Healthy person is a constant value, with slight fluctuations in tenths of a degree, then its increase on a more significant scale always indicates the presence inflammatory processes in the body, including those of an infectious nature. The level of warmth of the human body in dynamics is called the temperature curve, which is often equated with fever (a temporary rise in temperature).

The graphical plotting of the patient's temperature curve plays essential in making a diagnosis and making predictions, and also necessary for objective assessment the course of the disease. Body temperature is measured at least twice a day: in the morning and evening hours, and at the height of an infectious disease - several times a day.

What are the types of temperature curves?

They are distinguished depending on the degree of increase. There are the following types of temperature curves: subfebrile - not exceeding 38 ° C, medium or moderate - 39 ° C, pyretic - up to 41 ° C, superpyretic - over 41 ° C (extremely rare).

The types of temperature curves for infectious diseases determine the classification of fever depending on the degree of daily temperature fluctuations. We list these types of fever (types of temperature curves): constant, laxative, intermittent, exhausting, recurrent, wavy and inverse.

Characteristic of persistent fever

It is observed in infectious diseases such as abdominal and pneumococcal pneumonia. Graphically persistent fever displayed as trapezoidal types temperature curves, characteristic feature which is the fluctuation in body temperature by no more than 1 °, while the body temperature for a long time remains on high level- in the region of 39 °. As the disease recedes, the temperature curve can decrease both abruptly and gradually.

Characteristics of relapsing fever

Laxative types of temperature curves are observed with purulent diseases, catarrhal pneumonia, as well as with tuberculosis. The body temperature also remains at a high level, however, unlike a constant fever, in this case, the amplitude of fluctuations in morning and evening temperatures reaches 2 degrees, thus dropping to 38 ° C, but not returning to normal values.

Intermeting fever

Intermeting, or laxative, fever most often expresses the type of temperature curve of malaria. It is accompanied by sharp increases in body temperature (febrile condition), which are replaced by afebrile periods, that is, with normal temperature indicators. The time intervals between attacks of febrile condition can last from one to 3 days, while the patient feels chills when the temperature rises, and when it decreases, there is pronounced sweating.

A laxative fever cannot unconditionally indicate the presence of malaria in a patient, this type of febrile condition is actually inherent in many infectious diseases, such as recurrent epidemic typhus, focal purulent infections, sodoku (an infection transmitted to humans from a rat bite), liver disease and others.

Wasting fever

A debilitating type of fever is accompanied by large swings between morning and evening temperatures, reaching 3-5 ° C. The febrile period can last for several days, after which the temperature conditions normalize due to the weakening of the disease. Wasting fever is a sure sign also found in tuberculosis.

Recurrent fever

The characteristic of this is covered in its name. This means that the period of pyrexia (increased body temperature) with a duration of several days returns again after a predetermined period of aporexia. Thus, the patient has an obvious fever for several days with insignificant amplitude fluctuations in morning and daytime temperatures, then a lull sets in for several days, the body temperature returns to normal, but then the picture repeats again up to 4-5 times. Such a temperature curve is characteristic of infectious diseases caused by spirochete bacteria, an example of this kind of disease is relapsing fever.

Ripple fever

The wavy temperature curve is a type of recurrent fever, since it also has periods of alternation of febrile condition with remission. However, the wavy curve is distinguished by smoother transitions, demonstrating a gradual increase in temperature over several days, and then it also gradually decreases for several days. Such a fever is accompanied by the course of brucellosis.

Inverse fever

Inverse, or perverted, fever differs from other types of temperature curves in that the temperature apogee does not occur in the evening, but, on the contrary, in the morning hours. This course of febrile condition is characteristic of prolonged sepsis and running forms tuberculosis, as well as viral diseases.

Wrong fever

Irregular fever does not have a clear schematic manifestation. It includes all the main types of temperature curves at once. The amplitude of fluctuations in temperature values ​​can be varied, with different frequency. However atypical form temperature curve occurs most often, accompanying not only infectious diseases, but also different stages rheumatism, flu, dysentery, pneumonia, etc.

Regardless of what types of temperature curves in fever occurred in a patient, fever goes through three main stages:

1. Temperature rise stage. Under the influence of pyrogens (in the case of infectious diseases, this is external factor, namely various pathogenic bacteria and viruses), the so-called "set point" in neurons is shifted. Thus, the mode of heat transfer of the body is disrupted, and the available temperature on this moment it is considered lower than necessary, as a result of which the body actively increases its temperature.
2. Temperature maximum (apogee). The body temperature continues to increase to the level to which the “set point” has shifted, at this moment the temperature maximum is reached, an equilibrium is established between the production and release of heat.
3. Remission occurs when the effect of pyrogens weakens, and the body temperature that was elevated at that time is perceived by the body as excessive. The process of enhanced heat transfer begins and the setpoint returns to its previous level.

Fever types

Depending on the degree of temperature rise, the following types of fevers are distinguished:

• - subfebrile (from 37.2 to 38 ° C),
• - febrile - moderate (from 38.1 to 39 ° C),
• - pyretic - high (39.1 to 4 ° C),
• - hyperpyretic (excessive) (over 40 ° C).

Hyperpyretic fever is life-threatening, especially in children.

Fever types by duration:

• - fleeting - up to 2 hours;
• - acute - up to 15 days;
• - subacute - up to 45 days;
• - chronic - over 45 days.

There are two types of fever: "white" and "pink":

- "white" fever is manifested by pallor, dryness, marbling of the skin. The limbs are cold to the touch. The pulse quickens, the pressure rises. White fever must be converted to pink! - With "pink" fever skin pink, moist, hot to the touch. At the same time, there is an active release of heat by the body through the skin and there is less danger of overheating of the body.

Types of temperature curves

A temperature curve is a graphical display of daily temperature fluctuations.

The type of temperature curve depends on the nature of the factor causing the fever and on the reactivity of the human body.

The following types of temperature curves are distinguished:

• - constant fever (febris continua). The temperature remains high for a long time. During the day, the difference between morning and evening temperatures does not exceed 1 ° C, usually in the range of 38-39 ° C. This fever is typical for lobar pneumonia, Stage II typhoid fever, erysipelas;
• - laxative (remitting) fever (febris remittens). The temperature is high, daily temperature fluctuations exceed 1-2 ° C, while the morning minimum is above 37 ° C; but does not reach normal numbers. Typical for tuberculosis, purulent diseases, focal pneumonia, in the III stage of typhoid fever, viral diseases, rheumatoid arthritis;
• - intermittent (intermittent) fever (febris intermittens) - short-term increases in temperature to high numbers (39-40 ° C) and within a few hours (i.e. quickly) decreases to normal. After 1 or 3 days, the rise in body temperature is repeated. Thus, a more or less correct change of high and normal temperature body for several days. It is observed in malaria, each rise in temperature is accompanied by chills, and a fall is accompanied by torrential sweat; and the so-called Mediterranean fever.
• - exhausting (hectic) fever (febris hectica) is characterized by large (3-4 ° C) daily temperature fluctuations, which alternate with a drop to normal and subnormal values. Such fluctuations in body temperature can occur several times a day, which is accompanied by exhausting sweat. Typical for severe pulmonary tuberculosis, abscesses, abscesses (for example, lungs and other organs), sepsis;
• - undulating (undulating) fever (febris undulans). It is characterized by periodic post-foam increases in temperature (over several days), and then a gradual decrease in the level to normal values. Such "waves" follow one another for a long time; typical for brucellosis, lymphogranulomatosis;
• - recurrent fever (febris recurrens) - strict alternation of periods high temperature with febrile periods. Unlike intermittent fever, a rapidly increased body temperature remains at elevated level for several days, then temporarily decreases to the norm, followed by a new increase, and so many times The febrile period comes suddenly and suddenly ends. It is characteristic of relapsing fever;
• - perverted fever (febris inversus) - morning body temperature is higher than evening; sometimes observed with sepsis, tuberculosis, brucellosis, some rheumatic diseases;
• - irregular fever (febris irregularis) is characterized by varied and irregular daily fluctuations; often noted in rheumatism, endocarditis, sepsis, tuberculosis, flu. This fever is also called atypical (irregular).

The types of fever during illness can alternate or pass one into the other. The most severe toxic forms of some infectious diseases, as well as infectious diseases in elderly patients, weakened people, children early age often occur with little or no fever or even hypothermia, which is an unfavorable prognostic sign.

FEVER is a general adaptive response of the body to the effects of a harmful, often infectious agent and is a change in thermal regulation with the accumulation of heat and an increase in body temperature. Fever can result from the action of bacteria and their toxins (infectious), products of protein breakdown (with hemolysis, tissue necrosis, bone fractures, in the presence of purulent foci, etc.), hormones and poisons, and also occur when the heat center is irritated as a result injuries and bruises of the brain.

With fever, all types of metabolism are disrupted. The amount of nitrogen excreted in the urine increases, hyperglycemia develops, sometimes glucosuria, fat metabolism increases, and the water-salt balance is disturbed.

An increase in temperature by 1 ° C is usually accompanied by an acceleration of the heart rate by 10 beats. Breathing with fever becomes more frequent in parallel with an increase in the heart rate and body temperature.

Fever is characterized not only by an increase in temperature, but also by a disruption in the activity of all body systems. The degree of temperature rise is important, but not always critical, in assessing the severity of the fever. It is accompanied by an increase in heart rate and respiration, a decrease blood pressure, expressed general symptoms intoxication: headache, weakness, feeling of heat and thirst, dry mouth, lack of appetite; a decrease in urination, an increase in metabolism due to catabolic processes.

A rapid and severe rise in temperature (for example, with pneumonia) is usually accompanied by chills, which can last from a few minutes to an hour, rarely longer. With severe chills, the patient's appearance is characteristic: due to a sharp narrowing blood vessels(capillarospasm) the skin becomes pale, the nail plates acquire a bluish color (cyanosis), feeling cold, the patients tremble, chatter their teeth. A slight chilliness is characteristic of a gradual increase in temperature. At high temperatures, the skin has characteristic appearance: red, warm ("fiery"). The lytic drop in temperature is accompanied by profuse sweat. In fever, the evening body temperature is usually higher than the morning. A rise in temperature above 37 ° C during the day is a reason to suspect a disease.

Fever stages.

1) station of temperature rise

2) the stage of its relative standing

3) stage of temperature drop

The first stage is characterized by an increase in body temperature above normal values. The rise in temperature can be rapid, when in a few minutes it rises to 39.0-39.5 ° C (typical for lobar pneumonia) and can be slow for several days, sometimes unnoticed by the patient himself.

The next is the stage of relative temperature standing. Its duration is different. By the degree of maximum rise? temperatures during the standing stage, fever is targeted for weak or subfebrile - the temperature does not exceed 39, O0C, moderate or fibril - 38.0-39.00C, high or pyretic -39.0-41.0C and very high or hyperpyretic, when the temperature rises above 41оС.

The drop in body temperature, as well as its rise, can be rapid, i.e. within a few hours - half a day, and slow, over several days. A rapid drop in body temperature is called a crisis, and a slow drop is called lysis. The minimum temperature differs in the morning at 6 o'clock, and the maximum in the evening at 18 o'clock.

Fever types

Depending on the degree of temperature rise, the following types of fevers are distinguished:

1) subfebrile temperature- 37-38 ° C:

low subfebrile condition - 37-37.5 ° С;

high subfebrile condition - 37.5-38 ° C;

2) moderate fever - 38-39 ° C;

3) high fever - 39-40 ° C;

4) very high fever - over 40 ° C;

5) hyperpyretic - 41-42 ° C, it is accompanied by severe nervous phenomena and itself is life-threatening.

Great importance has a fluctuation in body temperature during the day and the entire period of the disease.

Fever types

1) persistent fever (febriscontinua). The temperature remains high for a long time. During the day, the difference between morning and evening temperatures does not exceed 10 ° C; typical for croupous pneumonia, stage II typhoid fever;

2) laxative (remitting) fever (febrisremittens). The temperature is high, daily temperature fluctuations exceed 1–2 ° С, and the morning minimum is higher than 37 ° С; typical for tuberculosis, purulent diseases, focal pneumonia, in stage III typhoid fever;

3) exhausting (hectic) fever (febrishectica) is characterized by large (3-4 ° C) daily temperature fluctuations, which alternate with a drop to normal and below, which is accompanied by exhausting sweats; typical for severe pulmonary tuberculosis, suppuration, sepsis;

4) intermittent (intermittent) fever (febrisintermittens) - short-term temperature rises to high numbers strictly alternate with periods (1-2 days) of normal temperature; observed in malaria;

5) undulating (undulating) fever (febrisundulans). It is characterized by periodic increases in temperature, and then a decrease in the level to normal numbers. Such "waves" follow one another for a long time; typical for brucellosis, lymphogranulomatosis;

6) recurrent fever (febrisrecurrens) - a strict alternation of periods of high temperature with febrile periods. At the same time, the temperature rises and falls very quickly. The febrile and non-febrile phases each last for several days. It is characteristic of relapsing fever;

7) reverse type of fever (febrisinversus) - morning temperature is higher than evening; sometimes observed with sepsis, tuberculosis, brucellosis;

8) irregular fever (febrisirregularis) is characterized by varied and irregular daily fluctuations; often noted in rheumatism, endocarditis, sepsis, tuberculosis. This fever is also called atypical (irregular).

Fever in outpatients. The causes and types of fever in the clinic.

Short-term fevers (lasting less than one week) are usually the result of viral diseases ending in spontaneous healing. The most common causes of non-viral short-term fever are bacterial infections throat, ear, paranasal sinuses, bronchi or urinary tract.

However, if at the same time the patient persists elevated temperature more than one to two weeks, it is worth conducting a more thorough examination. In this case, we are dealing with a patient, the condition of which is most appropriate to designate as "fever of an unknown nature" (LDL).

V individual cases the truth of the patient's disease state should be questioned, since one of the ways to simulate organic diseases is to report an allegedly elevated temperature. There are knowledge-based techniques for identifying simulation physiological characteristics thermoregulation. So, such cases are unlikely as: a temperature jump above 41 "C, which is extremely rare in adults; a rapid drop in temperature without corresponding sweating; absence of daily fluctuations in the temperature curve; lack of increased heart rate and respiration with fever; the difference between rectal temperature and temperature has just excreted urine.At the same time, it should be remembered that in some cases, such as fever with typhoid fever, mycoplasma pneumonia, psittacosis, no increased heart rate.

According to the degree of increase in body temperature, fever is distinguished:

subfebrile (from 37 ° to 38 °),

moderate (from 38 ° to 39 °),

high (from 39 ° to 41 °),

excessive, or hyperpyretic, (over 41 °).

According to the duration of the course, fever is distinguished:

acute (lasting up to two weeks);

subacute (lasting up to six weeks).

According to the types of temperature curves, the following main types of fever are distinguished:

constant,

remitting (laxative),

intermittent (intermittent),

perverted,

hectic (depleting),

wrong.

4. The nature of the temperature curve

Changes in the temperature curve are of the most diverse nature and are due to the direct cause that caused these changes.

Constant fever (febris continua). With persistent fever, the increased body temperature persists for several days or weeks with daily fluctuations within 1 ° C. The body temperature may be high

Day of stay in the hospital

(exceeds 39 ° C). It proceeds without chills, profuse sweats, the skin is hot, dry, the linen is not moistened. This temperature is typical for croupous pneumonia, erysipelas, typhoid fever of the classical course, typhus.

Remitting fever (febris remittens). With relapsing fever, which occurs with purulent diseases (for example, exudative pleurisy, lung abscess), temperature fluctuations during the day reach 2 ° C and

1. Sick day

   Day of stay in the hospital

   b The degree of temperature rise may vary. Daily fluctuations are 1-2 ° C, not reaching normal values. Chills are characteristic. Sweating is observed in the phase of temperature decrease.

Intermittent fever (febris intermittens). Intermittent fever is characterized by alternating periods of normal body temperature and

1. Sick day

   Day of stay in the hospital

   increased; at the same time, it is possible both sharp, for example, in malaria, and gradual, for example, with relapsing fever (relapsing fever), brucellosis (wave-like fever), an increase and decrease in human body temperature. A rise in temperature is accompanied by chills, fever, a decline - profuse sweat. It should be borne in mind that sometimes the intermittent type of fever is not immediately established. In the first days of illness, it may be preceded by a so-called initial fever of a persistent or irregular type. Typical for malaria, pyelonephritis, pleurisy, sepsis, etc.

G
ectic fever (febris hectica). With hectic fever, the resulting changes in body temperature are especially large and amount to 3-4 ° C with a fall to a normal or subnormal level (below 36 ° C) and occur, as a rule, 2-3 times a day. Fevers like this are typical for severe forms tuberculosis, sepsis. With hectic fever, trembling chills occur, followed by profuse sweating.

Wave-like fever is characterized by smooth rises and falls in body temperature with its normal values ​​in the intervals between rises in temperature (some forms of lymphogranulomatosis and malignant tumors, brucellosis).

The types of fever during illness can alternate or change from one to the other. The intensity of the febrile reaction can vary depending on the functional state of the central nervous system at the time of exposure to pyrogens. The duration of each stage is determined by many factors, in particular the dose of pyrogen, the time of its action, disorders that have arisen in the body under the influence of a pathogenic agent, etc. Fever can end in a sudden and rapid drop in body temperature to normal and even lower (crisis) or a gradual slow decrease body temperature (lysis). The most severe toxic forms of some infectious diseases, as well as infectious diseases in the elderly, debilitated people, and young children, often occur with almost no fever or even hypothermia, which is an unfavorable prognostic sign.

With fever, a change in metabolism occurs (protein breakdown increases), sometimes there is a violation of the activity of the central nervous system, cardiovascular and respiratory systems, gastrointestinal tract... At the height of the fever, confusion, delirium, hallucinations, and later loss of consciousness are sometimes observed. These phenomena are not directly related to the nervous mechanism of the development of fever, but they reflect the peculiarities of intoxication and the pathogenesis of the disease.

An increase in body temperature with fever is accompanied by an increase in heart rate. This does not occur with all febrile illnesses. So, with typhoid fever, bradycardia is noted. The effect of an increase in body temperature on the heart rate is at the same time weakened by other pathogenetic factors of the disease. An increase in heart rate, directly proportional to an increase in body temperature, is noted in fevers caused by low-toxic pyrogens.

Breathing increases with increasing body temperature. The degree of rapidity in breathing is subject to significant fluctuations and is not always proportional to the increase in body temperature. The rapidity of breathing is for the most part combined with a decrease in its depth.

With fever, the function of the digestive organs is disrupted (reduced digestion and absorption of food). Patients have a coated tongue, dry mouth is noted, appetite is sharply reduced. The secretory activity of the submandibular glands, stomach and pancreas is weakened. The motor activity of the gastrointestinal tract is characterized by dystonia with a predominance increased tone and a tendency to spasmodic contractions, especially in the area of ​​the pylorus. As a result of reducing the opening of the gatekeeper, the rate of evacuation of food from the stomach slows down. The formation of bile decreases slightly, its concentration increases.

The activity of the kidneys during fever is not noticeably disturbed. An increase in urine output at the onset of fever is explained by the redistribution of blood, an increase in its amount in the kidneys. Water retention in tissues at the height of fever is often accompanied by a drop in urine output and an increase in urine concentration. There is an increase in the barrier and antitoxic function of the liver, urea production and an increase in the production of fibrinogen. The phagocytic activity of leukocytes and fixed macrophages increases, as well as the intensity of antibody production. The production of ACTH by the pituitary gland and the release of corticosteroids, which have a desensitizing and anti-inflammatory effect, are enhanced.

Metabolic disorders depend more on the development of the underlying disease than on an increase in body temperature. Strengthening immunity, mobilizing humoral mediators contribute to an increase in the body's protective functions against infection and inflammation. Hyperthermia creates in the body less favorable conditions for reproduction of many pathogenic viruses and bacteria. In this regard, the main treatment should be aimed at eliminating the disease that caused the fever. The question of the use of antipyretic drugs is decided by the doctor in each case, depending on the nature of the disease, the patient's age, his premorbid state and individual characteristics.

Depending on the degree of temperature rise, the following types of fevers are distinguished:

1) subfebrile temperature - 37-38 ° С:

low subfebrile condition - 37-37.5 ° С;

high subfebrile condition - 37.5-38 ° C;

2) moderate fever - 38-39 ° C;

3) high fever - 39-40 ° C;

4) very high fever - over 40 ° C;

5) hyperpyretic - 41-42 ° C, it is accompanied by severe nervous phenomena and itself is life-threatening.

Fluctuations in body temperature during the day and during the entire period of the disease are of great importance.

Fever types

The main types of fever are:

1) constant fever (febris continua). The temperature remains high for a long time. During the day, the difference between morning and evening temperatures does not exceed 10 ° C; typical for croupous pneumonia, stage II typhoid fever;

2) laxative (remitting) fever (febris remittens). The temperature is high, daily temperature fluctuations exceed 1–2 ° С, and the morning minimum is higher than 37 ° С; typical for tuberculosis, purulent diseases, focal pneumonia, in stage III typhoid fever;

3) exhausting (hectic) fever (febris hectica) is characterized by large (3-4 ° C) daily temperature fluctuations, which alternate with a drop to normal and below, which is accompanied by exhausting sweats; typical for severe pulmonary tuberculosis, suppuration, sepsis;

4) intermittent (intermittent) fever (febris intermittens) - short-term temperature rises to high numbers strictly alternate with periods (1-2 days) of normal temperature; observed in malaria;

5) undulating (undulating) fever (febris undulans). It is characterized by periodic increases in temperature, and then a decrease in the level to normal numbers. Such "waves" follow one another for a long time; typical for brucellosis, lymphogranulomatosis;

6) recurrent fever (febris recurrens) - a strict alternation of periods of high temperature with febrile periods. At the same time, the temperature rises and falls very quickly. The febrile and non-febrile phases each last for several days. It is characteristic of relapsing fever;

7) reverse type of fever (febris inversus) - the morning temperature is higher than the evening; sometimes observed with sepsis, tuberculosis, brucellosis;

8) irregular fever (febris irregularis) is characterized by varied and irregular daily fluctuations; often noted in rheumatism, endocarditis, sepsis, tuberculosis. This fever is also called atypical (irregular).