Fever

Symptoms

DEFINITION

• Fever is the only symptom

Fever can be defined using one of the following measurements:

• Oral temperature greater than 99.5° F (37.5° C)
• Ear (tympanic) temperature greater than 100.4° F (38.0°C)
• Rectal temperature greater than 100.4°F (38.0°C)
• Forehead temperature strips are unreliable

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General Information

• In most clinical situations, fever does no major harm, and may actually benefit the human body by helping it to fight off infection. Nevertheless, fever is an abnormal finding. It can signal a serious illness, especially in adults who are old, frail, or have a weakened immune system.
• Adults tend to run lower fevers than children. Fever may be further blunted or even absent in elderly patients.
• Fever itself can cause muscle aches, nausea, lightheadedness, weakness and headache.

Normal Body Temperature

• 98.6° F (37°C) is the oral temperature that most physicians, nurses, laypersons, and medical references state is "normal."
• The average temperature of healthy elderly patients is the same as younger adults. However, there is some data to suggest that the average temperature in chronically ill elderly patients is lower than that of other healthy adults. Thus, interpretation of a temperature reading in a chronically ill elderly adult must be done with caution. Because lower baseline temperatures can be expected in this group of patients, it may be easy to miss a fever if the conventional fever definition is used.

Normal Variations in Body Temperature

• There is a normal daily awake-sleep cycle variation in temperature, with the low occurring at 6 AM and the high occurring at 6 pm. The low and high temperatures vary by 0.9° F (0.6° C).
• In women, temperature increases about 0.9° F (0.6° C) at the time of ovulation.
• Temperature can go up in response to physical activity, particularly during hot weather.

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See More Appropriate Topic (instead of this one) If

• Any other symptom is present with the fever (See that topic; e.g. COLDS, COUGH, SORE THROAT, EARACHE, DIARRHEA, VOMITING, etc.)

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FIRST AID Advice for Shock: Lie down with the feet elevated.

Should I Call?

WHEN TO CALL YOUR DOCTOR

Call 911 Now (you may need an ambulance) If

• Difficult to awaken or acting confused
• Very weak (can't stand)
• Severe difficulty breathing (e.g., struggling for each breath, unable to speak)
• Lips or face are blue
• Rash with purple (blood-colored) spots or dots

Call Your Doctor Now (night or day) If

• You feel weak or very sick
• Fever of 103° F (39.4° C) or higher
• Fever of 100.5° F (38.1° C) or higher and you:
  • Are over 60 years of age OR
  • Have diabetes mellitus or a weakened immune system (e.g., HIV positive, cancer chemotherapy, chronic steroid treatment, splenectomy) OR
  • Are bedridden (e.g., nursing home patient, stroke, chronic illness, recovering from surgery) OR
  • Are a transplant patient (e.g., liver, heart, lung, kidney)
• Headache and stiff neck (can't touch chin to chest)
• Difficulty breathing
• Signs of dehydration (e.g., no urine in more than 12 hours, very dry mouth, lightheaded, etc.)
• Have an intravenous catheter (e.g., central line, PICC, or peripheral intravenous line)

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

• You think you need to be seen
• Fever of 100.5° F (38.1° C) or higher and you have traveled to a foreign country in the last month
• Fever lasts longer than 3 days (72 hours)

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns

Self Care at Home If

• Fever with no signs of serious infection and you don't think you need to be seen

Care at Home

HOME CARE ADVICE FOR FEVER

1. Reasurance: The presence of a fever usually means that you have an infection. Most fevers are good and help the body fight infection. The goal of fever therapy is to bring the fever down to a comfortable level. Use the following definitions to help put the level of fever into proper perspective:
   • 100-102 F (37.8 - 38.9 C): Low-grade fevers and may help body fight infection.
   • 102-104 F (38.9 - 40 C): Moderate-grade fevers; cause discomfort.
   • Over 104 F (over 40 C): High fevers; cause discomfort, weakness, headache, lethargy.
   • Over 107 F (over 41.7 C): The fever itself can be harmful.
2. For All Fevers:
   • Drink cold fluids orally to prevent dehydration (Reason: good hydration replaces sweat and improves heat loss via skin). Adults should drink 6-8 glasses of water daily.
   • Dress in one layer of lightweight clothing and sleep with one light blanket.
   • For fevers 100-101° F (37.8-38.3° C), this is the only treatment and fever medicine is unnecessary.
3. Fever Medication:
   • For fevers above 101° F (38.3° C) take acetaminophen or ibuprofen. The goal of fever therapy is to bring the fever down to a comfortable level. Remember that fever medicine usually lowers fever 2 degrees F (1 - 1 1/2 degrees C).
   • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
   • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
   • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
   • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
   • CAUTION: Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take.
4. Lukewarm Shower for Reducing Fever: Take the fever medicine first. Take a lukewarm shower or bath for 10 minutes. Lukewarm water should be warm enough that it does not make you shiver, but cold enough that it helps cool you off and reduce your temperature. Do not sponge yourself with rubbing alcohol.
5. Expected Course: Most fevers from a viral illness such as a cold fluctuate between 99.5 and 103° F (37.5 - 39.5° C) and last for 2 or 3 days.
6. Contagiousness: You can return to work or school after the fever is gone.
7. Call Your Doctor If:
   • Fever lasts longer than 3 days (72 hours)
   • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Photo Example

Rocky Mountain Spotted Fever

This photo shows the lower legs of a patient with the the typical rash of Rocky Mountain Spotted Fever.

There is a wide spread red rash (red spots). There are also some petechiae (very small red-purple spots that don't blanch when you push on them).

First Aid - Heat Exhaustion

• Move to a cool shady area. If possible, move into an air-conditioned place.
• Remove excess clothing or equipment (e.g., sports gear).
• Lie down with the feet elevated.
• Sponge the entire body surface continuously with cool water (as cool as tolerated without shivering). Fan the victim to increase evaporation.
• Give the victim cold water or sports drink (e.g., Gatorade). 

Scarlet Fever Rash

The photo shows the typical Scarlet Fever rash on the forearm.

The scarlet fever rash first appears as tiny red bumps on the chest and abdomen that may spread all over the body. Looking like a sunburn, it feels like a rough piece of sandpaper, and lasts about 2-5 days.

Scarlet fever is a disease caused by the same bacteria (Streptococcus) that causes strep throat. A person with Scarlet fever has a throat that is red and sore, usually a fever, usually swollen glands in the neck, and a Scarlet fever rash.

Source: CDC PHIL

From the CDC's Public Health Image Library (http://phil.cdc.gov/), ID#5163, in the public domain.