Saturday, December 13, 2014

Medical lesson on fevers, written by Gloria Poole, RN, artist of Missouri and Georgia

About fevers that develop suddenly
 written by Gloria Poole, Registered Nurse, artist of Missouri and Georgia

This "lesson" for the public's health is about the diagnosis and treatment of a sudden fever, and is intended as a mere guideline for anyone anywhere who develops a fever suddenly or has a family member who does; or who is expected to care for a person with a fever.  Pay attention to what other symptoms the person with a fever develops. Does shaking of body or arms and legs occur  called "chills" ? Is there a general overall feeling of not being well, called "general malaise"?  Did the person with fever lose the appetite for food? Does the person have a headache? Does the person with fever have spots or rash on face or body? Can the person swallow normally? Can the person keep down liquids? Has the person with fever lost weight? When did the fever begin? Is the fever worse at night? Does the person with a fever also have a cough? If so,, does the coughing occur in spasms? Does the coughing cause the person to spit out mucus? Are the pupils of the eyes reddened? Does the person's nose run ? Does the person have vomiting or diarrhea? Does the person have bleeding from eyes, nose, ears, rectum? 

In a normal healthy person, the normal temperature when taken by mouth varies from 96.5degrees fahrenheit [35.8  degrees Centigrade] to 99.0 degrees fahrenheit [37.2  degrees Centigrade] and usually the temperature is lowest between the hours of 2 -4 am, and highest between 6 -10pm. In very hot weather or after running, the body temperature may be 0.5 to 1.0 degrees  fahrenheit higher [03. to 0.6 degrees centigrade] temporarily. Most pharmacies sell some sort of thermometer for home use either the glass bulb sort that has mercury in it that is very durable but has to be disinfected between patients; or electronic ones which are much more expensive, have to be recalibrated at every use, and have to be replaced often.  

Infection somewhere in the body is the most likely cause of any fever. Some infections cause other symptoms within a day or two. Some fevers can persist for 3 weeks without developing other symptoms. Most common infections are viral infections including infectious mononucleosis, viral hepatitis, varicella [chicken-pox], rubeola, [measles], rubella [German measles], human immunodeficiency virus {HIV], and rickettsial infections such as Rocky Mountain spotted fever, caused by tick bites, and Q fever caused by airborne rickettsiae in dust caused by contaminated animals or by direct contact with infected animals; Lyme disease which is a spirochetal infection caused by deer ticks; and a variety of bacterial infections including infections of the pleura, biliary tract, retroperitoneum, kidney, liver, spleen; and several acute [creating a crisis] bacterial infections including acute bacterial endocarditis [bacteria affecting the outer sac of the heart] and Salmonella bacteremia [food poisoning] , and Leptospirosis caused by contact with domestic or wild animals' urine in moist soil or water.

Also, if the person with the fever has traveled to other countries that he or she does not normally live in, the diseases prevalent in those countries must be taken into consideration when arriving at a diagnosis. Some of those diseases that cause fever are malaria, dengue fever, scrub typhus, tuberculosis, ebola,  plaque caused by rodents, typhoid, tetanus.

The incubation period varies for different fevers. Incubation period means the time it takes for symptoms to develop after the person was exposed to the virus or bacteria. The incubation period for chicken-pox is 10-21 days; for German measles it is 14-21 days, for ebola it is up to 21 days after exposure, for Leptospirosis it is 4-19 days, for measles it i 9 to 11 days, for Q fever it is 14- 26 days, for Rocky Mountain Spotted fever it is 3 to 14 days.

Hypersensitivity to prescribed medicines can cause fever also, but digitalis preparations and insulin almost never are the cause of fever. Medicines that frequently cause fever because of hypersensitivity of the patient to them are: Allopurinol, Amphotericin B, antihistamines, Atropine, barbiturates, Bleomycin, Captopril, cephalosporins, Clofibrate, Ethambutol, Heparin, Hydralazine, Ibuprofen. iodides, Isoniazid, Methyldopa, Nifedipine, Nitrofurantoin, p-Aminosalicyclic acid, Penicillinamine, Penicillins, Phenolphthalein, Phenytoin, Procainamide, Propylthiouracil, Pyrazinamide, Quniidine, Salicylates, Streptomycin. Sulindac, Sulfonamides. Fever may begin [promptly with the first dose of these drugs or occur weeks later, but a person who has taken any of these for longer than 3 months' time,  is not having fever because of these drugs. A drug-induced fever may be low grade or rise to 104 degrees fahrenheit [40 degrees centigrade]. Chills do not commonly occur with drug-induced fevers. But itching, rash, eosinphilia occur in many cases. In a few cases drug induced fevers progress to serum sickness [rash, swollen lymph nodes, arthritis, nephritis, swelling . Some drugs can cause a lupus-like syndrome of fever, arthralgias, and positive anti-nuclear antibody [ANA] titers, If removing the drug causes the fever to go away, that is a definitive establishment of cause and effect. If organ damage occurred with the administration of any drug, the drug should not be taken again. Administration-related fever may occur with any medicine give by intravenous method. Some medicines cause leukopenia and fever.

Other causes of fever are vascular occlusion events such as deep vein thrombophlebitis, minor pulmonary embolus, asymptomatic myocardial  infarction [ M.I., commonly called heart attack]. Also, fever may be the only symptom of acute autoimmune hemolytic anemia or hemolytic anemia due to glucose-6-phosphate dhydrogenase [G6PD] deficiency. Some vaccines cause fever.

The people who at most at risk of developing infections are those with preexisting conditions such as lymphoma, HIV, those receiving corticosteroids, those on immuno-suppressive drugs, rheumatic valvular disease, certain congenital heart diseases, multiple myeloma, splenectomy, sickle cell disease, granulocytopenia [less than 1,000 granulocytes/mm] , advanced cirrhosis, diabetes, alcoholism, and those who use illegal substances .

Fevers lasting more than 3 weeks are usually chronic conditions such as tuberculosis, subacute bacterial endocarditis, [SBE, chronic osteomyelitis, cytomegalovirus infections, intra-abdominal abscesses, urinary tract infections, HIV, systemic lupus erythematosus, temporal arthritis, certain neoplasms especially lymphoma, acute leukemia, hypernephroma, hepatoma, pancreatic carcinoma. carcinoma of lung, bone malignancies, granulomatous hepatitis, hyperthyroidism, drug fever, inflammatory bowel disease, sarcoidosis, thyroiditis, recurrent pulmonary emboli. If fever has continued longer than 3 weeks in spite of diagnostic studies, these diseases must be considered as the possible cause of it.

To diagnose fever, start with taking a  comprehensive history from the patient. Ask the questions in paragraph one and include other questions about possible exposure to other people who have symptoms of any disease? Any travel abroad? To where, when, for how long? Are other people in the same household sick or have a fever? Does the person with a fever have any of the diseases listed in the above paragraph? Does the person with fever take any of the drugs or illegal substances listed in the paragraph about hypersensitivity ?  After the history is written see if any of it suggests a path to take to diagnose? if not, start the diagnostic work-up  to include: a chest X-ray of both lateral and posterior-anterior views, a complete blood count with differential, erythrocyte sedimentation rate, liver function tests, at least two blood cultures [aerobic and anaerobic], urinalysis, quantitative urine culture if urinalysis reveals pyuria or bacteriuria . If symptoms are severe, the patient may be hospitalized and treated with prompt anti-microbial drugs to prevent sepsis.  A physical examination should be done intermittently as long as fever persists to see if organs are being affected; and should include examination of the eyes with opthalmoscope, palpation for an enlarged or tender temporal artery, listen for a new or changing heart murmur, palpate for an enlarged  or tender thyroid gland, listen for pericardial, pleural, or hepatic friction rubs, palpate the liver, spleen, abdomen, for swelling or tenderness, examine the rectum [and prostate in men], feel for enlarged or tender lymph nodes, look at mucus membranes of mouth, eyes; look at nail beds for color and any splinter hemorrhages. Give the person with fever a PPD [Purified protein derivative test] for tuberculosis  unless there is a documented history of a positive PPD or of tuberculosis. Examine blood smears if the person has traveled to countries where malaria exists in past six months. Evaluate medicines patient takes.  If any are on the list of medicines and are not essential, discontinue them. If they are essential, change the medicine to something not on the list above that are known to cause fever.

Have patient take their own temperate twice a day for at least  two weeks and chart it so you can see if a pattern emerges? If fever persists, continue diagnostic work-up with skin tests, electrocardiogram, serum calcium level, serum titers of antistreptolysin O, rheumatoid factor, antinuclear antibody, HIV antibody, and a Monospot test and repeat the complete blood count with differential. It is important at this point to have an independent observer/ care giver to test the temperature and record it for another week. A fever of unknown origin lasting more than 3 weeks probably should be evaluated in an acute care hospital. Fevers that have other symptoms especially causing hemorrhaging or vomiting and diarrhea need to be hospitalized as quickly as possible.

It is important to note that not all fevers have to be treated. Some will run their course and the patient will get well. The use of antipyretics may not be needed but if so, aspirin is a very good anti-pyretic but may cause the patient to sweat and have shaking chills. That response can be diminished by giving the patient aspirin in dose of .03 to 0.g grams regularly at 3 to 4 hour intervals. If patient is allergic to aspirin, or at risk of bleeding,  acetaminophen may be given.  Unless the patient is acutely ill, with involvement of organs, it is considered best to hold off on treatment with antibiotics until you know what you are treating.

To prevent contamination of other persons the care taker and or medical doctor must use good handwashing technique including scrubbing under fingernails with a strong disinfectant and a nail brush and washing any part of their body that came into contact with infected person. If the virus or bacteria is airborne [spread by droplets through the breathing in and out of the infected person] then masks and covering head to toe must be  apart of the regimen of care. See the links in previous posts on how to do that. 

I referred to medical textbook, Principles of Ambulatory Medicine, edited by L. Randol Barker, MD; John R Burton,MD,;and Phillip Zieve, MD; chapter 26 to summarize and put into my own words so that average persons could understand this.

13 Dec  2014: Copyright notice: this blog and all content on it is created by me and owned by me  Gloria Poole residing in Missouri but born in the state of Georgia, and it is covered by U S copyright law. I, Gloria Poole, own all rights to this blog and to all content on it, all words, all photos, and all art represented by photos that I photographed. I have the actual, tangible art I created and photographed.  This blog and or its individual posts may not be transferred to anyone anywhere,nor have domains forwarded to it that do not belong to me, nor be saved to disk, nor downloaded, nor printed at remote,  nor copied, nor photo-copied [screen-captured] , nor in any way with any method be reproduced. I, Gloria Poole, own all rights to all words, art and photos I create  with any method of technique or medium on any surface anywhere any location any reason or no reason, whether or not I photograph it on any camera, phone, etc, and whether or not I publicly display it anywhere. I have never signed a blanket waiver of my copyrights to art I have created and do not have an artist's rep [agent], nor literary agent to represent me, and never did.  I drew,  painted, signed, photographed and uploaded all art on this blog and on any blog of mine.

For the record and to establish provenance of art I have already created also: the art I have created and signed and posted to this blog of mine is part of an on-going series of art I created since year 1991 beginning in Atlanta, GA that "blossomed"  in year 2005 in  Aurora, Colorado when I lived there for one year [May 2006-May 2007], and art began to really become an integral part of my efforts to save the baby humans from premeditated destruction. In 2005, I began to realize I could use the art to illustrate my talking points in some cases, and to build a secondary "career' for me as artist.  In the year 2006 when I had endured and lived to tell about it a violent crash down a flight of stairs and had trauma, fractures, concussion, because my then-husband DBP tried to kill me to 'make it look like an accident" and he tried to twist off my broken leg, I had immobility for months except on crutches and walking boot after surgery to repair fractures and implant metal. As I sat with leg propped up I began to draw daily and paint to occupy the time and my mind. I also began to post art to the web on my blogs and websites, and also photographs I had photographed. I began a series of art then that is named "ethnic series by Gloria" [me] to attempt to draw and paint an art work of every ethnic group tribe, language, culture in the world and I created eight initial oil paintings in the first batch and posted them to the web on domains of mine.  I moved from Aurora to zip code 80203 for 2 and 1/2 years and then moved to Missouri on Oct 31, 2009 with the art I had in my possession at that time. I paint some of the sketches I created  in do-overs into oils on canvas and those are very visible on the web. I put many of them on my mini exhibit of art at, and also on my Picasa albums at

 I, Gloria Poole, am a white, Southern Baptist Christian, brown-haired woman, single-again, twice-divorced,natural mother of only two children who are grown daughters named Jennifer and Leigh, and also a republican, personhood promoter, prolife activist-blogger, photographer, artist in all mediums, poet, author, illustrator, cartoonist, writer, University of Georgia alumna, U S citizen born in the state of Georgia [but I lived in several places including New York, UK briefly, Nebraska, South Carolina, Colorado, Virginia, North Carolina], former TV producer,tweeter, Registered Nurse licensed in Missouri [but before that in Georgia, UK, other states], owner/writer/blogger/photographer/illustrator for words that WORK, and also for Tapestry of LIFE,and also for Life Media & Publishing in years 2004-2011; and a just-for-fun-photographer, and citizen journo . Gloria Poole is my real, born with legal name and I resumed my full maiden name including my surname of Poole legally by Court order at the time of divorce from male DBP in Colorado in Oct, 2007 at Centennial, Colorado; and I also removed the Pappas name from my name forevermore at the time of final decree in Oct 2007 . I was glad to end that four year horrible marriage of multiple trauma and injuries to me caused by male DBP, [which I testified about in Court on several occasions ].  That second divorce is public record in the state of Colorado, and my first divorce is public record in the state of Georgia. I have created art regularly since 1991, and I had formal training in drawing and in mixing colors /paint and painting in oils and I post much of the art I create on blogs of mine. You can see some of that art on one of my name blogs at and see the about me page of that blog for the list of art blogs I own and post art too, that are all different. .

Copyright. Gloria Poole also known as Gloria on art I create and sign and in real life since it is my real, born with first name;  and as  Gloria Poole, RN, artist and on the web as : gloriapoole; gloria-poole; gloria.poole; artist-gloriapoole; @gloriapoole; @gloria_poole; gloria0817; gpoole817; Ms. Gloria Poole; Poole.Gloria; gloriapoole-paintings; cartooning-by-gloriapoole; photo-by-gloriapoole; gloriapoole.RN; gloriapooleRN at yahoo in which the RN is standard abbreviation for Registered Nurse, and other variations of my real, born with and legal name of Gloria Poole  at my own, private apt in Missouri which is not shared with anyone, on 13 Dec 2014 at  9:12am.