1、 发热待查中南大学湘雅医院感染病科 Definition Temperature in the anus (rectum/rectal) is at or over 37.538.3 C Temperature in the mouth (oral) is at or over 37.7 C Temperature under the arm (axillary) or in the ear (otic) is at or over 37.2 C Fever is a common medical sign characterized by an elevation of temperatur
2、e above the normal range of 36.537.5 due to an increase in the body tempreture regulatory set-point. Types Intermittent feverContinuous fever Remittent feverRecurrent feverIrregular feverPersistent fever that cannot be explained after repeated routine clinical inquiries .Fever Of Unknown Origin FUOP
3、athophysiology Pyrogen is a substance that induces fever. Exogenous : many kinds of microorganisms and their metabolic substance、necrotic tissue 、 Ag-Ab complexes 、steroid such as etiocholanoloneEndogenous :all endogenous pyrogens are cytokines .IL-1 、 IL-6 、 TNF- 、 IFN et al.extrogenous endogenous
4、going through the blood-brain barriers activating arachidonic acid pathway PGE2the ultimate mediator of the febrile response acts on the hypothalamus generates a systemic response back to the rest of the body Pathophysiology skin vasoconstriction decrease heat loss rigor、 hormones like epinephrine p
5、roduce body heat UsefulnessIncreased mobility of leukocytesEnhanced leukocytes phagocytosis Endotoxin effects decreased Increased proliferation of T cells 常见引起发热的疾病发热性质 病 因 疾 病各种病原体（病毒、细菌、 急性、慢性全身或局灶感染感染性 支原体、衣原体、螺旋体、发热 立克次体和寄生虫等）血液病 淋巴瘤、恶组、噬血细胞综合征、白血病等风湿热、药物热、 SLE、 皮肌炎、变态反应及结缔组织病 多肌炎、结节性多动脉炎、结节性脂膜炎、成人 Still病等实体肿瘤 肾癌、肾上腺癌、肝癌、肺癌、肠癌等理化损伤 热射病、大的手术、创伤及烧伤等 神经源性发热 脑出血、脑损伤、植物神经功能紊 乱等其 他 甲亢、内脏血管梗塞、组织坏死、痛风非感染性发热
