I decided to discuss fever, because of the latest Ebola outbreak in the Democratic Republic of Congo(DCR), in a remote Northeastern Province of Bas-Uele, near the border with Central African Republic. As reported by World Health Organization ( WHO) Congo spokesman Eugene Kabambi. As confirmed by spokesperson in Geneva via an e-mail. As at the time of writing this, “so far there are 19 suspect cases, including three deaths and two lab-confirmed cases”. The WHO has said the outbreak appears to be limited to that remote area, and that there is no need for travel restrictions for the time being.
You see two countries are already under threat, the world being a global village – it will take a plane only three hours to fly the deadly virus into our shores, in Nigeria, so we can’t be too careful. Remember our ugly experience with the Liberian Diplomat. Are we ready?. So as a prelude, I am discussing fever.
• Do you know that some fevers are necessary to the body? This is a medical statement of fact. Yes some fevers are protective to the functions of the body’s mechanism. Confusing isn’t it? Not to talk of now that Ebola virus is practically at our borders, we must all know what steps to take when we have persistent and unexplained fevers. Let us begin from the beginning.
What is fever?
¤ Fever, an elevation of body temperature above 37^C(100^F) is actually a protective response to infection and injury. The elevated body temperature enhances the body’s defense mechanism while causing relatively minor discomfort for the person. Fever is also known as pyrexia and febrile response, is defined as having a temperature above normal range.
¤ Normally, body temperature goes up and down each day. It is lowest at about 6am(36.5^C/98.6^F), and highest from 4 to 6pm(37.5^C/100.5^F). Fever may follow a pattern in which the temperature peaks each day and then returns to normal, whenever this does not occur then we have fever.
¤ A fever is usually accompanied by sickness behaviour, which consists of lethargy, depression, anorexia, sleepiness and hyperalgesia.
¤ Certain people, for example alcoholics, the very old, and the very young, may have a drop in temperature as a response to severe infection, that is why we medically advise that they be covered with warm clothes, especially during cold seasons, because they could have fever without their body showing it.
¤ Substances that cause fever are called pyrogens, and may come from inside or outside the body. External pyrogens include microorganism like bacteria, ebola or lassa viruses, they produce toxins that cause fever. Internal pyrogens include white blood cell – monocytes that are stimulated to produce toxins.
How do we diagnose fever?
• The investigation of any body with prolonged fever, must follow the standard procedure established by Oxford University handbook first published in 1850. This follows four main laid down stages. 1) History. 2) Examination. 3) Investigation. & 4) Evaluation.
NB – this procedure is not followed during outbreaks of epidemics like Ebola, but we follow what we call “barrier investigative procedure”, and this is employed for the protection of the medical personnel.
Stage I – History.
A thorough history of the patient suffering from fever must be taken. Special note must be taken of foreign travels, contact with animal, bites, cuts, surgery, rashes, occasional mild diarrhoea, pleurisy, drugs(including non prescription) and immunization. Also excessive sweats, weight loss, lumps, and itching.
Stage II – Examination.
Examination should be thorough and repeated. On examination, is the patient ill-looking, alert, dehydrated, cyanosed, shocked, anemic, feverish, jaundiced, fat, wasted, tremulous. Note: any skin lesions, lymphadenopathy, enlarged liver and spleen, rectal and vaginal examination, oro-pharyngeal examination.
Stage III – Investigations.
Part One – the first day, in the investigation of prolonged fever, we do FBC, ESR, U & E, LFT, blood cultures, baseline serum for virology. Swab nose and throat. Stool sample. CXR. If patient is very ill, we consider treatment for septicaemia. All the abbreviations are known by the lab-man.
Part Two – If diagnosis of the fever is still uncertain, after reviewing the collated results, we re-do history and examination. Also do tests for rheumatoid factor, ANF, antistreptollysin, tuberculin test, ECG. We then consider withholding drugs one at a time for 48 hours each. Then we consider lumbar puncture for culture.
Part Three – We now consider further investigation of abdomen: ultrasound, Barium enema, IVU, liver biopsy, laparotomy.
Part Four – Then we consider treating for tuberculosis, polyartiritis nodosa, infective endocarditis.
Stage IV – Evaluation.
If the results of these investigations and all the trial treatments turn out negative, by the fever still continuing, we wait for 7 days and repeat the process of trying to identify the cause of the prolonged fever. If still negative, then keep the patient under strict observation and monitor the temperature spikes. Researches have shown that before we reach stage – iv, in our diagnostic inquest for fever, over 97% of what caused the fever had been identified.
Now, just reflect on the rigors of identifying the cause of a simple fever, then you will agree with the advertisers of analgesic, which states – take two tabs three times a day, if symptoms persist after 3-days, consult your doctor. Always manage your fever well.
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