What is intermittent fever
There is talk of intermittent fever when the basal temperature undergoes wide fluctuations, alternating periods of apyrxia (absence of fever) with others of pyrexia / hyperpyrexia (fever, even very high).
To define itself as "intermittent", the temperature fluctuations during the day must be higher than at least 1 ° C and, during the periods of apyraxia, the basal temperature must fall below 37 ° C.
Intermittent fever must be distinguished from the "remittent" form, in which the body temperature fluctuates over 24 hours with fluctuations above 1 ° C, BUT does not fall below 37 ° C for a few days.
Classification
Intermittent fever can be differentiated based on the dynamic behavior of the basal temperature:
- Intermittent daily fever: the interval between hyperthermia and apyraxy is short, and temperature fluctuations (> 1 ° C) recur several times over a 24-hour period.
- Two-day intermittent fever: it presents two febrile accesses and two falls in the basal temperature below 37 ° C during the day.
- Intermittent tertiary fever: the body temperature suddenly increases with diffuse chills and lasts 1 day, disappears on the second day to reappear 24 hours later (hyperpyrexia on days 1, 3, 5, 7 etc.). Fever appears every other day.
- Quartan intermittent fever: body temperature suddenly increases with widespread chills and lasts 1 day. Two days of apyressia follow; on the following day, the fever appears again (fever on days 1, 4, 7, 9 etc.). The course of quartan intermittent fever is typical of malaria.
- Quintana intermittent fever: the interval between the pyrexia and apyrectic phase lasts 3 days. Fever occurs on days 1, 5, 9, 13 etc.
Related diseases
Intermittent fever may occur on several occasions. Only rarely, unfortunately, intermittent fever is a symptom of benign diseases and simple resolution; more often, in fact, the wide fluctuating fluctuation of body temperature conceals far more serious underlying pathologies. Intermittent fever is comparable to the tip of an iceberg: the actual disturbance lies below and is not seen.
What diseases can hide behind intermittent fever?
- AIDS: some AIDS patients may have symptoms such as intermittent fever, low-grade fever or high fever
- Kidney cancer: intermittent fever is typical of malignant neoplasms, especially kidneys
- Cholangitis (inflammation of the bile ducts): intermittent fever is one of the characteristic symptoms of cholangitis
- Gonococcal endocarditis: infectious / inflammatory pathology of the endocardium supported by Neisseria gonorrhoeae
- Septic fever: fever induced by bacterial infections; the thermal excursions that characterize it are very wide
- Trench fever: infectious disease carried by fleas infected by the bacterium Bartonella quintana . The bite of a flea infected with this pathogen can transmit the infection to humans.
- Urinary tract infections: often accompanied by so-called uroseptic fever, characterized by a transient entry of pathogens into the bloodstream. The febrile peaks, always accompanied by apyrectic moments, are very high (39-40 ° C).
- Trematode infections (flatworm parasitic worms)
- Suppurative infections (with formation of purulent material)
- Tuberculosis infections: the disease is characterized by tertian remittent fever, in which temperature acme is generally found in the morning.
- Visceral leishmaniasis: is characterized by bi-everyday intermittent fever
- Malaria: intermittent malaria fever has a particular trend: based on the Plasmoidium strain involved, high fever can occur daily, appear on alternate days (terzana) or occur on the first day, vanish completely for two days and recur later (fever) intermittent quarter).
- African sleeping sickness ( trypanosomiasis ): tropical disease spread in African equatorial lands, caused by Tripanosomabrucei, a protozoan parasite with flagella. This is a serious health problem, after malaria, AIDS and severe diarrhea. The final stage of the disease involves lethargy, cachexia, apathy, inability to get up and feed: hence, the name "sleep sickness".
- Infant Crohn's disease: complex chronic disease of the gastrointestinal tract, with (potentially) auto-immune etiology. Intermittent fever completes the heterogeneous clinical picture of the affected patient. Intermittent fever is not an exclusive and typical symptom of the disease; despite this, in some patients this characteristic is constantly observed.
- Acute pyelonephritis: upper urinary tract infection in which sporadic or frequent episodes of intermittent fever are possible
- Rickettsiosi: infectious disease caused by gram-negative microorganisms, known as Rickettsia . These are infectious diseases transmitted by ticks, fleas and lice. Intermittent quintana fever characterizes this variant.
- Gonococcal sepsis: it is characterized by bi-everyday intermittent fever
- Septicemia: people with septicemia often complain of intermittent daily fever
- Triad of Charcot (not to be confused with Charcot-Marie-Tooth disease): it is a pathology marked by the concomitant presence of cholangitis, jaundice, chills and episodes of intermittent fever.
Differential diagnosis and therapy
Intermittent fever therapy is related to the underlying cause, so differential diagnosis is essential.
In the absence of clinical indications, the patient suffering from intermittent fever may undergo multiple diagnostic tests, such as:
- Blood count, ESR (erythro-sedimentation rate), glycemia, electrolyte research, urine test, blood culture, transaminase
- ELISA test
- Chest x-ray
- Eco-abdomen
Remember, however, that in 22-50% of cases, intermittent fever is defined as "idiopathic", ie no underlying cause can be traced.
