*See [[Pediatric fever of uncertain source]] for infants and children
*See [[Neutropenic fever]] for oncology patients
*See [[AIDS fever of unknown origin]] for HIV/AIDS patients
*See [[Fever in traveler]] for returned travelers
*See [[Fever and rash]] for fever with associated rash


==Management==
==Management==
*Antipyretics:
**[[Acetaminophen]] 650-1000 mg PO/IV q4-6h (max 4g/day)
**[[Ibuprofen]] 400-800 mg PO q6-8h
**Antipyretics improve comfort but do not treat the underlying cause
**Fever itself is generally not harmful in immunocompetent adults (except in [[hyperthermia]] where temperature >41C/106F can cause organ damage)
*Treat the underlying condition:
**Empiric antibiotics if bacterial infection suspected — do not delay for cultures
**Source control (I&D of abscesses, removal of infected lines/devices)
**See specific disease pages for targeted management
*Fluid resuscitation: Fever increases insensible losses; ensure adequate hydration
*Avoid "fever phobia": In immunocompetent patients, aggressive fever treatment is not required and may mask clinical trends


==Disposition==
*Admit:
**Suspected sepsis or bacteremia
**Immunocompromised with fever (neutropenic fever)
**Hemodynamic instability
**Identified source requiring IV antibiotics or surgical intervention
**Unreliable follow-up with concerning clinical picture
*Discharge:
**Well-appearing with clear viral syndrome
**Identified source amenable to outpatient treatment (uncomplicated UTI, mild cellulitis)
**Reliable follow-up with clear return precautions
**Return precautions: worsening symptoms, inability to tolerate PO fluids, rigors, altered mental status


==See Also==
==See Also==
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*[[Environmental heat diagnoses]]
*[[Environmental heat diagnoses]]
*[[Fever in traveler]]
*[[Fever in traveler]]
==External Links==


==References==
==References==
<references/>
<references/>


[[Category:Symptoms]]
[[Category:ID]]
[[Category:ID]]

Revisión actual - 09:41 22 mar 2026

Background

Definition

  • Defined as temperature ≥38°C (100.4°F).
  • Peripheral temperature is not clinically accurate and central measurements are the preferred means of determining fever.
    • Rectal or oral
    • Rectal temperatures should not be performed in neutropenic patients[1]

Clinical Features

  • Fever directly causes an increase in:[2]
    • Heart rate: 10 beats per minute per degree centigrade
    • Respiratory rate

Differential Diagnosis

<translate>

Fever

Infectious


Non-infectious

</translate>

DDx by Heart Rate

Every 0.55°C increase in temperature should → increase HR by ~10BPM

Evaluation

General Approach

  • History: duration, recent travel, sick contacts, immunocompromised status, medications, recent procedures/hospitalizations, indwelling devices
  • Physical exam: systematic search for source — HEENT (sinuses, pharynx, ears, dental), lungs, heart, abdomen, skin/wounds, GU, joints, spine
  • Not all fevers require a workup — well-appearing immunocompetent adults with clear viral URI symptoms may need only supportive care

Workup (when indicated)

  • Basic: CBC with differential, BMP, urinalysis, blood cultures (x2 if concern for bacteremia), CXR
  • Additional based on suspicion:
    • Lactate, procalcitonin — if sepsis suspected
    • Lumbar puncture — if meningitis/encephalitis suspected
    • CT imaging — guided by suspected source (abdomen/pelvis for abdominal source, CT chest for pulmonary, CT head if AMS)
    • LFTs, lipase — if hepatobiliary or pancreatic source suspected
    • Joint aspiration — if septic arthritis suspected
    • Wound cultures — if skin/soft tissue infection

Special Populations Requiring Lower Threshold for Workup

Management

  • Antipyretics:
    • Acetaminophen 650-1000 mg PO/IV q4-6h (max 4g/day)
    • Ibuprofen 400-800 mg PO q6-8h
    • Antipyretics improve comfort but do not treat the underlying cause
    • Fever itself is generally not harmful in immunocompetent adults (except in hyperthermia where temperature >41C/106F can cause organ damage)
  • Treat the underlying condition:
    • Empiric antibiotics if bacterial infection suspected — do not delay for cultures
    • Source control (I&D of abscesses, removal of infected lines/devices)
    • See specific disease pages for targeted management
  • Fluid resuscitation: Fever increases insensible losses; ensure adequate hydration
  • Avoid "fever phobia": In immunocompetent patients, aggressive fever treatment is not required and may mask clinical trends

Disposition

  • Admit:
    • Suspected sepsis or bacteremia
    • Immunocompromised with fever (neutropenic fever)
    • Hemodynamic instability
    • Identified source requiring IV antibiotics or surgical intervention
    • Unreliable follow-up with concerning clinical picture
  • Discharge:
    • Well-appearing with clear viral syndrome
    • Identified source amenable to outpatient treatment (uncomplicated UTI, mild cellulitis)
    • Reliable follow-up with clear return precautions
    • Return precautions: worsening symptoms, inability to tolerate PO fluids, rigors, altered mental status

See Also

External Links

References

  1. ↑ Niven DJ, Gaudet JE, Laupland KB, Mrklas KJ, Roberts DJ, Stelfox HT. Accuracy of Peripheral Thermometers for Estimating Temperature: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;163(10):768-777. doi:10.7326/M15-1150.
  2. ↑ Davies P, Maconochie I. The relationship between body temperature, heart rate and respiratory rate in children. Emerg Med J. 2009 Sep;26(9):641-3. doi: 10.1136/emj.2008.061598.
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