Should a Fever be Cooled?

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  • #1
.Scott
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Decades ago I read a Scientific American article probably based on this article:
"The actions of interferon are potentiated at elevated temperature"
http://www.nature.com/nature/journal/v274/n5670/abs/274508a0.html

It's a study from 1978 that compared some of the activities of interferon at 37 and 39 C (98.6 and 102.2 F).

It made sense to me. You would think that mammals running fevers would have been worked out over 200 million years ago with plenty of time for fine tuning since. And when I tried it, it pretty much seemed to work. If I felt chilly and thought a fever was coming on, take my temperature, I put on a jacket, raise the room temperature, and snuggle up in bed. My temperature would peak a bit over 104 and in less than 4 hours total, the fever would break.

I noted about 15 years ago that nurses were still cooling down adult fevers - and then was surprised when a nurse on "60 Minutes" last night described cooling off Mr Dunkin's fever, the Ebola victim.

So what's going on? Does it really make any sense to cool a building fever?
 

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  • #3
.Scott
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Without more information, no, a simple fever should not be cooled. Fear of febrile seizures is conventional ignorance.

You might start at the Wikipedia article 'Fever' and follow its citations and references.
I read through that article and a few of the abstract of the citations. Even the "cool the fever" arguments seem to exclude serious infections ("The role of fever for the recovery from low risk infections is marginal at best.") and cite bacterial (not viral) infections.

Here's some discussion on it. It seems that too high a fever will result in brain damage which is something to be avoided.

http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm
Per that article:
Brain damage from a fever generally will not occur unless the fever is over 107.6 °F (42 °C). Untreated fevers caused by infection will seldom go over 105 °F unless the child is overdressed or trapped in a hot place.
Clearly, if the child feels, hot, it's time to removed some of the layers.

If everyone agrees that a potential adult Ebola (or other life-threatening virus) patient should be allowed to run a fever - at least to 105F - shouldn't there be some kind of official nursing procedure saying this?
 
  • #4
Evo
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For babies and small children
Treating your child's fever
Do not bundle up a child with blankets or extra clothes, even if the child has the chills. This may keep the fever from coming down, or make it go higher.

  • Try one layer of lightweight clothing, and one lightweight blanket for sleep.
  • The room should be comfortable, not too hot or too cool. If the room is hot or stuffy, a fan may help.
http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000319.htm

For adults http://www.emedicinehealth.com/fever_in_adults/page6_em.htm
 
  • #5
Doug Huffman
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I see that my quoted post has been disappeared. Have I intruded somehow?
 
  • #6
.Scott
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I think the problem here is that people are far to quick to skip to page 6 - how to reduce the fever. More importantly, there is no mention in any of those pages that a fever can be part of the immune response to a virus and that, depending on which studies you read, it either might or will be useful in fighting a virus.

I know that every 5 years ILCOR does an evidence based assessment of the treatment proscribed for heart and respiratory emergencies. Is that ever done for other conditions such as fever?
 
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This is still debated, and I've been in M2 pathology lectures with a professor who extolls the virtue of fever as well as with infectious disease specialists who virtually always recommend antipyretic treatment.

There are some clear benefits, though. Bugs grow best within a narrow range of temperatures, so even small increases in temp can significantly reduce their growth. There is also evidence that antibody production is up-regulated when body temperature is increased. In fact, before antibiotics fevers were artificially induced for the treatment of things like neurosyphilis (and was actually beneficial). A third and not commonly mentioned thing of (perhaps some) benefit is a rightward shift of the oxyhemoglobin dissociation curve.

Also fever patterns can be helpful diagnostically in some rare situations.

Of course, very high temperatures result in enzyme denaturation and it is known that rectal temps over 41 degrees Celsius (106F) for prolonged periods cause permanent brain damage. When you get into the 43 C range, death from heat stroke is very common.

Despite all this, the UpToDate article I just glanced at says "treating fever and its symptoms does no harm and does not slow the resolution of common viral and bacterial infections."
 
  • #8
Evo
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This is still debated, and I've been in M2 pathology lectures with a professor who extolls the virtue of fever as well as with infectious disease specialists who virtually always recommend antipyretic treatment.

There are some clear benefits, though. Bugs grow best within a narrow range of temperatures, so even small increases in temp can significantly reduce their growth. There is also evidence that antibody production is up-regulated when body temperature is increased. In fact, before antibiotics fevers were artificially induced for the treatment of things like neurosyphilis (and was actually beneficial). A third and not commonly mentioned thing of (perhaps some) benefit is a rightward shift of the oxyhemoglobin dissociation curve.

Also fever patterns can be helpful diagnostically in some rare situations.

Of course, very high temperatures result in enzyme denaturation and it is known that rectal temps over 41 degrees Celsius (106F) for prolonged periods cause permanent brain damage. When you get into the 43 C range, death from heat stroke is very common.

Despite all this, the UpToDate article I just glanced at says "treating fever and its symptoms does no harm and does not slow the resolution of common viral and bacterial infections."
Thank you for your post but we require the actual sources, so if you could please post those.
 
  • #10
Evo
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We require sources here so that we can verify information, and as reading material for members that wish to learn more. I understand that "you' may know it, but we don't, and we need to verify and have the sources available. Those sources should come preferably come from peer reviewed journals that appear on the Thomspon Reuters list, and that we accept which show the actual research that supports a statement.
 
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  • #11
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In fact, before antibiotics fevers were artificially induced for the treatment of things like neurosyphilis (and was actually beneficial).
This assertion is supported by this paper:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1660025/?page=1

The benefits were limited, interestingly, only to advanced cases of neurosyphilis.

I pipe in because I ran across mention of this before in this book: https://www.amazon.com/dp/0465028829/?tag=pfamazon01-20&tag=pfamazon01-20, and thought it was interesting.
 
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