Topic: FEVER. Always a good topic as to what constitutes fever. We all remember the days when normal was 98.6 degrees F. Now, with digital read outs, Harrisons textbook of internal medicine defines a fever as a morning oral temperature of >37.2 °C (>98.9 °F) or an afternoon oral temperature of >37.7 °C (>99.9 °F) while the normal daily temperature variation is typically 0.5 °C (0.9 °F). Additionally, so we are all on the same page, we would really like to have it as close to the core body temperature as possible but, in reality, most of us dont want an esophageal probe every time we feel uneasy, so we do need another way that best approximates our own, individual core body temperature. Only you know what that is. Also the manner in which it is measured and observed by another is critical in its accuracy. A rectal thermometer is the best, then oral (mouth closed!), temporal artery (not across the forehead, not a strip), then tympanic in that order. A lot of variability. Because of that, and my soap-box statement is I am weary of check-box medical history taking, a blanket check box that specifies a single number to fit every single individual is simply thoughtless. Lets take a scenario of infection. On day 1, you are infected by an Ebolavirus by whatever cause. The virus then passes into human tissue. It then must specifically recognize a receptor on a cell (dendritic cell; macrophage) and attaches itself to that specific receptor on that specific cell to interact in essentially a key and lock formation. Not a random event as there are many folds in the viral glycoprotein (GP spike much smaller) that must bind with and interact with the 3d structure of its receptor (NP1). Structure of the protein is the most important. The initial virus then injects its RNA and, to greatly simplify the rest, makes several viral proteins after it converts its antisense (backward), single strand, RNA from 3 -> 5 to 5->3 . It then also must make multiple copies of its original antisense genome, reassemble the virus together and then bud along with taking part of the host cell to form its envelope. The person it infects reacts to this invasion by the production of cytokines, resulting in a fever (febrile response). This obviously is not abrupt and this prodromal phase where symptoms begin gradually before the full manifestation of the disease occurs, can be where inadvertent transmission can occur. People then take Tylenol/Aspirin/Ibuprofen, etc, drink water, pass it if as anxiety, and walk on. Denial of disease is big, especially when it can be fatal. I have seen patients with cancer deny it until its metastasized. Human behavior cannot fit in a check box nor does It respond to rules, human declared regulations, and legislations. Look at the image below. The chart A is what Ebola follows. Viral hemorrhagic fever. A rise in temperature from the individual normal to the elevated stage (fever) and maintained through the viruses life cycle. Anywhere on the elevation can be contagious. It just so happens that in EVD, that rise is quick. There is still the pre-prodrome and prodromal stage of fever, headache, myalgia, an malaise (general yuk feeling) that really could be anything. Throw in denial and, well, I think we see the consequences. I will post the Ebola life cycle next. This is just a simple fever discussion. Be vigilant, be decisive, ask questions. It isnt a single individual.
Posted on: Thu, 16 Oct 2014 04:37:27 +0000
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