Fever: Symptoms, Complaints, Signs

The following symptoms and complaints may occur along with fever:

Leading symptoms

  • Vasoconstriction (vasoconstriction) in the hands and feet.
  • Freezing
  • Muscle tremor
  • Sweating (hot, very red skin, glassy eyes in high fever).
  • Vasodilation (vasodilatation)

Associated symptoms

  • General feeling of illness
  • Anorexia (loss of appetite)
  • Headache*
  • Pain in the limbs*
  • Febrile convulsions especially in infants and young children.
  • Chills

* Mostly in viral infections

Tumor fever

The following symptoms and complaints may indicate tumor fever:

  • Daily fever > 38.3 °C
  • Persistent fever lasting longer than two weeks despite empiric antibiotic therapy for five to seven days
  • Absence of signs of infection in comprehensive diagnostics.
  • Lack of evidence of an allergic reaction (transfusion, medication).

Warning signs (red flags)

  • Anamnestic information:
    • Consider tuberculosis in immigrants from Africa, Southeast Asia, and the Western Pacific region and in homeless persons.
    • If fever is unclear after a long-distance trip in exotic regions, refer early to an institute for tropical medicine* .
    • In case of fever and asplenia* (non-existence of the spleen) consider that untreated a lethal sepsis (fatal blood poisoning) is possible!
    • In the case of fever and neutropenia (reduction of neutrophil granulocytes in the blood; this is accompanied by a significantly reduced defense against infection), a rapid progression (progression) is to be expected if untreated. A prophylactic antibiotic therapy is indispensable here.
    • Fever under immunosuppression* (immunosuppressants) (eg, measures to suppress the defense reactions of the recipient organism against a foreign donor organ) is potentially dangerous, opportunistic pathogens (bacteria, fungi, viruses and parasites) are also possible.
    • Fever in patients > 60 years of age is associated with increased mortality (death rate).
    • Fever in patients with heart valve defects/prostheses* .
    • Fever in patients with condition n. chemotherapy with suspected mucositis (inflammation of mucous membrane)* .
    • I. V. drug use*
  • In case of chills and fever, think of bacteremia (washing of bacteria into the bloodstream) or endotoxinemia (endotoxins are decay products of bacteria that lead to inflammation and fever). “Chills“, on the other hand, are common when fever rises, including viral infections (viral infections).
  • In adults with fever > 40 ° C think of a serious bacterial infection. Extreme values also in heat stroke or malignant hyperthermia (a very rare, life-threatening complication of anesthesia).
  • Hypothermia (< 36 °C) is a poor prognostic sign in elderly patients with bacterial infection.
  • The cardinal symptom of bacterial infection, fever, is absent in elderly patients in more than 30% of cases.
  • Fever in dyspnea (shortness of breath) + tachycardia (heartbeat too fast: > 100 beats per minute)* .
  • Consider SIRS* (systemic inflammatory response syndrome) if fever is present with the following symptoms:
    • Respiratory insufficiency (limitation of breathing) with any of the following:
      • Arterial partial pressure of oxygen <70 mmHg during spontaneous breathing.
      • Horowitz index (oxygenation index; paO2/FiO2 < 175 mmHg) – index that provides information about lung function.
      • Hyperventilation
      • Tachypnea (> 20 breaths/min)
    • Tachycardia (heartbeat too fast: > 100 beats per minute).
    • Temperature < 36 °C or > 38 °C
    • Change in leukocyte count (white blood cell count) – < 4,000/μl or > 12,000/μl or ≥ 10% immature neutrophil granulocytes (e.g., rod-nucleated granulocytes/rod-nuclei).
  • If fever and meningismus* (painful neck stiffness), think of meningitis (cardinal symptom).
  • The appearance of CNS symptoms* (CNS, central nervous system / nerve structures located in the brain and spinal cord) such as impaired consciousness, seizures are warning signs of encephalitis / brain inflammation (prognostic unfavorable factor).
  • Consider infective endocarditis (endocarditis) in patients with persistent fever and murmur.
  • If fever and pruritus (itching) persist, think of leukemia (blood cancer) or lymphoma (malignant disease originating in the lymphatic system).
  • Dehydration (lack of fluids) can kill a baby* and an elderly patient* quickly!
  • Caution. The level of fever usually does not correlate with the severity of an illness. Babies are an exception to this. An alarm signal is:
    • Baby < 3 months: temperature > 38 °C
    • Baby 3-6 months: temperature > 39 °C
  • A floppy and sleepy baby with fever must be admitted immediately!

* Inpatient admission accompanied by an emergency physician due tovital danger.