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FEVERS9

In this chapter, you will learn:Page Number

1. What are fevers 9-12. Types of fevers 9-2 to 9-33. Malaria 9-5 to 9-7

4. Typhoid 9-85. Viral fever 9-96. Thermometer Reading 9-10 to 9-12

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FEVERS

The human body has a normal hotness (temperature) of 98.4 degrees For 37 degrees C. At this temperature, the body systems work the best.The body does not work so well if the temperature is hotter or colder.And if the temperature gets very hot (above 107 degrees, or very cold(below 90 degrees) the working of the body may become absolutely

crazy. Different parts and organs of the body may fail for a short whileuntil things become normal. If the temperature continues to be very highor very low, permanent failure may set in and the person may die.

Low temperatures below normal may set in if our surroundings are verycold. Anyone without adequate clothing and food may die if exposed to such cold climate for too long.But children who have been born much before nine months in the mothers’ wombs and those who aremuch below normal weight can die of cold if exposed to low surrounding temperatures for a few hours.Such children need to be well wrapped up during cold.

What we usually find amongst our people are illnesses in which the body temperature has become

high. A body temperature above 99 ° F is called fever. We as health workers will often be called uponto help out, as people are very scared of fevers.

Fever is our friendTrue, people are scared of fevers for they have seen their near and dear ones dying of fevers. Yet we need tounderstand one thing. All fevers are not our enemies . Fevers are part of the defence mechanism of the body. Thebody rises its temperature to stop the attacking germs from multiplying too fast. In fact, fevers warn us when ourbody has been attacked by germs. Hence, Fevers are friends! What we should be fighting are germs that bringsfever, not the fever itself. Once the germs are killed, the fever shall go away. Fevers by themselves may get

worrisome only beyond 107 degreesF in adults and 104 degrees F in children.

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9-2

KNOW THE FEVERSInstead of taking fever - reducing medicines every time there is fever, it may be better to see its patternof rise and fall. Just by seeing some of the points below, we can get good hints as to the possible reasonof the fever:

whether the fever is low or highwhether there are also complaints specific to a body organ systemwhether there is a rise & fall pattern of temperature

1. Low grade Fever(Not very high temperature)• Cold, cough, Sinusitis• Dysentery• TB• AIDS• Cancers• Boils, appendicitis, etc• Viral hepatitis, any small infec-tion

3. Fevers with General com-plaints – body ache, weakness

• Viral fevers including Dengue• Malaria• Typhoid• Initial stages of cancers, AIDS

2. High fever• Malaria• Pneumonia• Abscess• Urinary Tract Infection• Viral Fevers including Dengue• Typhoid• Severe infection anywhere

4. Fevers with Organsystem specific com-

plaints• Urinary Tract Infection• Appendicitis• Pneumonia• Abscess

5. Fevers that are accompa-nied by shivering:• Malaria• Urinary Tract Infection• Pneumonia• Abscess• Infections spread by lice and ticks etc.

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1. Fever come and goes :It disappears completely (evenwithout taking any fever-reduc-ing medicine like Paracetamol)before reappearing:

• Malaria• Kala Azar – found mainlyin Bihar in India, occasionallyseen in Meghalaya.

2. Fever disappears for afew days and then reappears:• Infections spread by lice and ticks(TYPHUS fever)• Rat bite fevers

Fevers that show a pattern:

3. Fever That Shows aStep Ladder Pattern- starts low and then increases bit by bit.• Typhoid

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The word “Typhoid” means “like Typhus” .Typhus is a fever that was very commonearlier but is rare now. We can suspectTyphus if a person with lice has some typhoidlike fever with some rash.

It is spread by lice on the body. Typhus canbe sucessfully treated by DOXYCYCLINE.

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1. MALARIA

3. VIRAL FEVER

2. TYPHOIDor ENTERIC

FEVER

Some Common Fevers to know

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9-5

Malaria is a disease caused by a small germ called Plas-modium that can be tested by checking our blood under amicroscope. Usually of two types, Plasmodium f alciparumand Plasmodium vivax are also commonly - and moreeasily — referred to as PF and PV.

Malaria is commonly known to cause high fever that comes after half an hour of severe shivering and chills. After the fever that lasts one to two hours or so, thefever comes down on its own with lots of sweating . The fever may be accompaniedby headache and vomiting. Any health worker can easily treat such malaria.

How mosquitoes spread malaria? Mosquitoes spread malaria germs by carrying them from a patient whose blood has the PV or PF germ. The female Anopheles mosquito has to feed on human or animal blood every few days inorder to lay eggs. During such a time when it is feeding on a malaria patient, it takes the germsalong with the blood. These germs stay in the mosquito’s mouth and stomach for seven to ten daysand give thousands of baby germs. After these seven to ten days, if the mosquito bites another normal person, such a person receives the baby germs. In about ten days time, these new germsthat have entered the body multiply into thousands again and give rise to the first bout of shiver-ing and fever.

As the fever rises, the germs try to hide inside the red blood cells and once again multiply. Within two days, they multiplytenfold and come out of the red cells into the blood and yet again cause shivering and fever. No wonder that the malaria

fever comes every two days!

To check if one has malaria, a trained person can test a small drop of blood pricked out from the finger and look for themalaria germ under the microscope. There are other tests also available, but none as cheap and reliable.

1. MALARIA Fever

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9-6Dangerous malariaAlthough both PV and PF cause similar prob-lems as given above, PF can get very danger-ous and kill the patient. It can give rise to com-plications by blocking the blood supply to:

- the brain : the patient may•get very severe headache

•start talking irrelevantly•may get fits or convulsions•become unconscious or•get a new squint (both eyeslook in different directions)

- the kidneys : urine production may becomevery less - at times none - and at times theremay be blood with the urine.

- the lungs: the person may have great diffi-

culty in breathing and breathing rate may gethigh.

- the heart: the pumping of the heart may de-crease and the pulse gets difficult to find.

In all such cases it is better to get the patient to a qualified doctor immediately.

Treatment for MalariaReplace fluids in body :As sweating and fever cause loss of lots of fluid, it is important to drink plenty of watery sub-stances like soups, milk, lime juice, etc. Water with some saltand sugar is also excellent.

Keep fever down : If the fever is very high, it may be agood idea to bring the fever down by applying again and

again some cloth dipped in cool water to the forehead andbody. Paracetamol may also be taken to bring down the tem-perature.

Malaria medicines : Fever of any type may be malaria.Before starting any treatment, try to confirm that it is malariaby asking for blood test using a microscope. After a test hasbeen sent - even if the result is not available yet — start themalaria treatment according to the age as given later. If it isnot confirmed, the first day’s treatment is considered enough.However, if one is sure that it is malaria DO REMEMBERTO COMPLETE THE COURSE even if the fever has goneafter the first day’s dose.

Under 1year

1 to 4years

5 to 8years

9 to 14years

Above14 years

1/4thtablet

Half atablet

Half to 1tablet

1 tablet1 to 2tablets

1. Early diagnosis and prompt treatment - we need tomake arrangements that every village knows the signals of malaria and the problems that it may give. There must beat least one person trained in every village whoknows how much of Chloroquine and otherdrugs need to be given. She should have free orcheap Chloroquine available with her and everyvillager must know its availability with her. Earlytreatment decreases the number of people withmalaria germs that may be bitten by mosqui-toes and this reduces the spread of the disease.

2. Personal protection - each one of usshould know that covering our hands andfeet especially during dark hours will re-

duce the biting of mosquitoes andhence malaria. A few leaves of Neemeaten every day are known to decreasethe chances of malaria. A broth madeof Chiraita leaves taken every day dur-ing the rainy season is reputed to keepmalaria away.

4. Killing mosquitoes - mosquitoeskilled by spraying DDT on the walls helpsto prevent them from spreading malaria.Walls of cattle sheds should not besprayed so that the mosquitoes can bitethe cattle and have no need to bite hu-mans. This decreases malaria spread.

3. Killing larvae - Larvae of mosquitoes growin stagnant or slow flowing water. Various fishes may eatthese and the most efficient of such species are availablewith the malaria department. Also, any kind of oil or in-secticide can be sprayed on the water surface to kill thelarvae in the ten days that it takes them to develop fromthe egg stage to the adult stage.

Ways to prevent the spread of malaria

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2. TYPHOID or ENTERIC FEVER

What is the typhoid fever like?The typhoid fever usually starts as a low-grade fever that is continuous. There are not much ups and downs in thetemperature unless the patient is taking fever-reducing tablets. Headache is a common accompaniment and is specially agood indicator if a child is complaining of it. There may be a rash in the second week but can usually be seen only in fairskinned people.

These days, a bit of cough and cold are also seenin typhoid. Typhoid is said to have a character-istic pattern , that of a stepladder . If the tem-perature of a person is taken at regular intervalsin typhoid, the temperature does not fluctuatemuch and instead it is seen to rise bit by bit untilin the second week, when it becomes quite high.

Although adults with typhoid fever are usuallyconstipated, children often have diarrhoea and

vomiting in the first few days. In the second week though, diarrhoea and pain on pressing the rightside of the abdomen are common. A blood testcan help to indicate Typhoid in a person.

The fever either gets better on its own in the thirdweek or else the patient can really get very worseby then. Bleeding from the intestine and punctureof the intestine is what can kill the patient in thethird week.

Treatment of Typhoid Fever• Typhoid must be suspected especially if there is any fever that has been continuously increasing since more than

a week and has no other signals of any other organ being involved.

• An antibiotic needs to be given and that too for 14 days and no less . This is because typhoid is known to comeback and in such a case, the chances of intestinal perforation and death are higher.

• Give AMOXYCILLIN or CIPOFLOXACIN in highest doses three times a day. Once the fever has come down,the dose may be reduced and continued until 14 days are completed. If the person cannot afford it or if Amoxycillinis not accessible, COTRIMOXAZOLE may be given, but it may take more time to bring the fever down.

Typhoid fever is also called enteric fever becauseit is due to an infection of the intestines. It has beenan old problem with us. Before we found good an-tibiotics to take care of typhoid, it used to killpeople in the third week of fever because the infec-tion would puncture the intestine. Nowadays, al-most all fevers attract a dose of antibiotics fromdoctors and hence even typhoid gets treated be-fore anyone can die of it. Rarely do people die of itthese days. Yet, it remains a common illness thatleads to a lot of misery and is badly treated.

What Causes Typhoid?Typhoid is caused by bacteria that come to stayin the intestine along with food that has been ‘dirt-ied’ by flies, dirt and unwashed hands. Water brought from rivers and canals or water from wellsand from hand pumps that are close to where

people shit is a known source of spreading typhoid. At times, people who pass typhoid germsin their shit do not suffer from any illness and may ‘silently’ pass the germ to many others if they are cooks or handle water and food.

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3. VIRAL FEVERLearn to Differentiate TYPHOID from VIRAL FEVER and also DENGUEViral fevers also have a continuous and a stepladder pattern. Headache is common likein Typhoid. But severe body ache is more common in Viral fevers. Occasionally shiver-ing and a bit of cough and cold may be seen in viral fevers.

In Dengue (Den-gee) fever that is spreadby Aedes mosquitoes (which breed inclean water especially in coolers / coco-nut shells) although other signs of Viralfevers are also present, severe body acheand pain in moving the eyes or in lookingat light are common. Fever may decreasefrom its high state after 7-8 days for twoto three days and return, often with a rash.Usually though, there is no fever after 7to 10 days.

More importantly though, is the fact that Vi-ral Fevers only rarely last beyond 7 days. As

there are no germkiller medicines for Viralfevers, it is suggested that unless one is sure,we can wait until the eighth day of fever be-fore we start any antibiotic. And if the feverstarts coming down within two days of start-ing the antibiotic, one can safely assume thediagnosis to be that of Typhoid and the medi-cine MUST BE CONTINUED UNTIL 14DAYS OF TREATMENT IS COMPLETED.

Other fevers usually have signs and symptoms of an infection being present at different parts of the body. For example, in pneumonia there are signs of the lungs and the air tubes being infected. If an abscess, a big boil can be asked for. Pain in the abdomen, and painwhile passing urine or with loose motions can also hint at the underlying cause of fever.

These kinds of fevers are dealt with in other sections of the manual.

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THERMOMETER READING

It is important at times to know the temperature of aperson. It can help us understand what disease itis. By measuring and recording temperature, wecan see the pattern of rise and fall of temperature,which can help in diagnosing.

The normal temperature of a person is between 98 ° and 99 ° F (36.7° C and 37.2 ° C).The body works best between thesetemperatures. But when germs enter our body, the body fights back by raising the

temperature to kill the germs. This is thefever that we feel. The higher temperaturealso helps in decreasing the rate of multiplication of the germs.

You should understand that in many cases fever isa way to protect our body from harm done by germs.Only at times we should give medicines likePARACETAMOL which reduce the fever. Unless thetemperature is above 104 ° F (102 ° F for children andold people), we need not give PARACETAMOL. Know-ing how to take the temperature of the body will alsotell you when to give medicines.

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ThermometerTemperature is measured by a THERMOMETER. Thermometers can be of different types. The simplest ther-mometer is a plastic strip that can be kept pressed on the forehead and one can directly read the temperature off it. But the surrounding temperature can affect this reading – it shows a lesser temperature if the room is cold anda higher reading if the person is sitting in the sun.

The commonest thermometer is made of glass and has a bulb with mercury. To measure the temperature with this:1. Clean the thermometer with normal water and shake it (take care not to hit the glass to a wall or table

nearby while doing this).

2. Check the level of mercury column – the silver coloured shiny column visible against a white wall orceiling) and ensure that it is lower than 96 ° F mark.

3. Now ask the patient to open her mouth and lift the tongue to touch the palate. Place the bulb of thethermometer under the tongue and ask the person to close the mouth, taking care not to close the teeth orelse the bulb may break inside.

4. Although the guidelines of thermometers asks only for a time of half a minute, one should keep thethermometer in the mouth for at least one and a half minutes.

5. After this period, take out the thermometer from the patient’s mouth and check the level of the mercurycolumn against the scale marked next to it. Note the reading in ° F or ° C. If the person has a temperaturemore than 99 ° F or 37.2 ° C, she can be said to have fever.

6. After recording the temperature carefully, one should clean the thermometer by rinsing it in water orwiping it clean with cotton dipped in antiseptic. Preferably, shake down the mercury column to normalbefore replacing the thermometer in its case.

Convert Fahrenheit (F) to Centigrade (C), subtract 32 and then multiply by 5/9, i.e., F-32 X 5/ 9=C. For the reverse, multiply by 9/5 and add 32, i.e., C X 9/5 + 32 = F

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9-12Measuring Temperature of ChildrenFor a small child who cannot be trusted to keep her mouth closed or someone who is not cooperative, the bulb of the thermometer can be kept under the armpit for two minutes while the health worker holds the arm next to thebody. For a very small child, keep the thermometer on the thigh fold and keep the thigh folded on the abdomenfor two minutes. The body temperature is 1 to 2 ° F more than the armpit or thigh temperature and the take care of this while recording it.

In children, the best place to measure the temperature is the rectum, as the reading taken from the rectum is

considered to be the most reliable. The same thermometer that is used to measure the temperature in the mouthcan also be used for the rectum. Ask the person to take deep breaths and gently insert the thermometer into theanus after applying a bit of Vaseline or oil, and press both the buttocks against each other for a minute. Take thereading – this is the most reliable temperature of the body! However, it may not be easy to convince people in ourareas to allow this.

Sites for Taking Thermometer Reading

Temperature without thermometerAnother way to measure the temperature is by measuring the person’s pulse. Theheart rate – and hence pulse - increases by 10 per minute for every 1 ° F. If a patient’spulse counted for one minute is 100 per minute and her normal pulse at rest was 80per minute, we can say that her temperature would be 98.6 plus (100 minus 80divided by 10) or 98.6 plus 2 or 100.6 ° F.

However this may not be very accurate unless we are sure of a person’s pulse ratebefore the illness. Some athletes may have a resting pulse as low as 40 or 50 per minute and a pulse rate of 100per minute in such cases would falsely get calculated at 100.6 ° F instead of 103.6 ° F. Besides, blood loss oranaemia since the time we last counted the pulse may also increase the pulse rate even without any fever.

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Know the Answers

Fevers

1. Mark whether “Right” or “Wrong”

a. Fevers harm the body and should be brought down withmedicines immediately.

b. All fevers should be treated with germkillers.

c. Typhoid fevers should be treated with germkillers for at least 14 days.

d. Malaria fever can quickly result in death unless treated.

e. It is difficult to make a difference between Typhoid and Urine Infection.

2. Please answer the follwing questions:

a. How can you make out Typhoid fever from Malaria?

b. Can we give Chloroquine to pregnant women?

c. How can you make out the difference between typhoid and viral fevers?

d. What are the methods that we can use to lower temperature?

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My Notes9-14

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