INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH

ISSN No. : xxxx-xxxx

Volume : 01

Issue : 01

DOI : 10.5281/zenodo.8147570

Abstract

Introduction

Cite this article as : - Dr. Vaishali Nawalkar (2023), Investigations In Fever and an Overview of its Outbreak

Inter.J.Dignostics and Research1(1) 27-31 https:/doi.org/10.5281/zenodo.8147570

027

Investigations in Fever and an Overview of its Outbreak

Prof. and HOD Rog nidan and vikruti vigyan dept.

Sri Sai Institute of Ayurved Research and Medicine, Bhopal, MP

Email id: drvaishaliganorkar2@gmail.com

Dr. Vaishali Nawalkar

Fever is a common physiological response characterized by an elevation in body temperature, often indicating an

underlying medical condition. This abstract provides an overview of fever, including its causes, symptoms, and

management strategies. Fever occurs when the body's internal thermostat, located in the hypothalamus, raises the body

temperature in response to various stimuli. These stimuli can be infections caused by bacteria, viruses, or other pathogens.

Non-infectious causes such as inflammatory conditions, medication side effects, malignancies, or even physical exertion

can also trigger fever. Symptoms of fever vary depending on its underlying cause and severity. Common symptoms

include an elevated body temperature above the normal range of 36-37°C (96.8-98.6°F), chills, sweating, headache,

muscle aches, fatigue, and loss of appetite. In some cases, additional symptoms specific to the underlying condition may

also manifest. The management of fever primarily focuses on treating the underlying cause while alleviating symptoms

and providing comfort. Non-pharmacological interventions such as rest, maintaining adequate hydration, and utilizing

cooling measures like tepid sponging or cooling blankets can help reduce temperature. Over-the-counter medications like

acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to control fever and alleviate

associated discomfort. However, it is essential to follow appropriate dosing guidelines and consult a healthcare

professional, especially for children or individuals with pre-existing medical conditions.

Keywords: - Fever, Body Temperature, Diagnosis

Acute onset fever is a sudden elevation in the body

temperature a symptom of an underlying medical

condition. The major challenge confronted by the physician

is to differentiate bacterial infection and to identify other

pathogens requiring specific treatment (eg. Malaria).

Another challenge is the diagnostic and management

dilemma associated with fever in person without an

identifiable focus. According to World Health

Organization, a disease outbreak is the occurrence of cases

of diseases over what would normally be expected in a

defined community, geographical area, or season.

The extent of an outbreak may vary from a limited area to

several vast countries. The present review discusses how the

investigation needs to be carried out for a fever outbreak,

which helps in preventing a similar outbreak from happening

in the future.

Corresponding author : Dr. Vaishali Nawalkar Article Info : Published on : 14/07/2023

Publisher

ROGANIDAN VIKRUTIVIGYAN PG ASSOCIATION

FOR PATHOLOGY AND RADIODIGNOSIS

Year of Establishment – 2016

Reg. No. : MAHA-703/16(NAG)

INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH

Volume : 01 Issue : 01 DOI : 10.5281/zenodo.8147570

Myths

Fever is harmful to the body.

Brain injury is caused by fevers up to

104°F

Treatment is required for all fevers.

Only injections can bring the temperature

down.

Testing the temperature by touching the

skin is a trustworthy method.

No, fever shouldn't be treated as soon as

it manifests.

Facts

Fever is a sign of a strong immune

system and aids in the body's ability to

fight illness.

Temperatures exceeding 108°F are

dangerous for the brain, and temperatures

below this rarely cause injury.

Treatment is only necessary if the

temperature makes the patient

uncomfortable (often >102°–103°F).

Most of the time, oral analgesics and oral

medications for fever reduction are

sufficient.

Not really

Fever, however, boosts the body's ability to fight

against infections and slows the growth of

microorganisms.

Salient factors are to be considered in a case of fever. The

following factors need to be considered in a patient

presenting with acute fever.

•Presence of any risk factor (eg: receiving chemotherapy

or having immunosuppression)

•Any danger signs.

•Presence of diagnostic focus.

•Age group to which child belongs (0 to 28 days, 1 to 3

months, and 3-36 months or above) The general rule

followed in clinical practice is that if the fever > 105’F,

the most probable cause is a bacterial infection.

However, there are exceptions like influenza and

adenoviral infection which can cause fever > 105’F.

Danger Signs

It is paramount to identify life-threatening signs such as

reduced level of consciousness and difficulty in

breathing the ABCD red flag signs to be noted are:

A - arousal, alertness, activity

B - breathing, difficulty

C - color and circulation

D - decreased intake and urine output

Focus of Infection

If the focus is present, all investigations are directed

towards the confirmation of the focus of infection some

of the examples are listed below:

•X-ray for chest findings a suspected case of pneumonia

or respiratory distress.

•Urine routine and culture analysis for urinary

symptoms.

•Splenomegaly, especially in an endemic area -

peripheral blood smear / rapid test for malaria.

Fever without focus is the most confusing and difficult

situation. Bacteremia, urinary tract infection (UTI), and

pneumonia are the most common severe bacterial

infection in infants that may not be clinically apparent.

The choice of the worker depends on the pace and

severity of the illness. The Investigation must be done in

all these sick children without focus by 72 hours if the

fever doesn't subside.

Material & Methods

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INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH

Volume : 01 Issue : 01 DOI : 10.5281/zenodo.8147570

Investigations

•Complete Hemogram

The white blood cell (WBC) count with differential count

is the most commonly preferred test in the hemogram.

Value < 5000 and > 15,000/cumm suggest an abnormal

finding. In nearly 50% of children with bacteremia esp.

with Haemophilus influenza type b (HIB), the WBC

range is between 5000 to 15,000/cumm. The researchers

have noted higher WBC values in UTI infection. •

Inflammatory markers: C reactive protein (CRP) and

procalcitonin

CRPF and procalcitonin are the commonly used acute-

phase reactants. The increased CRP level is noticeable

only after 12 hours after the onset of fever and the

elevated levels are noted both in viral and bacterial

infection. CRP >80mg/L and procalcitonin > 2ng/L help

in identifying severe bacterial infection with 40 to 50%

sensitivity and 90% specificity.

• Chest X-ray

Pneumonia is useful in detecting complications such as

effusions and empyema.

• Blood culture

Blood culture is another gold standard test in acute fever

management, and it should be done before initiation of

antibiotic treatment. Preliminary results are available

within 24 to 48 hours of culture. Negative blood result

from prior antibiotic use missing the bacteremic episode.

Therefore, sending a blood culture before the initiation of

antibodies should be implemented in routine practice.

Blood culture is usually negative in subjects who are

already on antibiotics.

·CSF exam for sick infants without localization

CSF exam is indicated in children less than 28 days

without any signs and symptoms of neurologic

complications. It is also recommended in children with

sepsis and localized on CNS.

· Serology

For dengue, the commonly performed diagnostic test are

NS1, antigen IgM and IgG. Widal agglutination test in

clinical practice is plagued by controversy. The

possibility of false positive findings is higher due to

repeated exposure to salmonella typhi in the endemic

zone and the cross-reactiveness of the non-salmonella

antigen. Even if a widal test has to be performed it should

be done after one week of exposure. It is no longer

acceptable as the clinical method of diagnosis and the test

has to be repeated after 4 weeks to demonstrate a rise in

titers. For malaria as per the Government of India policy,

only the IgM test has to be performed. The finding should

be corporate by conducting a peripheral blood smear

which is still considered to be the golden standard. The

golden standard test for rickettsia disease is the indirect

immunoperoxidase test immunofluorescence test and

PCR. The microagglutination test (MAT) is considered

the golden standard for leptospirosis.

· USG/Echo

Ultrasonography (USG) of the abdomen assists in

identifying hidden findings even in the early stages of the

disease, especially in a patient with localizing signs and

symptoms. In patients with a typical or incomplete

Kawasaki disease, it is wise to perform early

echocardiography to detect coronary artery

abnormalities.

·Urine analysis and culture

It is necessary to inform the patients to catch clean,

midstream urine. The urine analysis is considered one of

the gold standard tests for acute fever evaluation.

· Stool analysis

It is recommended only if diarrhea is present and is

considered a focus of infection. The presence of blood in

the stool is indicative of a bacterial infection in the

presence of a fever.

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INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH

Volume : 01 Issue : 01 DOI : 10.5281/zenodo.8147570

Results/observations

Investigating a fever outbreak is necessary to identify the

source of illness and to formulate guidelines on public

health intervention. An outbreak can be recognized

through surveillance activities like integrated disease

surveillance programs (IDSP) and by analyzing the

reports of clinicians laboratories press and the media.

A battery of tests are available for the evaluation of acute

fever however the judicious selection of the appropriate

test is mandatory. In most cases, clinical and investigative

revaluation at the end of 24 hours gives a better

understanding of the associated problem. Investigations

help in identifying risk factors associated with the

outbreak and providing newer research insights on the

emerging pathogen only by participating in

investigations repeatedly public health professionals can

learn the 8-step process of outbreak investigations. This

paper provides a summary of investigations into fever.

A battery of tests are available for the evaluation of acute

fever however the judicious selection of the appropriate

test is mandatory.

Conclusion

The key objective of outbreak investigation are :

• To control ongoing outbreaks and prevent future

outbreaks.

• To provide statutorily mandated services.

• To strengthen surveillance at a local level.

• To advance knowledge about a disease.

• To provide training opportunities.

Investigations into outbreaks take the following

steps:

1. Confirm the epidemic and the diagnosis.

2. Establish a case and carry out case research.

3. Compile and organize time, place, and person data.

4. Implement prompt preventative measures.

5. Construct and examine a hypothesis.

6. Arrange and carry out additional research.

7. Put controls in place and assess them.

8. Share your results.

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blic_health_pin The infectious etiologies of curves e.htm

In most cases, clinical and investigative revaluation at the

end of 24 hours gives a better understanding of the

associated problem. Investigations help in identifying

risk factors associated with the outbreak and providing

newer research insights on the emerging pathogen only

by participating in investigations repeatedly public health

professionals can learn the 8-step process of outbreak

investigations. This paper provides a summary of

investigations into fever.

References

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INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH

Volume : 01 Issue : 01 DOI : 10.5281/zenodo.8147570

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