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This article is about the medical condition. For other uses, see Fever (disambiguation).
Clinical thermometer 38.7.JPG
An analog medical thermometer showing a temperature of 38.8 °C or 101.8 °F
ICD-10 R50
ICD-9 780.6
DiseasesDB 18924
MedlinePlus 003090
eMedicine med/785
MeSH D005334

Fever, also known as pyrexia and febrile response,[1] is defined as a temperature above the normal range due to an increase in the body's temperature set-point.[2][3] There is not a single agreed upon upper limit for normal temperature with sources using values between 37.5 and 38.3 °C (99.5 and 100.9 °F).[1][4] The increase in set-point triggers increased muscle contraction and causes a feeling of cold.[5] This results in greater heat production and efforts to conserve heat.[6] When the set-point temperature returns to normal a person feels hot, becomes flushed, and may begin to sweat.[6] Rarely a fever may trigger a febrile seizure. This is more common in young children.[7] Fevers do not typically go higher than 41 to 42 °C (105.8 to 107.6 °F).[3]


Treatment to reduce fever is not required.[5] Treatment; however, may increase comfort and help a person rest. Measures such as putting a cool damp cloth on the forehead and having a slightly warm bath may help.[7] Medications such as ibuprofen or paracetamol may also be effective at lowering the temperature.[9] Children younger than three months with a fever should be medically assessed.[7] Hyperthermia does require treatment.[5]

Fever is one of the most common medical signs. It is part of about 30% of healthcare visits by children[5] and occurs in up to 75% of adults who are seriously sick.[10] While fever is a useful defense mechanism; treating fever does not appear to worsen outcomes.[11][12] Fever is viewed with greater concern by parents and healthcare professionals than it usually deserves, a phenomena known as "fever phobia".[5]


A wide range for normal temperatures has been found.[4] Fever is generally agreed to be present if the elevated temperature is caused by a raised set point and:

  • Temperature in the anus (rectum/rectal) is at or over 37.5–38.3 °C (99.5–100.9 °F)[1][4]

In healthy adult men and women, the range of normal, healthy temperatures for oral temperature is 33.2–38.2 °C (91.8–100.8 °F), for rectal it is 34.4–37.8 °C (93.9–100.0 °F), for tympanic membrane (the ear drum) it is 35.4–37.8 °C (95.7–100.0 °F), and for axillary (the armpit) it is 35.5–37.0 °C (95.9–98.6 °F).[18] Harrison's 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).[19]



Performance of the various types of fever
a) Fever continues
b) Fever continues to abrupt onset and remission
c) Fever remittent
d) Intermittent fever
e) Undulant fever
f) Relapsing fever

The pattern of temperature changes may occasionally hint at the diagnosis:

    • Quartan fever (72-hour periodicity), typical of Plasmodium malariae malaria.




Hyperpyrexia is a fever with an extreme elevation of body temperature greater than or equal to 41.5 °C (106.7 °F).[23] Such a high temperature is considered a medical emergency as it may indicate a serious underlying condition or lead to significant side effects.[24] The most common cause is an intracranial hemorrhage.[23] Other possible causes include sepsis, Kawasaki syndrome,[25] neuroleptic malignant syndrome, drug effects, serotonin syndrome, and thyroid storm.[24] Infections are the most common cause of fevers, however as the temperature rises other causes become more common.[24] Infections commonly associated with hyperpyrexia include roseola, rubeola and enteroviral infections.[25] Immediate aggressive cooling to less than 38.9 °C (102.0 °F) has been found to improve survival.[24] Hyperpyrexia differs from hyperthermia in that in hyperpyrexia the body's temperature regulation mechanism sets the body temperature above the normal temperature, then generates heat to achieve this temperature, while in hyperthermia the body temperature rises above its set point due to an outside source.[23]


Hyperthermia is an example of a high temperature that is not a fever. It occurs from a number of causes including heatstroke, neuroleptic malignant syndrome, malignant hyperthermia, stimulants such as amphetamines and cocaine, idiosyncratic drug reactions, and serotonin syndrome.

Signs and symptoms[edit]

Michael Ancher, "The Sick Girl", 1882, Statens Museum for Kunst

A fever is usually accompanied by sickness behavior, which consists of lethargy, depression, anorexia, sleepiness, hyperalgesia, and the inability to concentrate.[26][27][28]

Differential diagnosis[edit]

Fever is a common symptom of many medical conditions:





In many respects, the hypothalamus works like a thermostat.[29] When the set point is raised, the body increases its temperature through both active generation of heat and retention of heat. Peripheral vasoconstriction both reduces heat loss through the skin and causes the person to feel cold. If these measures are insufficient to make the blood temperature in the brain match the new set point in the hypothalamus, then shivering begins in order to use muscle movements to produce more heat. When the hypothalamic set point moves back to baseline either spontaneously or with medication, the reverse of these processes (vasodilation, end of shivering and nonshivering heat production) and sweating are used to cool the body to the new, lower setting.

This contrasts with hyperthermia, in which the normal setting remains, and the body overheats through undesirable retention of excess heat or over-production of heat.[29] Hyperthermia is usually the result of an excessively hot environment (heat stroke) or an adverse reaction to drugs. Fever can be differentiated from hyperthermia by the circumstances surrounding it and its response to anti-pyretic medications.


A pyrogen is a substance that induces fever. These can be either internal (endogenous) or external (exogenous) to the body. The bacterial substance lipopolysaccharide (LPS), present in the cell wall of some bacteria, is an example of an exogenous pyrogen. Pyrogenicity can vary: In extreme examples, some bacterial pyrogens known as superantigens can cause rapid and dangerous fevers. Depyrogenation may be achieved through filtration, distillation, chromatography, or inactivation.


In essence, all endogenous pyrogens are cytokines, molecules that are a part of the immune system. They are produced by activated immune cells and cause the increase in the thermoregulatory set point in the hypothalamus. Major endogenous pyrogens are interleukin 1 (α and β)[30] and interleukin 6 (IL-6). Minor endogenous pyrogens include interleukin-8, tumor necrosis factor-β, macrophage inflammatory protein-α and macrophage inflammatory protein-β as well as interferon-α, interferon-β, and interferon-γ.[30] Tumor necrosis factor-α also acts as a pyrogen. It is mediated by interleukin 1 (IL-1) release.[31]

These cytokine factors are released into general circulation, where they migrate to the circumventricular organs of the brain due to easier absorption caused by the blood–brain barrier's reduced filtration action there. The cytokine factors then bind with endothelial receptors on vessel walls, or interact with local microglial cells. When these cytokine factors bind, the arachidonic acid pathway is then activated.



PGE2 release[edit]







There are arguments for and against the usefulness of fever, and the issue is controversial.[32][33] There are studies using warm-blooded vertebrates[34] and humans[35] in vivo, with some suggesting that they recover more rapidly from infections or critical illness due to fever. Studies suggest reduced mortality in bacterial infections when fever was present.[36]

In theory, fever can aid in host defense.[32] There are certainly some important immunological reactions that are sped up by temperature, and some pathogens with strict temperature preferences could be hindered.[37]

Research[38] has demonstrated that fever assists the healing process in several important ways:


Fever should not necessarily be treated.[40] Most people recover without specific medical attention.[41] Although it is unpleasant, fever rarely rises to a dangerous level even if untreated. Damage to the brain generally does not occur until temperatures reach 42 °C (107.6 °F), and it is rare for an untreated fever to exceed 40.6 °C (105 °F).[40]

Conservative measures[edit]

Some limited evidence supports sponging or bathing feverish children with tepid water.[42] The use of a fan or air conditioning may somewhat reduce the temperature and increase comfort. If the temperature reaches the extremely high level of hyperpyrexia, aggressive cooling is required.[24] In general, people are advised to keep adequately hydrated.[43] Whether increased fluid intake improves symptoms or shortens respiratory illnesses such as the common cold is not known.[44]


Medications that lower fevers are called antipyretics. The antipyretic ibuprofen is effective in reducing fevers in children.[45] It is more effective than acetaminophen (paracetamol) in children. Ibuprofen and acetaminophen may be safely used together in children with fevers.[46][47] The efficacy of acetaminophen by itself in children with fevers has been questioned.[48] Ibuprofen is also superior to aspirin in children with fevers.[49] Additionally, aspirin is not recommended in children and young adults (those under the age of 16 or 19 depending on the country) due to the risk of Reye's syndrome.[50]

Using both paracetamol and ibuprofen at the same time or alternating between the two is more effective at decreasing fever than using only paracetamol or ibuprofen.[51] It is not clear if it increases child comfort.[51]


About 5% of people who go to an emergency room have a fever.[52]


A number of types of fever were known as early as 460 BC to 370 BC when Hippocrates was practicing medicine including that due to malaria (tertian or every 2 days and quartan or every 3 days).[53] It also became clear around this time that fevers were a symptom of a disease rather than a disease in and of itself.[53]

Society and culture[edit]


Pyrexia is from the Greek pyr meaning fire. Febrile is from the Latin word febris, meaning fever, and archaically known as ague.

Fever phobia[edit]

Fever phobia is the name given by medical experts to parents' misconceptions about fever in their children. Among them, many parents incorrectly believe that fever is a disease rather than a medical sign, that even low fevers are harmful, and that any temperature even briefly or slightly above the oversimplified "normal" number marked on a thermometer is a clinically significant fever.[54] They are also afraid of harmless side effects like febrile seizures and dramatically overestimate the likelihood of permanent damage from typical fevers.[54] The underlying problem, according to professor of pediatrics Barton D. Schmitt, is "as parents we tend to suspect that our children’s brains may melt."[55]


Other animals[edit]

Fever is an important feature for the diagnosis of disease in domestic animals. The body temperature of animals, which is taken rectally, is different from one species to another. For example, a horse is said to have a fever above 101 °F (38.3 °C).[56] In species that allow the body to have a wide range of "normal" temperatures, such as camels,[57] it is sometimes difficult to determine a febrile stage.

Fever can also be behaviorally induced by invertebrates that do not have immune-system based fever. For instance, some species of grasshopper will thermoregulate to achieve body temperatures that are 2 - 5 °C higher than normal in order to inhibit the growth of fungal pathogens such as Beauveria bassiana and Metarhizium acridum.[58] Honeybee colonies are also able to induce a fever in response to a fungal parasite Ascosphaera apis. [58]


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Further reading[edit]


External links[edit]