Fever

I decided to discuss fever, because both lassa fever and corona virus present with fever as the first symptom. We are not praying for corona virus to come to Nigeria, but it is good to know as Minister of Health stated on Wednesday February 12, 2020, that Nigeria has equipped 3 centres that can diagnose corona virus.

We know that death from lassa fever is now put at 70, while suspected cases increased from 700 to 1,708. Confirmed cases are now put at 402, and still counting. Since fever is the first symptom of both diseases, let us educate ourselves on fever.,

• Do you know that some fevers are necessary to the body? This is a medical statement of fact. Yes some fevers are protective to the functions of the body’s mechanism. Confusing isn’t it? Not to talk of now that lassa fever is practically rampaging us in Nigeria , we must all know what steps to take when we have persistent and unexplained fevers. Let us begin from the beginning.

What is fever?

• Fever, an elevation of body temperature above 37^C(100^F) is actually a protective response to infection and injury. The elevated body temperature enhances the body’s defence mechanism while causing relatively minor discomfort for the person. Fever is also known as pyrexia and febrile response – is defined as having a temperature above normal range.

• Normally, body temperature goes up and down each day. It is lowest at about 6am (36.5^C/98.6^F), and highest from 4 to 6pm (37.5^C/100.5^F). Fever may follow a pattern in which the temperature peaks each day and then returns to normal, whenever this does not occur then we have fever.

• A fever is usually accompanied by sickness behaviour, which consists of lethargy, depression, anorexia, sleepiness and hyperalgesia.

• Certain people, for example alcoholics, the very old, and the very young, may have a drop in temperature as a response to severe infection, that is why we medically advise that they be covered with warm clothes, especially during cold seasons, because they could have fever without their body showing it.

• Substances that cause fever are called pyrogens, and may come from inside or outside the body. External pyrogens include microorganism like bacteria, ebola, corona or lassa viruses, they produce toxins that cause fever. Internal pyrogens include white blood cell – monocytes that are stimulated to produce toxins.

How do we diagnose fever?

• The investigation of any body with prolonged fever, must follow the standard procedure established by Oxford University handbook first published in 1850. This follows four main laid down stages. 1) History. 2) Examination. 3) Investigation. & 4) Evaluation.

NB – this procedure is not followed during outbreaks of epidemics like Lassa, but we follow what we call “barrier investigative procedure”, and this  is employed for the protection of the medical personnel.

Stage I – History.

   A thorough history of the patient suffering from fever must be taken. Special note must be taken of foreign travels, contact with animal, bites, cuts, surgery, rashes, occasional mild diarrhoea, pleurisy, drugs(including non prescription) and immunization. Also excessive sweats, weight loss, lumps, and itching.

Stage II – Examination.

   Examination should be thorough and repeated. On examination, is the patient ill-looking, alert, dehydrated, cyanosed, shocked, anemic, feverish, jaundiced, fat, wasted, tremulous. Note: any skin lesions, lymphadenopathy, enlarged liver and spleen, rectal and vaginal examination, oro-pharyngeal examination.

Stage III – Investigations.

    Collect first blood sample and send to Centre for Disease Control ( CDC) to rule out lassa, ebola and corona viruses.

   Part One – the first day, in the investigation of prolonged fever, we do FBC, ESR, U & E, LFT, blood cultures, baseline serum for virology. Swab nose and throat. Stool sample. CXR. If patient is very ill, we consider treatment for septicaemia. All the abbreviations are known by the lab-man.

   Part Two – If diagnosis of the fever is still uncertain, after reviewing the collated results, we re-do history and examination. Also do tests for rheumatoid factor, ANF, antistreptollysin, tuberculin test, ECG. We then consider withholding drugs one at a time for 48 hours each. Then we consider lumbar puncture for culture.

   Part Three – We now consider further investigation of abdomen: ultrasound, Barium enema, IVU, liver biopsy, laparotomy.

   Part Four – Then we consider treating for tuberculosis, polyartiritis nodosa, infective endocarditis.

Stage IV – Evaluation.

If the results of these investigations and all the trial treatments turn out negative, by the fever still continuing, we wait for 7 days and repeat the process of trying to identify the cause of the prolonged fever. If still negative, then keep the patient under strict observation and monitor the temperature spikes. Researches have shown that before we reach stage – iv, in our diagnostic inquest for fever, over 97% of what caused the fever had been identified.

Now, just reflect on the rigours of identifying the cause of a simple fever, then you will agree with the advertisers of analgesic, which states – take two tabs three times a day, if symptoms persist after 3-days, consult your doctor. Always manage your fever well.

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