Overheating (Hyperthermia): Or something else? Differential Diagnosis

Fever

Respiratory System (J00-J99).

  • Bronchitis* – inflammation of the bronchial mucosa.
  • Pharyngitis* (inflammation of the throat)
  • Pneumonia* (pneumonia)
  • Sinusitis (sinusitis)
  • Tonsillitis* (tonsillitis) or tonsillopharyngitis* (pharyngitis and / or tonsillitis).
  • Tracheitis* (inflammation of the trachea)

Blood, blood-forming organs – immune system (D50-D90).

  • Congenital immunodeficiencies (see below immunodeficiency/immune deficiency).
  • Hemophagocytic lymphohistiocytosis (HLH; Engl. Synonyms: hemophagocytic syndrome (HPS), lymphohistiocytic syndrome (LHS), macrophage activation syndrome (MAS, German Makrophagenaktivierungssyndrom) or reactive hemophagocytic syndrome (RHS) – rare, potentially fatal hyperinflammatory syndrome; clinical triad: High fever, hepatosplenomegaly (liver and spleen enlargement), (pan-)cytopenia (pancytopenia: Cell count decrease in all three cell series); less commonly, lymphadenopathy (lymph node enlargement), exanthema (skin rash), and ascites (abdominal fluid) or pleural effusion (water accumulation between the pleura and pleura); lethality: 3-50%; possible triggers are malignancies (especially lymphomas/tumors of lymphoid tissue) as well as infections and autoimmunopathies (autoimmune diseases). Laboratory diagnostics: cytopenia as well as massive and rapidly increasing ferritin values (about three quarters of all patients show ferritin peak values > 10,000 μg/l).
  • Sickle cell anemia (med.: Drepanocytosis; also sickle cell anemia, sickle cell anemia) – genetic disease with autosomal recessive inheritance, which affects the erythrocytes (red blood cells); it belongs to the group of hemoglobinopathies (disorders of hemoglobin; formation of an irregular hemoglobin, the so-called sickle cell hemoglobin, HbS).

Endocrine, nutritional, and metabolic diseases (E00-E90).

  • Addisonian crisis (acute NNR insufficiency; acute adrenocortical insufficiency).
  • Adrenocortical insufficiency (NNR insufficiency; adrenocortical weakness).
  • Graves’ disease – form of hyperthyroidism (hyperthyroidism) caused by an autoimmune disease (= immune hyperthyroidism). It is a hyperthyroidism (hyperthyroidism) induced by stimulating autoantibodies against the TSH receptor (TRAK).

Skin and subcutaneous (L00-L99).

Cardiovascular system (I00-I99).

  • Infective endocarditis (endocarditis of the heart); esp. to be excluded after dental surgery (90% of cases accompanied by fever).
  • Myocarditis
  • Pericarditis (inflammation of the pericardium) (body temperature > 38 °C is considered to indicate a worse prognosis).
  • Postinfarction fever/after a heart attack (25-50% of cases associated with elevated body temperature).
  • Postcardiotomy syndrome (synonym: postpericardiotomy syndrome) as a special form of pericarditis; incidence 10-15% after cardiac surgery – symptoms similar to Dressler myocarditis; Dressler syndrome (synonyms: postmyocardial infarction syndrome, postcardiotomy syndrome) – several weeks (1-6 weeks) after a myocardial infarction (heart attack) or an injury to the myocardium (heart muscle) occurring pericarditis (pericarditis) and / or pleurisy (pleurisy) as a late immunological reaction at the pericardium (pericardium) after the formation of myocardial antibodies (HMA)In postcardiotomy syndrome: pericardial effusions (55-90% of patients) and increased inflammation (40-75% of patients); prognosis is favorable.

Infectious and parasitic diseases (A00-B99).

  • Viral infections
    • Chikungunya fever
    • Cytomegalovirus
    • Dengue fever – infectious disease that occurs mainly in tropical and subtropical regions (Southeast Asia) [Asia].
    • Exanthema subitum* (three-day fever).
    • Epstein-Barr virus infection (EBV e.g. reactivated by tumor disease).
    • Flu infection* (common cold)
    • Hand-foot-mouth disease* (HFMK; hand-foot-mouth exanthema) [most common cause: Coxsackie A16 viruses].
    • Hepatitis B (liver inflammation).
    • Hepatitis C
    • HIV / AIDS
    • Infectious mononucleosis* (synonyms: Pfeiffeŕsches glandular fever, infectious mononucleosis, mononucleosis infectiosa, monocyte angina or kissing disease, (Student́s) kissing disease, called) – common viral disease caused by the Epstein-Barr virus (EBV); this affects lymph nodes, but can also affect the liver, spleen and heart.
    • Influenza (flu)
    • Measles (Morbilli)
    • Pseudocroup* / croup coughlaryngitis, which leads mainly to swelling of the mucous membrane below the vocal cords.
    • Ringworm* (erythema infectiosum) – parvovirus B19
    • Rubella
    • Viral hemorrhagic fever (VHF), e.g. dengue fever, Crimean-Congo hemorrhagic fever.
    • Chickenpox* (varicella)
    • Yersiniosis, chronic – disease caused by bacteria of the genus Yersinia.
  • Bacterial infections
  • Mycoses (fungal infections)
    • Actinomycosis
    • Aspergillosis
    • Blastomycosis
    • Candidiasis
    • Histoplasmosis
    • Coccidiomycosis
    • Cryptococcosis
    • Mucor
    • Pneumocystis jirovecii
  • Parasitic infections
    • Amoebic dysentery (tropical intestinal infection).
    • Babesiosis – infectious disease caused by babesia (small intracellular parasites transmitted by tick bite):ticks of the family Ixodidae: in Europe, infections are dominated by Babesia divergens, in the United States by Babesia microti and or Babesia duncani; pathogens infect erythrocytes (red blood cells) and cause a malaria-like disease.
    • Chinese liver fluke
    • Echinococcus (dog tapeworm, fox tapeworm).
    • Entamoeba histolytica
    • Spotted fever – also called “lice fever” or faecal fever; infection with microorganisms of the genus Rickettsia (Rickettsia prowazekii) transmitted by lice, mites, ticks or fleas.
    • Giardiasis* – small intestine infection caused by Giardia lamblia (Giardia duodenalis, Giardia intestinalis, Lamblia intestinalis).
    • Gnathostomiasis (pathogen: Gnathostoma spinigerum or Gnathostoma hispidum).
    • Katayama fever (referred to as acute schistosomiasis / bilharzia) – worm disease (tropical infectious disease) caused by trematodes (sucking worms) of the genus Schistosoma (couch flukes).
    • Leishmaniasis
    • Lung fluke
    • Malaria – tropical infectious disease transmitted by the Anopheles mosquito [Africa].
    • Protozoonosis (a disease transmitted by protozoa), e.g. leishmaniasis, cryptosporidiosis.
    • Rickettsioses (rickettsiae; transmitted by ticks, mites or mite larvae, and by lice or fleas) [Africa].
    • Schistosomiasis
    • Strongyloidiasis
    • Toxocara canis (canine roundworm)
    • Trichinosis (synonym: trichinellosis; causative agent: trichinae).
    • Toxoplasmosis
  • Infections with different types of pathogens
    • Gastroenteritis* (gastrointestinal flu) (in children up to 5 years old in about 40% of cases by rotaviruses).
  • Sepsis; most common sites of infection in community-acquired sepsis are:
    • Lower respiratory tract (e.g., pneumonia/pneumonia, pleural empyema/accumulation of pus (empyema) within the pleura, that is, between the two pleural leaves)
    • Gastrointestinal tract (e.g., intra-abdominal abscess, cholangitis/bile duct inflammation, diverticulitis/disease of the large intestine in which inflammation forms in protrusions of the mucosa (diverticula))
    • Genitourinary tract (eg, pyelonephritis/renal pelvic inflammation with obstruction).

Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).

Musculoskeletal system and connective tissue (M00-M99).

  • Collagenoses (group of connective tissue diseases caused by autoimmune processes): systemic lupus erythematosus (SLE), polymyositis (PM) or dermatomyositis (DM), Sjögren’s syndrome (Sj), scleroderma (SSc), and Sharp syndrome (“mixed connective tissue disease”, MCTD).
  • Ankylosing spondylitis (AS) – chronic inflammatory disease of the spine that can lead to joint stiffness (ankylosis) of the affected joints. The sacroiliac joints (ISG; sacroiliac joints) are typically affected first
  • Necrotizing fasciitis (lat. Fasciitis necroticans) – foudroyant proceeding, bacterial soft tissue infection of the skin and subcutis, in which the fascia is also affected, by Streptococcus pyogenes (GAS, group A streptococci); usually after (minor) trauma [creatine kinase ↑]
  • Osteomyelitis (bone marrow inflammation).
  • Rheumatic diseases (eg, rheumatoid arthritis, rheumatic fever).
  • Vasculitides (autoimmune disease affecting blood vessels: e.g., periarteritis nodosa; Kawasaki disease (synonyms: Kawasaki syndrome, mucocutaneous lymph node syndrome, MCLS) – acute, febrile, systemic disease characterized by necrotizing vasculitis (vascular inflammation) of small and medium-sized arteries.

Neoplasms – tumor diseases (C00-D48).

  • Tumor diseases (below are details of tumors most commonly associated with fever):
    • Acute leukemias (blood cancers).
    • Bronchial carcinoma (lung cancer)
    • Colon carcinoma (colon cancer)
    • Hepatocellular carcinoma (liver cancer)
    • Lymphoma (Hodgkin, non-Hodgkin)
    • Hypernephroma (renal cell carcinoma).
    • Leukemias
    • Breast carcinoma (inflammatory; inflammatory breast cancer).
    • Hodgkin’s disease – malignant neoplasia (malignant neoplasm) of the lymphatic system with possible involvement of other organs; is counted among the malignant lymphomas.
    • Myelodysplastic syndrome (MDS) – group of heterogeneous (inconsistent) diseases of the bone marrow (stem cell diseases) represent.
    • Non-Hodgkin’s lymphoma
    • Plasmocytoma (multiple myeloma) – malignant (malignant) systemic disease that is one of the non-Hodgkin’s lymphomas of B lymphocytes.
    • Pleural mesothelioma (pleural cancer) – > 90% of cases associated with exposure to asbestos.
    • Liver metastases or hepatocellular carcinoma (hepatocellular carcinoma).
    • Ovarian carcinoma (ovarian cancer).

Ears – mastoid process (H60-H95)

Psyche – nervous system (F00-F99; G00-G99).

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

  • Thirst (thirst fever)
  • Fever of travelers returning
  • Systemic inflammatory response syndrome (SIRS).

Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99).

  • Urinary tract infection (UTI)*
  • Pyelonephritis (inflammation of the renal pelvis)

Injuries, poisonings, and certain other sequelae of external causes (S00-T98).

Medication

  • Drug fever (synonym: drug fever) – mainly caused by hypersensitivity syndromes; fever occurs in this case relatively shortly after the first drug intake and subsides within 72 hours after discontinuation of the drug; examples:

Operations

  • First postoperative week:
    • Resorptive fever (“aseptic fever”) – due to the breakdown of destroyed tissue components after surgery.
    • Surgical complication
    • Catheter sepsis/thrombophlebitis
    • Nosocomial infection (hospital-acquired infection)
    • Thromboembolism – occlusion of a blood vessel by a detached blood clot.
    • Gout attack

Environmental pollution – intoxications (poisoning).

  • Climate-related heat stress (eg, desert climate).

Other causes

  • Abscess (somewhere)
  • Asplenia – absence of the spleen; congenital or acquired by splenectomy (removal of the spleen).
  • Blood transfusions, vaccinations* (toxic fever).
  • Heat accumulation (heat fever)

Hyperthermia

Hyperthermia – increased temperature without adjustment of the set point in the heat regulation center in the hypothalamus (part of the diencephalon) such as in:

  • Damage to the central nervous system
  • Disturbance of the body’s thermoregulation (e.g., insufficient fluid intake with consequent decreased sweating in elderly patients)
  • Drug abuse
  • Sports in midsummer → stress-induced hyperthermia.
  • Heat stroke
  • Medications such as antidepressants (anti-depressant medications) (for more medications, see “Heat stroke and sunstroke/pathogenesis – etiology” below).

Malignant hyperthermia

Legend

  • Bold (= persistent fever, i.e. > 3 weeks); marked were diseases that occur frequently to occasionally.
  • * Fever in children; marked were diseases that occur frequently to occasionally.
  • [typical travel destinations] were marked with square brackets