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Acute Fever in Adults: Evaluation & Management by Dr. Pothireddy Surendranath Reddy
By Dr. Pothireddy Surendranath Reddy
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Introduction
Fever is one of the most common clinical symptoms encountered across all age groups. In adults and elderly people, however, acute fever carries a particularly important clinical significance. Unlike children—where most fevers are viral and self-limiting—fever in adults and older adults often indicates an underlying infection, systemic disorder, inflammatory condition, or even a life-threatening emergency. The clinical approach must therefore be systematic, evidence-based, and age-specific.
This comprehensive article explains the causes, risk factors, clinical evaluation, red-flag signs, diagnostic methods, and treatment principles of acute fever in adults and elderly individuals. It also highlights how fever behaves differently in older adults, why early diagnosis matters, and what preventive measures can reduce morbidity.
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1. What Is Acute Fever?
Fever is defined as:
§ ≥38°C (100.4°F) when measured orally
§ ≥38.2°C (100.8°F) rectally
§ ≥37.8°C (100°F) axillary (less reliable)
Acute fever refers to:
§ Fever lasting < 7 days, usually due to infections
§ Subacute: 7–14 days
§ Chronic/persistent: >14 days
In elderly patients, fever may be mild or even absent despite serious infection due to:
§ Reduced immune response (immunosenescence)
§ Blunted temperature regulation
§ Use of steroids or anti-inflammatory drugs
Thus, elderly fever must always be taken seriously.
2. Pathophysiology: Why Fever Occurs
Fever is a defensive physiological response produced by the hypothalamus. Pyrogens trigger cytokine release—IL-1, IL-6, TNF-α—raising the thermoregulatory set point.
Benefits of fever:
§ Enhances white blood cell activity
§ Slows bacterial and viral growth
§ Improves host immune response
Dangers of fever in adults and elderly:
§ Dehydration
§ Delirium, confusion
§ Seizures (rare in adults)
§ Stress on heart in patients with cardiac disease
3. Causes of Acute Fever in Adults
The majority are infectious, but non-infectious causes must also be considered.
A. Infectious Causes
1. Viral Infections – Most Common
§ Influenza
§ Dengue, Chikungunya
§ COVID-19
§ Viral gastroenteritis
§ Respiratory viruses (RSV, Adenovirus)
Symptoms: Body pain, headache, dry cough, sore throat, mild diarrhoea.
2. Bacterial Infections – High Risk
§ Urinary tract infection (UTI)
§ Pneumonia
§ Skin infections (cellulitis, abscess)
§ Bacterial meningitis
§ Typhoid fever
§ Tuberculosis
§ Dental infections
§ Sepsis (life-threatening)
3. Parasitic Infections
§ Malaria
§ Amoebiasis
§ Leptospirosis (especially during monsoon)
B. Non-Infectious Causes
Although less common, these are crucial.
1. Autoimmune and Inflammatory
§ Rheumatoid arthritis
§ Systemic lupus erythematosus
§ Vasculitis
§ Inflammatory bowel disease
2. Drug-Induced Fever
§ Antibiotics (penicillin, cephalosporins)
§ Anti-seizure medications
§ Antihistamines
§ NSAIDs
3. Malignancies
§ Lymphoma
§ Leukemia
§ Solid organ cancers (lung, colon)
This is called neoplastic fever.
4. Miscellaneous Causes
§ Heat stroke
§ Thyroid storm
§ Blood transfusion reaction
4. Special Considerations: Fever in Elderly People
The elderly respond very differently to fever due to:
1. Blunted Immune Response
Fever may be absent or mild despite severe infection.
A temperature of 37.5°C (99.5°F) may indicate infection.
2. Atypical Symptoms
Older adults may present with:
§ Confusion
§ Fall
§ Reduced appetite
§ Weakness
§ Worsening of existing disease (COPD, heart failure)
3. Higher Risk of Complications
§ Pneumonia mortality increases significantly
§ Sepsis progresses rapidly
§ UTIs can cause delirium or septic shock
§ Dehydration occurs faster
4. Polypharmacy
Medications like steroids, beta-blockers, and anti-inflammatories mask fever.
Therefore, any acute fever in elderly requires urgent evaluation.
5. Clinical Presentation
Common Symptoms with Fever
§ Chills, rigors
§ Headache
§ Body pains
§ Cough or breathlessness
§ Diarrhoea or vomiting
§ Burning sensation during urination
§ Localized pain (ear, throat, abdomen)
Red-Flag Symptoms
Immediate medical attention required:
§ Difficulty breathing
§ Chest pain
§ Severe headache or neck stiffness
§ Persistent vomiting
§ Confusion or altered sensorium
§ Purple rash (possible meningococcemia)
§ Seizure
§ Very high temperature > 103°F (39.4°C)
6. Diagnostic Approach to Acute Fever
A systematic evaluation is essential.
A. Clinical History
§ Duration of fever
§ Pattern (continuous, remittent, intermittent)
§ Travel history
§ Mosquito exposure
§ Sexual history
§ Animal exposure
§ Drug history
§ Vaccination status
§ Recent hospitalization or catheter use
B. Physical Examination
§ Vitals (HR, BP, RR, SpO₂)
§ Skin inspection for rashes
§ Throat, lungs, abdomen
§ Neurological evaluation
§ Joint swelling
§ Urinary signs
C. Laboratory Investigations
Basic Tests
§ CBC (WBC count often elevated)
§ ESR, CRP
§ Liver & kidney function
§ Urinalysis and urine culture
§ Blood culture
§ Chest X-ray
§ Dengue NS1, malaria smear/rapid test
§ Influenza test
Advanced Tests (Based on need)
§ CT chest/abdomen
§ Lumbar puncture (suspected meningitis)
§ Thyroid function
§ Autoimmune markers
§ Procalcitonin (bacterial infection severity)
7. Management of Acute Fever
Treatment depends on underlying cause, not fever alone.
A. General Measures
§ Stay hydrated
§ Oral rehydration salts
§ Light clothing
§ Lukewarm sponge bath
§ Adequate rest
§ Avoid alcohol or smoking
B. Medications
1. Antipyretics
§ Paracetamol 500–650 mg every 6 hours
(Avoid exceeding 3 g/day; elderly need dose adjustment)
2. NSAIDs (if needed)
§ Ibuprofen
(Avoid in kidney disease, gastritis, heart disease)
C. Antibiotics
Only when bacterial infection is confirmed or strongly suspected:
§ UTI
§ Pneumonia
§ Skin infections
§ Typhoid
§ Sepsis
Overusing antibiotics leads to resistance and complications.
D. Antiviral/Specific Therapies
§ Oseltamivir for influenza
§ Acyclovir for herpes zoster
§ Artemisinin combination therapy for malaria
§ Doxycycline for leptospirosis
E. Hospitalization Criteria
§ Elderly patient with comorbidities
§ Low BP
§ Sepsis or shock
§ Hypoxia
§ Altered mental status
§ Pneumonia
§ Severe dehydration
§ Persistent high fever >3 days
8. Complications
Fever itself is usually not dangerous, but delayed treatment is.
Complications include:
Adults:
§ Severe dehydration
§ Acute kidney injury
§ Pneumonia complications
§ Sepsis
Elderly:
§ Delirium
§ Falls
§ Multi-organ dysfunction
§ Rapid progression to septic shock
9. Prevention of Acute Infections
A. Vaccination
Especially for elderly:
§ Influenza vaccine
§ Pneumococcal vaccine
§ COVID-19 boosters
§ Hepatitis B
§ Shingles vaccine
B. Hygiene
§ Handwashing
§ Avoiding contaminated food/water
§ Safe mosquito control
C. Chronic Disease Management
Better control of:
§ Diabetes
§ Hypertension
§ COPD
§ Kidney disease
10. When to Consult a Doctor
Seek immediate help if:
§ Fever > 3 days
§ Fever with rash
§ Severe sore throat
§ Difficulty breathing
§ Blood in urine or stool
§ Confusion or severe weakness
§ Persistent vomiting
§ In elderly: any mild fever with lethargy or confusion
11. Prognosis
Most viral fevers resolve in 3–5 days.
Bacterial infections recover well with early treatment.
Elderly outcomes depend on:
§ Early diagnosis
§ Comorbidity control
§ Prompt hospitalization when needed
Relevant Website Links (Authoritative Sources)
These are high-quality medical references relevant to fever evaluation and management:
1. World Health Organization (WHO) – Fever & Infectious Diseases
https://www.who.int/health-topics
2. Centers for Disease Control and Prevention (CDC) – Adult infections
https://www.cdc.gov
3. Mayo Clinic – Fever in Adults
https://www.mayoclinic.org/symptoms/fever
4. NHS UK – Fever in Adults
https://www.nhs.uk/conditions/fever-in-adults
5. Johns Hopkins Medicine – Symptoms & Conditions
https://www.hopkinsmedicine.org/health
6. UpToDate (Clinical Guidance)
https://www.uptodate.com
7. Cleveland Clinic – Fever Causes & Treatment
https://my.clevelandclinic.org/health/symptoms/15159-fever
References
Journal of General Internal Medicine – Diagnostic approach to febrile illness.
WHO. Clinical management of infectious diseases.
CDC. Guidelines for adult infection evaluation.
Mayo Clinic. Fever in adults: symptoms and treatment.
NHS Clinical Guidance. Fever assessment in adults.
UpToDate: “Evaluation of fever in adults”.
Cleveland Clinic. Fever: symptoms, causes, management.
Lancet Infectious Diseases – “Fever in the elderly: atypical presentations”.
You can find Dr. Pothireddy Surendranath Reddy’s articles and professional content on the following platforms:
· https://pothireddysurendranathreddy.blogspot.com
· https://medium.com/@bvsubbareddyortho
· https://www.facebook.com/share/14QLHsCbyQz/
· https://www.youtube.com/@srp3597
· https://www.linkedin.com/in/pothireddy-surendranath-reddy-a980b438a
· https://x.com/pothireddy1196?t=ksnwmG_zUgEt_NyZjZEcPg&s=08
· https://www.instagram.com/subbu99p?igsh=MTRldHgxMDRzaGhsNg==
· https://about.me/pothireddysurendranathreddy
· https://psnreddy.unaux.com
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