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Fever
1277
Infectious Diseases
body are not pyrogens but are capable of stimulating endogenous pyrogens. Such substances include antigenantibody complexes in the presence of complement, complement components, lymphocyte products,
bile acids, and androgenic steroid metabolites.
Exogenous pyrogens or substances that come from outside the body
include mainly infectious pathogens and drugs. Microbes, microbial
toxins, or other products of microbes are the most common exogenous
pyrogens and stimulate macrophages and other cells to produce endogenous pyrogens. Endotoxin is one of the few substances that can
directly affect thermoregulation in the hypothalamus as well as stimulate endogenous pyrogen release.
Many drugs cause fever, and the mechanism for increasing body
temperature varies with the class of drug. Drugs that are known to
cause fever include vancomycin, amphotericin B, and allopurinol.
Heat production exceeding heat loss is the second mechanism that
leads to fever, with examples including salicylate poisoning and malignant hyperthermia. Defective heat loss is the third mechanism of fever
genesis; for example, in children with ectodermal dysplasia or victims
of severe heat exposure.
ETIOLOGY
Chapter
176
Fever
Linda S. Nield and Deepak Kamat
DEFINITION
PATHOGENESIS
Table 176-1
INFECTIOUS CAUSES
Relapsing fever (Borrelia recurrentis)
Trench fever (Bartonella quintana)
Q fever (Coxiella burnetii)
Typhoid fever (Salmonella typhi)
Syphilis (Treponema pallidum)
Tuberculosis
Histoplasmosis
Coccidioidomycosis
Blastomycosis
Melioidosis (Pseudomonas pseudomallei)
Lymphocytic choriomeningitis (LCM) infection
Dengue fever
Yellow fever
Chronic meningococcemia
Colorado tick fever
Leptospirosis
Brucellosis
Oroya fever (Bartonella bacilliformis)
Acute rheumatic fever
Rat bite fever (Spirillum minus)
Visceral leishmaniasis
Lyme disease (Borrelia burgdorferi)
Malaria
Babesiosis
Noninfluenza respiratory viral infection
Epstein-Barr virus infection
NONINFECTIOUS CAUSES
Behet disease
Crohn disease
Weber-Christian disease (panniculitis)
Leukoclastic angiitis syndromes
Sweet syndrome
Systemic lupus erythematosus and other autoimmune disorders
PERIODIC FEVER SYNDROMES (see Chapter 163)
Familial Mediterranean fever
Cyclic neutropenia
Periodic fever, aphthous stomatitis, pharyngitis, adenopathy
(PFAPA)
Hyperimmunoglobulin D syndrome
Hibernian fever (tumor necrosis factor superfamily immunoglobulin
Aassociated syndrome [TRAPS])
Muckle-Wells syndrome
Others
CLINICAL FEATURES
Chapter 176
Table 176-2
EVALUATION
Fever
1279
MANAGEMENT