What Is A Recurrent Fever

Overview 

Recurrent fever is highly prevalent in children and also occurs within the adult population. If the underlying condition remains unknown and untreated, it can be lethal as well. Therefore, it is highly crucial to detect the condition and take precautions. 

Introduction 

Recurrent fever is characterized by a fever lasting for long periods and relapses 3 or more times within 6 months with at least one-week intervals between each other.¹ Persistent fever is highly common in children.² Managing recurrent fever is highly crucial both in short-term and long-term periods to prevent morbidity and lethality, respectively.³

A rise and decrease in bodily temperature is a normal process known as thermoregulation, which is the adjustment of the body temperature and is highly crucial for survival.⁴ Our brain contains a region called the hypothalamus, and temperature-sensitive neurons within this area feel the changes in temperature. Then, they direct commands to organs such as skin and muscles to re-regulate the body temperatures in a variety of ways, such as sweating, shivering, or raising hair follicles.⁴ 

What are the causes of recurrent fever?

The source of the fever episodes is highly diverse. However, the most common fever is accompanied by infectious problems in both the adult and child populations. On the other hand, cachexia, eating disorders, neurogenic and endocrinopathy are the rare causes.

• Immunologic
• Rheumatologic 
• hematologic 
• Oncologic  
• Drug
• Cachexia
• Eating disorders
• Neurogenic fever
• Fever of endocrinopathy
• Autoinflammatory disorders
• Allergies
• smoking

Common Symptoms of Recurrent Fever

• Recurrent fevers 
• Rashes 
• Cold-induced symptoms
• Conjunctivitis 
• Lymphadenopathy 
• Recurrent infections 
• Aphthous stomatitis
• Bloody stools 
• Abnormal blood cell counts  
• Weight loss
• Night sweats
• Ulcer
• Abdominal pain
• Bloating
• Diarrhea
• Weakness 
• Neurological symptoms such as sensorineural deafness.^3,4

Diagnostic methods for recurrent fever

Patient story 

The foremost important step in the diagnostic process is the evaluation of the patient's story. This can be further categorized into subtitles.³ Few examples can be listed below:

• How frequent is the fever 
• What is the age of onset?
• When was the highest score of the fever
• Is there contact with the ill patient, allergen, or recently vaccinated
• Which symptoms of recurrent fever have been experienced 
• What the patient consumes in daily life
• If the patient is a child, how are the growth patterns?

Physical examination

Organ-based, oropharyngeal, lymphadenopathy, skin-related, and musculoskeletal abnormalities should all be checked up. 

Further evaluation

A serologic investigation will give in-depth information to help diagnose relapsing fever. Complete blood count is one of those methods, and it is accompanied by serum evaluations. Serum can give further details, such as the presence of inflammation in the body, by checking CRP levels, uric acid and lactate dehydrogenase levels, and the amount of immunoglobulin levels.³

Moreover, urine and blood can be investigated as a culture to check the existence of any bacterial infections. 

Analysis by detection of antinuclear antibodies (ANA) and antineutrophil cytoplasmic antibodies (ANCA) are also part of the diagnostic process. ANA and ANCA are used to diagnose autoimmune diseases, which can be the underlying reason for recurrent fever.^5,6

Screening

After a physical examination, the health specialist will determine the method of screening using technological methods. Moreover, the biopsy of defective organs or tissues may be carried out.³

Treatment methods

Relapsing fever is treated with the standardized method of fever treatment. A common action is reducing the amount of clothing used to help with heat exchange. As a homecare treatment, antipyretic drugs such as ibuprofen and paracetamol are highly common.7 However, the misuse of those drugs is highly common. Especially the risk of toxicity from those drugs is especially high. Therefore, the use of those treatment methods should be monitored by a health professional.

You should also drink plenty of liquid and get an adequate amount of rest. If your fever is persistent, you should start taking notes of the days and intervals of the fever as well as its duration in hours. Then, you need to bring this information to a health specialist and seek medical advice for the possibility of the presence of underlying serious health conditions. 

Each underlying condition is treated case-specific, and the fever keeps occurring till the solution is found.

Prognosis of the disease

The prognosis of the fever depends on the underlying cause of the recurrent fever. If a pathogenic infection stimulates the recurrent fever, the prognosis changes according to how serious the infection is, and the mortality rate ranges from low to moderate. Autoimmune diseases and periodic fever syndromes are within the better prognosis group due to their ability to be kept under control with the treatments. Nevertheless, cancer-associated fever can be highly severe, and the prognosis will be very low in conjunction with the type and stage of cancer. Also, the mortality rate depends on the condition of the disease and can have a low to high risk of spectrum. 

Preventative measures

The definite measures of prevention supported by research data do not exist for now. However, there are a few steps you can apply, which are known as general practices for general health. For instance, prevention of the underlying diseases. For deadly infections, vaccination is very life-saving and will also suppress relapsing fever. Personal hygiene will also further enhance the protection from infections. Maintaining a healthy lifestyle will reduce the risk of developing cancer disease. Early diagnosis will provide a low mortality rate from cancer.

Summary

Recurrent fever, characterized by long-lasting fever episodes with multiple relapses, poses risks in both children and adults if left untreated. Commonly caused by infectious sources, it can also stem from immunologic, rheumatologic, or oncologic conditions, among others. Symptoms include fever, rashes, and various systemic manifestations. 

Diagnosis involves patient history, physical examination, and serologic investigations. Treatment includes fever management with antipyretics and addressing underlying conditions. Prognosis varies depending on the underlying cause, with infections having a moderate prognosis and autoimmune diseases being more manageable. 

Preventative measures include vaccination, personal hygiene, and early diagnosis of underlying diseases.