C h a p t e r 3
Inflammation, the Inflammatory Response, and Fever
69
■■
Fever, an elevation in body temperature, is one
of the most prominent manifestations of the
acute-phase response, especially if inflammation
is caused by infection. It is produced in
response to pyrogens that act by prompting the
release of prostaglandin E
2
or fever-producing
cytokines, which in turn resets the hypothalamic
thermoregulatory center.
■■
The reactions that occur during fever
consist of four stages: a prodromal period
with nonspecific complaints, such as mild
headache and fatigue; a chill, during which
the temperature rises; a flush, during which
the skin becomes warm and flushed; and a
defervescence stage, which is marked by the
initiation of sweating.
■■
The approach to fever in children varies
depending on the age of the child. Infants and
young children have decreased immunologic
function and are more commonly infected with
virulent organisms.
■■
The elderly tend to have a lower baseline
temperature, so that serious infections may go
unrecognized because of the perceived lack of a
significant fever.
R E V I EW E X E R C I S E S
1.
A 15-year-old boy presents with abdominal pain,
a temperature of 38°C (100.5°F), and an elevated
white blood cell count of 13,000/
μ
L, with an
increase in neutrophils. A tentative diagnosis of
appendicitis is made.
A.
Explain the significance of pain as it relates to
the inflammatory response.
B.
What is the cause of the fever and elevated
white blood cell count?
C.
What would be the preferred treatment for this
boy?
2.
Aspirin and other nonsteroidal anti-inflammatory
drugs are often used to control the manifestations
of chronic inflammatory disorders such as arthritis.
A.
Explain their mechanism of action in terms of
controlling the inflammatory response.
3.
Persons with long-standing ulcerative colitis, an
inflammatory bowel disease, have a higher risk of
colorectal cancer than the general population.
A.
Hypothesize on cancer-producing mechanisms
of this chronic inflammatory disease.
4.
A 3-year-old child is seen in a pediatric clinic with
a temperature of 39°C (103°F). Her skin is warm
and flushed, her pulse is 120 beats per minute,
and her respirations are shallow and rapid at
32 breaths per minute. Her mother states that she
has complained of a sore throat and has refused to
drink or take medications to bring her fever down.
A.
Explain the physiologic mechanisms of fever
generation.
B.
Are the warm and flushed skin, rapid heart rate,
and respirations consistent with this level of
fever?
C.
After receiving an appropriate dose of
acetaminophen, the child begins to sweat, and
the temperature drops to 37.2°C. Explain the
physiologic mechanisms responsible for the drop
in temperature.
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