Each infectious disease can have different variants of a temperature curve among which there are the most frequent, typical for this or that nosological form. Sometimes they even allow to diagnose reliably enough (a tetrian fever, etc.).
Duration of a fever has great value for differential diagnostics. A number disease is characterised by a short-term fervescence (a herpangina, small illness, an acute dysentery, etc.). And if, for example, the fever proceeds over 5 days it already allows to exclude such often meeting illnesses as a flu, and other acute respiratory virus diseases, quinsy (it is final if there are no complications). buy cipro On the contrary, the long fervescence (over a month) is observed rather seldom and only at some infectious diseases inclined to a fixing or chronic current (бруцеллез, a toxoplasmosis, a visceral leishmaniasis, a tuberculosis, etc.). Thus, expression of a fever, character, a temperature curve and duration of a fever allow to differentiate separate groups of infectious diseases in which differential diagnostics is carried out taking into account other parametres.
For differential diagnostics the interval between the beginning of a fever and occurrence органных lesions matters, in particular. At some infectious diseases this period less than 24 ч (герпетическая an infection, a scarlatina, a rubella, a meningococcemia, etc.), at others it lasts from 1 to 3 сут (a measles, a chicken pox, etc.) and, at last, at a number of illnesses it from above 3 сут (a typhoid, a virus hepatitis, etc.).
Character and level of an infectious case rate matter also. For example, any fervescence during a flu epidemic forces to think first of all of flu possibility. The indicating on contact to a sick measles, a scarlatina, a chicken pox, a rubella and other droplet infections is important. These data are compared with incubation interval terms. Other epidemiological data (stay in district, эндемичной on a malaria, and so forth) matter also.
For differential diagnostics change of a temperature curve under the influence of etiotropic medical preparations (malarial attacks are stopped by Delagilum, at a typhus the body temperature is quickly normalised after reception of Tetracyclinums and so forth) matters. Thus, in spite of the fact that the fever develops almost at all infectious diseases, there is a number of features of this syndrome which can be used for диф
ференциальной diagnostics. The differential diagnosis of a fever needs to be started to distinguish it from the raised body temperature of other nature.
Hyperthermia. At work indoors with the raised temperature of air or on the sun the simple hyperthermia at which only raised body temperature becomes perceptible can develop. Any clinical implications of illness at such persons are not present.
Thermal attrition is characterised by that, besides a moderate fervescence, delicacy, a headache, giddiness, thirst, pallor become perceptible, there can be a syncopal condition. The person not in a condition to continue work.
The heatstroke represents the most serious form of thermal disease. It is the difficult syndrome arising at an excessive fervescence [Lourin M. I, 1985]. At it the thermal lesion of many systems of an organism, in particular ЦНС develops. Very much the body heat is bound with дисбалансом between a heat production and a thermolysis. Besides heat production rising (physical work, etc.), matters the strengthened entering of heat at the expense of air heat, and also radiative entering of heat. The environment heat interferes with a thermolysis. A characteristic sign of a heatstroke is the diaphoresis termination.
The heatstroke begins acutely. This condition can be suspected at the patient at an ambient temperature 40 °С and above if it has suddenly lost consciousness in the conditions of intensive thermal influence, especially if there were exercise stresses. The body temperature at a heatstroke can fluctuate from 39,4 to 42,2 °С. Expression of changes ЦНС fluctuates from easy excitation and confusion of consciousness in initial stages of illness to a coma at the developed picture of illness. Cramps are quite often observed. There can be signs of an edema of a brain. A skin dry, hot. The tachycardia is characteristic, arterial pressure can be both lowered, and moderately raised. Breath speeded up, deep. At the majority of patients the dehydration develops. As a rule, liver function is broken, that is shown by rising of activity of an aspartate aminotransferase and аланинамино transferases (the AsAT, the AlAT), and then and an icterus. At a part of patients the hemorrhagic syndrome (диссеминированное intravascular coagulation), and also acute renal insufficiency as consequence of a canalicular necrosis in kidneys develops. At laboratory researches the hypopotassemia, an azotemia, a metabolic acidosis are often taped гипер натриемия.
Promote a fervescence by thermolysis buy rimonabant deterioration, especially at parenteral introduction, a number of medicinal preparations:
Derivatives фенотиазина (алиназин, Propazinum, алимемазин, etc.), трицикли ческие antidepressants (Imizinum, amitriptyline, Azaphenum, etc.), inhibitors monoaminoxidases (Nialamidum), amphetamines (Phenaminum), etc.
The original version of a fervescence is represented by a so-called malignant hyperthermia. It is rather rare version of a heatstroke. Ояа it is characterised by the catastrophic disorder of a muscular metabolism arising under the influence of the general anaesthesia or application of muscular relaxants. It is original «фармакогенети ческая a myopathy», caused genetically. It is sometimes bound to a subclinical myopathy which is shown only by rising of activity serumal креатининфосфокиназы. At children the malignant hyperthermia is observed at symptoms of abnormal development: a kyphosis, a lordosis, short growth, a cryptorchism, an underdeveloped mandible, a plaited neck, a ptosis, low planted auricles. The malignant hyperthermia can arise

It is necessary to mean, what not each fervescence is a fever, and for infectious diseases it is characteristic. As a fever understand терморегуляторное a fervescence which represents organised and координированный the answer of an organism to illness, i.e. The organism itself lifts a body temperature above norm [Law рин M. И, 1985].
The fervescence can be caused not only регуля торньши mechanisms, but result дисбаланса between a heat production and a thermolysis, order ultram as conducts to a fervescence contrary to organism attempts to maintain normal temperature. Such fervescence is called as a hyperthermia (it is not necessary to survey this term as a fever synonym, that sometimes meets in the literature). The hyperthermia is observed at so-called thermal diseases (a heatstroke, a hyperthyroidism, a poisoning with atropine, etc.).
At last, the fervescence can be caused normal activity or physiological processes. The small fervescence can be bound to circadian rhythms (daily fluctuations). The Body temperature at the healthy person usually reaches a maximum level to 18 ч and minimum happens in 3 ч nights. The small fervescence can come after plentiful meal and more appreciable - after a serious and long exercise stress. Thus, we can speak about different mechanisms of a fervescence:
For infectious diseases the fever is characteristic only, however it can develop and at other illnesses (breaking up tumours, an acute hemolysis, diseases of a connecting tissue, etc.), and some infectious diseases (a cholera, a botulism) can proceed and without a fever. All is necessary for considering it at carrying out of differential diagnostics. In connection with a fever wide circulation at many illnesses differentsialno-diagnostic value gets not so much fact of presence (or absence) fevers, how many a number of its features (the beginning, expression, temperature curve type, occurrence terms органных lesions and so forth) . In the illness beginning when still there are no data either about duration, or about character of a temperature curve, differentsialno-diagnostic value of a syndrome of a fever is less, than during the subsequent periods of illness when its many features are taped. The fervescence can be fast (acute) when the patient accurately notes even hour of the beginning of disease (an ornithosis, a canicola fever, etc.). At a fast fervescence, as a rule, the patient notes a fever of different expression - from a chilling to a tremendous fever (at a malaria, etc.). At other illnesses the fever accrues gradually (a typhoid, paratyphoids).
On expression of a fervescence allocate a subfebrile condition (37… 37.9 °С), a moderate fever (38… 39,9 °С), a high fever (40… 40,9 °С) and a hyperpyrexia (41 °С and above). Considering a fervescence pathogenesis, the subfebrile condition also should be surveyed as a fever.
Character of a temperature curve. Observation over dynamics of a fever raises its differentsialno-diagnostic value. At some infectious diseases the temperature curve is so characteristic, that defines the diagnosis (a malaria, a typhinia). It is accepted to allocate a number of types of a temperature curve which have diagnostic value.
The constant fever (febris continua) is characterised by that the body temperature is constantly enlarged, more often to 39 °С and above, its daily fluctuations less than 1 °С (it is observed at tifo-paratyphus diseases, fever Ку, a typhus, etc.)
Aperient (ремитгирующая) a fever (f. remittens) differs daily fluctuations of a body temperature from above 1 °С, but no more than 2 °С (an ornithosis, etc.).
Alternating fever (f. intermittens) it is shown by correct change of high or very high and normal body temperature with daily fluctuations in 3… 4 °С (a malaria, etc.).
Garapata disease (f. recurrens) it is characterised by correct change высоколихорадочных and the fever-free periods duration till some days (a typhinia, etc.).
Wavy or undulate fever (f. undulans) differs gradual increase of temperature to high digits and then its gradual depression to subfebrile, and sometimes and normal; through 2… 3 нед the cycle repeats (a visceral leishmaniasis, бруцеллез, a lymphogranulomatosis).
Gektichesky (exhausting) fever (f. hectica) a-long fever with very big daily fluctuations (3… 5 °С) with depression to normal or subnormal temperature (a sepsis, generalised virus infections, etc.).
Wrong (атипическая) a fever (f. irregularis) it is characterised by the big daily allowances разм; 1хами, different degree of a fervescence, uncertain duration. Costs to гектической to a fever more close, but it is deprived correct character (a sepsis, etc.).
The perverted (inverted) fever (f. inversa) the morning body temperature above, than evening differs that.
Besides these standard types, vpxl we consider expedient allocation of two more: an acute wavy fever and recurring.
Acute wavy fever (f. undulans acuta) unlike ундули рующей it is characterised by rather short-term waves (3… 5 days) and absence of remissions between waves; usually the temperature curve represents a number of fading waves, i.e. Each subsequent wave is less expressed (on height and duration), than previous (a typhoid, орни тоз, a mononucleosis, etc.); when the subsequent wave is caused by complication joining, return parities are observed, i.e. The second wave is more expressed, than the first (an epidemic parotitis, a flu, etc.).
Relapsing fever (f. recidiva) unlike a garapata disease (correct alternating of waves of a fever and апирексии) is characterised by relapse (usually one) fevers, which develops in various terms (from 2 days about one month and more) after the termination of the first temperature wave (a typhoid, an ornithosis, a canicola fever, etc.). Relapses develop at a part of patients (10… 20 %). In this connection, if relapse has the important diagnostic value its absence at all does not exclude possibility specified above illnesses.