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  FIEBRE SIN FOCO Literature review current through: Jul 2014. | This topic last updated:  Apr 04, 2013. INTRODUCTION  — Fever is a proi!e! s#p o o$ a!# %i$$ere! %isease pro&esses. Neo!a es a!% #ou!' i!$a! s a# a!i$es $ever as (e o!l# si'! o$ si'!i$i&a! u!%erl#i!' i!$e& io!. )(e i!&i%e!&e o$ serious *a& erial i!$e& io! +SBI is (i'(er i! i!$a! s less (a! (ree o! (s o$ a'e, par i&ularl# (ose u!%er 2- %a#s, (a! a a!# o (er ie i! &(il%(oo%. I! a%%i io!, (ese #ou!' pa ie! s &a! eperie!&e si'!i$i&a! or*i%i # $ro soe viral i!$e& io!s.)(is opi& /ill revie/ (e %e$i!i io! a!% e iolo'# o$ $ever i! (e !eo!a e a!% #ou!' i!$a! less (a! (ree o! (s o$ a'e. S ra e'ies (a (ave *ee! %evelope% o evalua e $e*rile &(il%re! i! (is a'e 'roup, as /ell as (e evalua io! a!% a!a'ee! o$ $ever i! !eo!a es a!% i!$a! s less (a! (ree o! (s o$ a'e a!% i! i!$a! s a!% &(il%re! a'e (ree o 3 o! (s are %is&usse% separa el#. +See S ra e'ies $or (e evalua io! o$ $ever i! !eo!a es a!% i!$a! s +less (a! (ree o! (s o$ a'e a!% Evalua io! a!% a!a'ee! o$ $ever i! (e !eo!a e a!% #ou!' i!$a! +#ou!'er (a! (ree o! (s o$ a'e a!% Fever /i (ou a sour&e i! &(il%re! 3 o 3 o! (s o$ a'e. DEFINITION OF FEVER  — Re& al epera ures are (e s a!%ar% $or %e e& i!' $ever i! i!$a! s less (a! (ree o! (s o$ a'e a!% (e aori # o$ s u%ies es a*lis(i!' (e ris o$ serious i!$e& io!s i! $e*rile #ou!' i!$a! s (ave relie% upo! re& al epera ures. A re& al epera ure o$ 3-C +100.4F 'e!erall# is re'ar%e% as $ever i! (e !eo!a e 0 o 2- %a#s o$ a'e. )(e %e$i!i io! o$ $ever i! (e o!e5 o (ree5o! (5ol% varies $ro 3- o 3-.2C +100.4 o 100.6F %epe!%i!' o! (e s u%# &i e% a!% o! lo&al &us o 71538. +See S ra e'ies $or (e evalua io! o$ $ever i! !eo!a es a!% i!$a! s +less (a! (ree o! (s o$ a'e, se& io! o! 9)ra%i io!al s ra e'ies9. Aillar#, eporal ar er# a!% #pa!i& e*ra!e epera ures are u!relia*le i! #ou!' i!$a! s /(e! &opare% o re& al (eroe r# as (e 'ol% s a!%ar% *u a# *e use% /(e! re& al (eroe r# is &o! rai!%i&a e%, su&( as i! pa ie! s /i ( !eu rope!ia, *lee%i!' %ia (esis +e', (ro*o&# ope!ia, or !e&ro i:i!' e! ero&oli is. ;lass (eroe ers s(oul% !o *e use%. +See Fever i! i!$a! s a!% &(il%re!< =a (op(#siolo'# a!% a!a'ee! , se& io! o! 9)epera ure easuree! 9. Caregiver report o ever   — I is !o u!&oo! $or &are'ivers o repor a! eleva e% epera ure i! a! i!$a! /(o is a$e*rile a (e ie o$ evalua io!. A (is or# o$ o*e& ive $ever *# re& al epera ure re>uires evalua io! eve! i$ (e i!$a! is a$e*rile a (e ie o$ prese! a io!. O! (e o (er (a!%, a! a$e*rile i!$a! /i ( a repor e% (is or# o$ su*e& ive $ever o!l# /(o (as !o (a% a! ip#re i& (erap# a!% /(o loos /ell a!% (as !o suspi&ious $i!%i!'s o! (is or# or p(#si&aleai!a io! a# avoi% la*ora or# es i!'. ?o/ever, (is s(oul% o!l# o&&ur /(e! relia*le $ollo/5up &a! *e arra!'e%, re& al epera ure &a! *e o!i ore% a (oe, a!% pare! s u!%ers a!% i!%i&a io!s o see e%i&al &o!sul a io!. As a! eaple, i! a s u%# o$ 2@2 i!$a! s #ou!'er (a! /o o! (s o$ a'e /i ( a (is or# o$ $ever /(o /ere a%i e% o (e (ospi al $or possi*le sepsis, &are aers repor e% $ever *# re& al  (eroe er i! 244 i!$a! s a!% a& ile $ever i! 4- i!$a! s 748. )(e $ollo/i!' /ere $i!%i!'s i! a re rospe& ive revie/ o$ ou &oes o$ (ese &(il%re!<  O$ 244 i!$a! s /i ( repor e% $ever per re& u, 224 +@2 per&e!  (a% $ever o! prese! a io! or %uri!' (e su*se>ue! 4- (ours o$ (ospi ali:a io!. I! &o! ras , 22 o$ 4- i!$a! s +4 per&e!  /i ( repor e% a& ile $ever (a% $ever o! prese! a io! or %uri!' (e su*se>ue! 4- (ours o$ (ospi ali:a io!.  O$ 2 i!$a! s /i ( a& ile $ever /(o /ere a$e*rile o! prese! a io!, !o!e (a% su*se>ue! $ever %uri!' (ospi ali:a io!, a!% o!e (a% a serious *a& erial i!$e& io! +uri!ar# ra& i!$e& io!.  O$ 40 i!$a! s /i ( repor e% $ever per re& u /(o /ere a$e*rile o! prese! a io!, ei'( +20 per&e!  (a% su*se>ue! $ever %uri!' (ospi ali:a io!, a!% $our +10 per&e!  (a% serious *a& erial i!$e& io!. +See 9Serious *a& erial i!$e& io!9 *elo/.   Ao!' (e 1@ i!$a! s /i ( serious *a& erial i!$e& io! +$ive o$ /(o /ere a$e*rile o! prese! a io!, all e(i*i e% a*!oral &li!i&al a!%or la*ora or# $ea ures o! evalua io! (a /ere su''es ive o$ u!%erl#i!' serious i!$e& io!.)(is s u%# /as &o!%u& e% s(or l# a$ er (e li&e!si!' o$ ?aeop(ilus i!$lue!:ae #pe * va&&i!e a!% prior o (e i! ro%u& io! o$ (e (ep avale! p!euo&o&&al va&&i!e. )(e $a& (a (ese pa ie! s %i$$er /i ( respe& o &urre! iu!i:a io! pra& i&e a!% (e possi*le *e!e$i %erive% $ro (er% iu!i # lii s i! erpre a io! o$ (ese $i!%i!'s i! a o%er!5%a# popula io! /(ere (e e iolo'ies o$ SBI a!% (e i!vasive!ess o$ (e rela e% pa (o'e!s (ave s(i$ e% si'!i$i&a! l#. )(is u!&er ai! # i!&reases (e ipor a!&e o$ (e &li!i&al assesse! a!% assura!&e o$ relia*le $ollo/5up.?o/ever, i! a s u%# o$ i!$a! s see! i! &ou!i # se i!'s, &ases o$ *a& ereia a!%or *a& erial e!i!'i is, al (ou'( rare, /ere %o&ue! e% ao!' i!$a! s /i ( !oral epera ures i! (e o$$i&e *u $ever a (oe *# re& al (eroe er 78. !undling  — Bu!%li!' o$ i!$a! s i! &lo (i!' or *la!e s 'e!erall# &auses a! eleva io! i! si! epera ure ra (er (a! re& al epera ure 78. ?o/ever, i! a s u%# o$ !e/*or!s /(o /ere *u!%le% a!% (a% re& al epera ures easure% over (e !e 2. (ours, 2 o$ 12 i!$a! s rea&(e%a epera ure o$ 3-C 768. Never (eless, a i!iall# eleva e% re& al epera ure s(oul% rarel#, i$ ever, *e a ri*u e% o *u!%li!'. I! a%%i io!, a $ever 3-.C +101F s(oul% !o *e a ri*u e% o *u!%li!' re'ar%less o$ (e a!!er ae!.D(e! over*u!%li!' is suspe&  as a &ause $or a! eleva e% epera ure, (e &(il% a# *e u!*u!%le% a!% (e epera ure re ae! re& all# i! 1 o 30 i!u es. )(e i!$a! &a! *e &o!si%ere% a$e*rile i$ (e repea epera ure is !oral a!% (e i!$a! reai!s /ell5appeari!' a!% (as !o re&eive% a! ip#re i& (erap# 78. =are! al e%u&a io! a!% $ollo/5up /i ( (e priar# &are provi%er are esse! ial i! (is &ir&us a!&e. I UNOLO#$  — )(e iu!olo'i& &ope e!&e o$ (e !eo!a e a!% #ou!' i!$a! iproves s ea%il# i! (e $irs (ree o! (s o$ li$e. )(e %evelopi!' $e us (as ) a!% B l#p(o&# es a a! earl# 'es a io!al a'e, *u (e %evelope! o$ iu!olo'i& $u!& io! us *e o%ula e% o  &oeis /i ( (e o (er9s iu!e s#s e. )(e !e/*or!9s iu!olo'i& as s/i &(es a*rup l# a *ir ( $ro (is &oeis e! s a e +'ra$ preserva io! o pro e& io! $ro i!va%i!' pa (o'e!s. A *ir (, ) a!% B l#p(o&# es are prese! i! !u*ers siilar o or e&ee%i!' a%ul levels. ?o/ever, (e $u!& io! o$ (ese &ells i! (e !e/*or! is %ii!is(e% i! areas su&( as i o'e!5i!%u&e% proli$era io! +) &ells a!% a*ili # o i!%u&e iu!o'lo*uli! s#! (esis +B &ells. evels o$ (e i!$a! 9s o/! I'; i!&rease s ea%il# i! (e $irs $e/ o! (s o$ li$e as a er!al levels %e&rease. Neu rop(ils also are prese! a earl# s a'es o$ 'es a io! *u %i$$er i! $u!& io!al &apa&i # $ro a%ul !eu rop(ils 7-8. +See )(e (uoral iu!e respo!se a!% Iu!i # o$ (e !e/*or!. )(is iu!e s#s e %evelope! eplai!s (e vul!era*ili # o %i$$ere! #pes o$ i!$e& ious %iseases a var#i!' a'es /i (i! (e $irs (ree o! (s o$ li$e. er# #ou!' i!$a! s are ore sus&ep i*le o serious *a& erial i!$e& io! (a! ol%er i!$a! s. )(is sus&ep i*ili # is rela e% o (e %e&li!e o$ a er!al a! i*o%# a a ie /(e! (e i!$a! 9s a! i*o%# pro%u& io! is *e'i!!i!' o i!&rease a!% (e &(il% (as !o #e *ee! iu!i:e% a'ai!s p!euo&o&&us a!% ?aeop(ilus i!$lue!:ae #pe * +see 9Ba& erial pa (o'e!s9 *elo/. A ore %e aile% %is&ussio! o$ !e/*or! iu!olo'# is $ou!% separa el#. +See )(e %evelope! o$ iu!e &ells i! (e $e us a!% !eo!a e a!% Iu!i # o$ (e !e/*or!. %&T'O%'$(IOLO#$ OF FEVER  — )(e pa (op(#siolo'#, a%ap ive value, a!% rea e! o$ $ever are %is&usse% separa el#. +See Fever i! i!$a! s a!% &(il%re!< =a (op(#siolo'# a!% a!a'ee! . ETIOLO#$  — )(e a*ili # o 'e!erali:e %a a $ro prior s u%ies is lii e% i! (a a!# o$ (ese prospe& ive a!% re rospe& ive s u%ies /ere &o!%u& e% i! a! era /(ere !uerous va&&i!es (a are !o/ i!&lu%e% i! rou i!e &(il%(oo% iu!i:a io!s /ere u!availa*le +e', p!euo&o&&al &o!u'a e va&&i!e, ?aeop(ilus i!$lue!:a #pe * va&&i!e, vari&ella va&&i!e, ro avirus va&&i!e.  A%%i io!all#, (e A%visor# Coi ee o! Iu!i:a io! =ra& i&es re&oe!%s i!$lue!:a va&&i!e a%i!is ra io! $or all &(il%re! G o! (s 7@8. D(ile va&&i!a io! $or i!$lue!:a %oes !o %ire& l# ipa& (e #ou!'es i!$a! s, ol%er &(il%re! serve as (e os e$$e& ive ve& ors o$ %isease ra!sissio! i! (e &ou!i #. Co!se>ue! l#, (e epi%eiolo'# o$ i!$lue!:a i! (e #ou!'es i!$a! s is liel# o *e &(a!'e% *# (e va&&i!a io! o$ ol%er &(il%re!. Viral inection  — iral i!$e& io! is (e os &oo! &ause o$ $ever i! (is a'e 'roup. I! a s u%#o$ i!$a! s 2- %a#s or #ou!'er, a su*'roup o$ @0 !eo!a es /i ( $ever 16 per&e! (a% i%e! i$ia*leviral i!$e& io!s a!% 14 per&e! (a% a SBI 7108. I! &o! ras , a prospe& ive s u%# o$ 166@ $e*rile i!$a! s 1 o @0 %a#s o$ li$e i%e! i$ie% viral pa (o'e!s i! 3 per&e! o$ (e &o(or versus *a& erial pa (o'e!s i! 10 per&e! 711   8.)(e !eo!a e a&>uires i!$e& io! (rou'( ver i&al ra!sissio! a!% pos !a all# $ro sour&es su&( as $ail# e*ers a!% (ospi al perso!!el. Neo!a es a!% #ou!' i!$a! s are ore liel# (a! ol%er i!$a! s o eperie!&e or*i%i # $ro a viral i!$e& io!, i! par *e&ause o$ a %e&rease% respo!sive!ess o$ ) &ell5e%ia e% iu!i #. +See 9Iu!olo'#9 a*ove. iruses (a &a! &ause serious ill!ess i! (is a'e 'roup i!&lu%e<   ?erpes siple +see Neo!a al (erpes siple virus i!$e& io!< Cli!i&al $ea ures a!% %ia'!osis  ari&ella +see ari&ella5:os er i!$e& io! i! (e !e/*or!  E! eroviruses +see Cli!i&al a!i$es a io!s a!% %ia'!osis o$ e! erovirus a!% pare&(ovirus i!$e& io!s  I!$lue!:a virus +see Seaso!al i!$lue!:a i! &(il%re!< Cli!i&al $ea ures a!% %ia'!osis, se& io! o! 9Cli!i&al $ea ures9  Soe a%e!oviruses +see Epi%eiolo'# a!% &li!i&al a!i$es a io!s o$ a%e!ovirus i!$e& io!  Respira or# s#!&# ial virus +see Respira or# s#!&# ial virus i!$e& io!< Cli!i&al $ea ures a!% %ia'!osis (erious )acterial inectionDeinition  — Ha!# o$ (e s u%ies o$ $ever i! (e !eo!a e a!% #ou!' i!$a! %e$i!e ou &oes *# (e o&&urre!&e o$ serious *a& erial i!$e& io! +SBI. I! os s u%ies, SBIs are %e$i!e% as *a& ereia, *a& erial e!i!'i is, *a& erial p!euo!ia, si! a!% so$ issue i!$e& io!s, os eo#eli is, *a& erial 'as roe! eri is, sep i& ar (ri is, or uri!ar# ra& i!$e& io!. Al (ou'( !o &lassi&all# %es&ri*e% i! (e li era ure o$ (e earl# 1@@0s, (e a e! io! o &ou!i #5a&>uire% S ap(#lo&o&&us aureus (as a%e pus ulosis a releva! %isease e! i # o *e &o!si%ere% i! si! a!% so$ issue i!$e& io!s i! !eo!a es 712   8. Incidence  — )(e i!&i%e!&e o$ SBI i! (e !eo!a e a!% #ou!' i!$a! is %i$$i&ul o >ua! i$# %ue o (e varia*ili # i! %e$i!i io!s o$ $ever provi%e% i! (e li era ure. Never (eless, a e a5a!al#sis o$ s u%ies pu*lis(e% *e /ee! 1@64 a!% 1@@0 $ou!% (a 6 per&e! o$ all $e*rile i!$a! s +3@C or 102.2F u!%er (ree o! (s o$ a'e (a% a! SBI, a!% *a& ereia or *a& erial e!i!'i is o&&urre% i! 2. per&e! 7138. A (i'(er i!&i%e!&e o$ (ese ill!esses o&&urre% i! i!$a! s i! (e $irs o! ( o$ li$e +-.6 a!% 3.6 per&e! , respe& ivel#.)/o s u%ies per$ore% a$ er (e i! ro%u& io! o$ va&&i!a io! a'ai!s ?aeop(ilus i!$lue!:a, #pe * $ou!% a (i'(er prevale!&e o$ SBI +12 o 13 per&e!  i! $e*rile !eo!a es u!%er 2@ %a#s o$ a'e 714,18. A! o*serva io!al s u%# %uri!' (e ie perio% a$ er i! ro%u& io! o$ rou i!e va&&i!a io! /i ( (ep avale! p!euo&o&&al va&&i!e %eo!s ra es a ra e o$ 12.- per&e! i! i!$a! s 1 o @0 %a#s /i ( $ever +1-.- per&e! i! &(il%re! 2- %a#s a!% 11.3 per&e! i! i!$a! s 2- %a#s 718. )(a (ei! ro%u& io! o$ (e (ep avale! p!euo&o&&al va&&i!e (as %e&rease% (e ra es o$ *a& ereia is evi%e! i! a! o*serva io!al &o(or s u%# (a i%e! i$ie% &(il%re! (ree #ears o$ a'e or #ou!'er a!% i!&lu%e% 0 iu!i:e% a!% 6 u!iu!i:e% &(il%re! 0 o @0 %a#s o$ a'e. I! (is &o(or , (era es o$ SBI /ere si'!i$i&a! l# (i'(er ao!' u!iu!i:e% &(il%re!. Horeover, (ere /ere !o &ases o$ p!euo&o&&al *a& ereia i! a!# o$ (e i!$a! s /(o (a% re&eive% a leas o!e %ose o$ (ep avale! p!euo&o&&al va&&i!e 7168. ?#perp#reia is rare ao!' $e*rile i!$a! s #ou!'er (a! (ree o! (s. ?o/ever, o!e o*serva io!al s u%# $ou!% (a (e @- i!$a! s +u!%er (ree o! (s o$ a'e /i ( epera ure G40C (a% a 2@ per&e! a*solu e i!&rease i! prevale!&e o$ SBI +3- versus @ per&e!  71-8.

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Jul 23, 2017

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