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Featured Medical Impossibility to have fever

  1. Mar 23, 2017 #1
    Hi all,

    I'd like to know if it's phisiologically possible for a human being to be unable to have fever. A related person to me claims that he has never expirienced fever in his life, even during influenza, pneumonia and other infections. Is there any similar case of immunodeficiency registered in the medical literature?

    Thanks

    EDIT: By "never experienced fever" I meant to say that everytime he was sick and measured his temperature, it was in the normal range (~ 36.5 °C/97.7 °F)
     
    Last edited: Mar 23, 2017
  2. jcsd
  3. Mar 23, 2017 #2
    He may not have felt as if he had raised body temperature while suffering from such as influenza, but unless his temperature was actually measured that doesn't mean much.
    That being said some people have more severe reactions to infections than others do.
     
  4. Mar 23, 2017 #3
    Sorry @rootone I think I incurred in a miscommunication when I said "never experienced fever". I meant to say that he claimed his temperature never raised to the value in which it's medically considered as fever. So everytime he got sick (a cold, pneumonia, dog bite, post-surgery complications) he measured his temperature and it was normal.
     
  5. Mar 23, 2017 #4
    The raised body temperature is advantageous for immune system agents, and disadvantageous for the infection.
    It is thought to be triggered by the lower brain as a response to detecting molecules associated with a pathogen.
    I suppose it is possible for that normal response to not occur, perhaps due to unusual genetics.
    It being absent probably will mean that the person will take longer to fully deal with the infection,
    though not to the extent of making the difference between life and death.
     
  6. Mar 23, 2017 #5

    berkeman

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    Has he ever asked his doctor about this? It would be interesting to hear what his doctor says...
     
  7. Mar 23, 2017 #6

    jim mcnamara

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    No. The possibility is virtually non-existent.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786079/

    Febrile response (fever) is a genetic trait in all mammals. However there are some studies to indicate genetic changes in pathogens can mediate (alter, change) the range of the response. Ask your "friends" parents if that person ever had a sick day. IMO that person is either fibbing, deluded or lucky that s/he never happened to encounter a genetic variant of a pathogen that induces high fever.

    Trends in DNA Fingerprinting Research
    M. M. Read 1991 e.g., p. 98
    There is a review discussing Mycobacterium tuberculosis (TB germ) genotypes - some genetic variants induce very high fever, others do not.
     
  8. Mar 28, 2017 #7

    rbelli1

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    Perhaps he has a particularly low normal body temperature. His "normal" temperature reading when ill is actually a fever for him.

    Has he ever taken his temperature when not ill? Doe he often complain about the room being too hot?

    98.6 for me is more than a degree higher than normal.

    BoB
     
  9. Mar 29, 2017 #8

    Choppy

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    I've found that these kinds of claims are best responded to with "that's nice."

    Based on empirical experience, the probability that your friend has the superhuman ability to fight off a serious viral infection without a fever is low. None of us can say that it's impossible though. Everyone's immune system is different. And that's also tempered with the fact that a person doesn't always develop a measurable fever in response to a viral infection - particularly minor ones.

    This is something that's basically a conversational claim. Someone makes a claim about an improbable event and most people have a natural reaction to start trying to either explain or dismiss it.

    To a scientist though, we need to understand the conditions of the claim first. To accept and seriously entertain the claim that this individual has never or does not develop a fever, we would need to track his temperature in a controlled manner after multiple exposures to multiple viral infections. And though I don't doubt this person has stuck a thermometer in his ear or mouth when he's felt sick, we have no way of knowing how well calibrated the thermometer was, how frequently his temperature was checked, whether he did it properly, of if the only viruses he was exposed to were minor colds that made his nose run for a day or two.

    So while it might be tempting to come back with "that's impossible and here's why" sometimes the best response is simply not to engage.
     
  10. Apr 1, 2017 #9

    atyy

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    https://www.ncbi.nlm.nih.gov/pubmed/19940926
    Nature. 2009 Nov 26;462(7272):505-9. doi: 10.1038/nature08596.
    Central control of fever and female body temperature by RANKL/RANK.
    Hanada R, Leibbrandt A, Hanada T, Kitaoka S, Furuyashiki T, Fujihara H, Trichereau J, Paolino M, Qadri F, Plehm R, Klaere S, Komnenovic V, Mimata H, Yoshimatsu H, Takahashi N, von Haeseler A, Bader M, Kilic SS, Ueta Y, Pifl C, Narumiya S, Penninger JM.

    Receptor-activator of NF-kappaB ligand (TNFSF11, also known as RANKL, OPGL, TRANCE and ODF) and its tumour necrosis factor (TNF)-family receptor RANK are essential regulators of bone remodelling, lymph node organogenesis and formation of a lactating mammary gland. RANKL and RANK are also expressed in the central nervous system. However, the functional relevance of RANKL/RANK in the brain was entirely unknown. Here we report that RANKL and RANK have an essential role in the brain. In both mice and rats, central RANKL injections trigger severe fever. Using tissue-specific Nestin-Cre and GFAP-Cre rank(floxed) deleter mice, the function of RANK in the fever response was genetically mapped to astrocytes. Importantly, Nestin-Cre and GFAP-Cre rank(floxed) deleter mice are resistant to lipopolysaccharide-induced fever as well as fever in response to the key inflammatory cytokines IL-1beta and TNFalpha. Mechanistically, RANKL activates brain regions involved in thermoregulation and induces fever via the COX2-PGE(2)/EP3R pathway. Moreover, female Nestin-Cre and GFAP-Cre rank(floxed) mice exhibit increased basal body temperatures, suggesting that RANKL and RANK control thermoregulation during normal female physiology. We also show that two children with RANK mutations exhibit impaired fever during pneumonia. These data identify an entirely novel and unexpected function for the key osteoclast differentiation factors RANKL/RANK in female thermoregulation and the central fever response in inflammation.

    From the main text of the above paper:
    Recently, in a Turkish consanguineous family, a homozygous RANK mutation (Arg170Gly mutation) was identified in two children, leading to severe autosomal-recessive osteopetrosis. We therefore speculated that these two patients might have impaired fever responses in their clinical history. ‘Normal’ children with pneumonia develop very high fever that then decreases to baseline after antibiotic treatment. Although hospitalized for severe pulmonary infections confirmed by serology and chest X-rays, both siblings with autosomal-recessive osteopetrosis had a markedly abrogated fever response compared to age-matched children with pneumonia. Thus, RANKL/RANK also control fever in humans.

    https://www.ncbi.nlm.nih.gov/pubmed/9751056
    Nature. 1998 Sep 17;395(6699):281-4.
    Impaired febrile response in mice lacking the prostaglandin E receptor subtype EP3.
    Ushikubi F, Segi E, Sugimoto Y, Murata T, Matsuoka T, Kobayashi T, Hizaki H, Tuboi K, Katsuyama M, Ichikawa A, Tanaka T, Yoshida N, Narumiya S.

    Fever, a hallmark of disease, is elicited by exogenous pyrogens, that is, cellular components, such as lipopolysaccharide (LPS), of infectious organisms, as well as by non-infectious inflammatory insults. Both stimulate the production of cytokines, such as interleukin (IL)-1beta, that act on the brain as endogenous pyrogens. Fever can be suppressed by aspirin-like anti-inflammatory drugs. As these drugs share the ability to inhibit prostaglandin biosynthesis, it is thought that a prostaglandin is important in fever generation. Prostaglandin E2 (PGE2) may be a neural mediator of fever, but this has been much debated. PGE2 acts by interacting with four subtypes of PGE receptor, the EP1, EP2, EP3 and EP4 receptors. Here we generate mice lacking each of these receptors by homologous recombination. Only mice lacking the EP3 receptor fail to show a febrile response to PGE2 and to either IL-1beta or LPS. Our results establish that PGE2 mediates fever generation in response to both exogenous and endogenous pyrogens by acting at the EP3 receptor.
     
    Last edited: Apr 1, 2017
  11. Apr 9, 2017 #10
    Generally speaking, a (sub)febrile temperature is not necessary during even an extreme immune reaction; this is somewhat commonly seen with elderly patients. This however is extremely unlikely with younger people.

    Source: I'm an MD
     
  12. Apr 9, 2017 #11

    FactChecker

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    I suspect that the lack of a fever is likely to be under-reported and often undetected. After all, how often would a person report or even notice the lack of a problem.
     
    Last edited: Apr 9, 2017
  13. Apr 9, 2017 #12
    I think that 'fever' is caused by toxins from the virus affecting the hypothalamus glad. This causes malfunction of the body's thermostat which can result in elevated temperature and also shivering when the hypothalamus thinks body temperature is too high. Fortunately an elevated temperature helps fight most types of virus so this response from the hypothalamus is advantageous and has been selected for in the evolution of our disease resistance. (this is just what i have come to understand)

    So, someone who fights the infection very effectively may never experience a fever, or alternatively their hypothalamus is not affected by the toxins.
     
  14. Apr 10, 2017 #13

    ChrisVer

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    if your friend is not a mammal, I guess his claim can be true :) I don't know how this can be a compliment as it becomes dehumanizing ...
     
  15. Apr 10, 2017 #14
    As far as I can tell me and my mom have lower "base" body temperature.

    Though while my doc have been a bit sceptical at times to my claims of feeling bad (since the temps have been "normal"), I definitely *feel* like I've have a fever when I'm sick.
     
  16. Apr 10, 2017 #15

    Evo

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    I have a lower basal body temperature, my regular temperature is around 97.7F, so 98.6F for me is running a slight temperature. I have had my temp as low as 94.3F quite often when I don't feel well, also with a very low blood pressure. The nurses in the hospital were going nuts. So for me running a temperature above 98.6 is very rare.
     
  17. Apr 10, 2017 #16

    StatGuy2000

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    I too have a relatively low basal body temperature, as my regular temperature is about 36.4C (97.5F) so 37C (98.6F) would be a very mild fever for me. My temperature has gone as low as yours, however. So running a temperature above 37C is quite rare for me, although it did happen earlier this past month, when I had a nasty case of the flu, and I was running a temperature of 39.5C (103.1F) at one point.
     
  18. Apr 10, 2017 #17
    I wouldn't say is not possible to get that symptom. because mechanism to develop febrile (fever) is quite complex. there are some cases for those people who may hardly develop fever, such as hematological malignancy or complicated immunodeficiency (SCID) case, due to genetic defect, this certain factors causes malfunction of common pathway in develop of fever which may usually related to cytokine, interleukin, lack of B-call, T-cell and etc..

    let says there are 10 ways to develop fever (unique pathway), but for these people, they may only has less than half of it can function normally. so relate to cases such as different viral infection, bacterial infection, toxic shock syndrome or symptom, or even poisoning could trigger fever by different pathway.
    maybe the person you mentioned does not having fever to common infection (glad that he can felt sick too, it is a good sign), if he got into those disease he might not develop any immune symptom, that will be big trouble.

    thus, please bring your "related person" go for advance medical diagnostic (genetic study) to get a better diagnosis and medical advices before worst situation happened.
     
    Last edited by a moderator: Apr 14, 2017
  19. Apr 14, 2017 #18

    Mark Harder

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    Since he recovered from the diseases he has experienced, he must have a pretty robust immune system. But the inflammatory response, alluded to in the above comments, is not simply an immune one. This raises a couple of possibilities:

    His inflammatory response system is weaker than most. This isn't very good news for him, since fever stimulates the ordinary immune response. ( One explanation for the common cold is that when the throat and respiratory passages are chilled, immune response in those mucosa is inhibited, and viruses have an easier time implanting and infecting those cells. That's why "cold" is a good name for it. It does indeed follow a chill, assuming the virus is also lurking nearby.) Or, he simply hasn't ever had a disease of sufficient severity to induce a febrile response.

    Which leads me to an important consideration: How old is your friend? He may not have lived long enough to have caught a severe disease. Absent some sort of immunological test to prove that the virus causing his "flu" is a true flu virus, we can't be certain that he's ever had a true flu, regardless of what his doctors have told him.

    I have to backpedal a bit from my previous remark about the disadvantage conferred by a weak inflammatory response. It's now known that something called a 'cytokine storm', an overreaction to a pathogen by the immune and inflammatory systems that overwhelms the respiratory system with excessive immune cells and inflammatory factors, is responsible for most deaths from the really bad flu pandemics of historical note. Adolescents and young adults, usually the survivors of other diseases, are more likely to die from a cytokine storm than middle-aged adults. Your friend should be at an advantage if we ever have another "Spanish" flu pandemic.
     
    Last edited by a moderator: Apr 14, 2017
  20. May 5, 2017 #19
    Well, if I may add, different people have different average body temperatures (obviously). However, to avoid a fever your entire life should be extremely unlikely, though I'm not saying it's impossible. I would also like to add that having a fever can cause different affects. Although it typically raises your temperature and upsets your stomach, it may just raise a few degrees depending on the person.

    But I must say, your friend here has a pretty extraordinary immune system.
     
    Last edited by a moderator: May 6, 2017
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