Viral fever

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Viral fever refers to a broad spectrum of conditions where viral infections are associated with elevation of body temperature. In medical terms, any fever caused as a result of viral infection is a viral fever. [1] The term viral fever covers a wide variety of viral infections, some of which can be clearly identified by their signs and symptoms. Though these infections show some generalised symptoms, it may target specific organs. Viral fever may affect any age group and are seen world wide. It is normally not dangerous being self-limiting, but some viral infections can progress rapidly to complications. In many cases problems related to throat and lung get associated. Depending on the body’s immune system the intensities of fever and body ache may vary and the following is understood by different grades of fever.

Contents

Types according to temperature

  1. Low-grade: 38 - 39 °C (99.5 - 102.2 °F)
  2. Moderate: 39 - 40 °C (102.2 - 104 °F)
  3. High-grade: > 40 °C (> 104 °F)
  4. Hyperpyrexia: > 42 °C (> 107.6 °F)

Low grade fever is a normal response of the body to limit the infection getting multiplied. Adequate measures should be taken to limit the fever and in no case be allowed to exceed 104 °C. The hyperpyrexia is clearly a medical emergency because it approaches the upper limit compatible with human life.

Causes

Most viral infections are spread by inhalation of aerosolised particles, by intake of contaminated water or food, or by direct contact. Infection then spreads locally and thereafter into the blood stream or lymph channels. Some of the viral infections can be transmitted sexually or by direct inoculation into the blood stream.

The duration of the primary infection may vary from days to several weeks. Manifestation of the disease clinically is usually a consequence of the virus multiplying at a specific site. Even though the fever comes down, in some infections the virus continues to multiply and cause persistent infection. [2]


Incubation period

Depending on the level of individual’s vital energy it may vary from days to several week. The clinical manifestation also varies, depending on the virus multiplication and the site. In some rare cases, virus continues to multiply even after the fever comes down and that causes persistent infection. Such cases will need careful case taking and management.

Signs and symptoms

It starts after incubation period, with fatigue and malaise. Body ache and muscle ache may follow and lead to the onset of fever. The fever may be low grade or high grade and remittent. Inflammation of pharynx, running nose, nasal congestion, headache, redness of eyes, cough, muscle and joint pains could be present.

The level of fever could be disproportionate to the fatigue and body pain. Later lymph glands may swell up. The illness is usually self-limited but the fatigue and cough may persist for a few weeks. Sometimes vomiting and diarrhoea, jaundice, symptoms similar to pneumonia or arthritis (joint swelling) may complicate the initial viral fever. Some viral fevers are spread by insects, for example, arbovirus, can cause a bleeding tendency, which results in bleeding from the skin and several other internal organs and can be fatal.

Investigation

Viral fever is based more on the clinical presentation than by laboratory investigations. Since these infections are commonly self-limited, investigations are usually not necessary. Diagnosis can be made with the clinical history of patient. Skin rash and lymph gland swellings have to be specifically looked for. Should symptoms indicate possibility of other condition investigation should be done to rule them out.

In viral infections blood tests will not show any remarkable increase in the white blood cells, which typically occurs with bacterial infections. The numbers of lymphocytes may be increased. The Erythrocyte Sedimentation Rate (ESR) is not elevated. Confirmation if needed can be done by culture of virus from the relevant specimens such as nasal swabs, and skin rash or by increase in antibody levels in serial blood samples.

Differential diagnosis

Following are some conditions to be ruled out

Typhoid fever or gastroenteritis

Gradual onset of malaise, headache, sore throat, cough; slow rise of (stepladder) fever, onset of diarrhoea or constipation; widal positive; blood, stool and urine culture positive for salmonella in typhoid, characteristic tongue coating; abdominal discomfort in gastroenteritis.

Drug fever

History of taking of drugs like progesterone, chemotherapeutics causing tumor necrosis in the past one week; discontinuation of drug like heroin; as an adverse reaction to the drugs like antibiotics, sulfa drugs, etc.

Inflammatory bowel disease

Low grade fever; diarrhoea; pain, tenderness and/or mass in the right lower quadrant of abdomen; evidence of ulceration in the X-Ray; anaemia; bloody and watery stool; sigmoidoscopic findings show oedema, erosions, mucopus and friability of mucosa

Malaria

Periodic attacks of chills, fever and sweating; anaemia, splenomegaly and leukopenia; thick or thin bloood films show the presence of one or more of the malarial parasites in erythrosites

Tuberculosis

Fever with evening rise of temperature; fatigue, weight loss, night sweats and cough; pulmonary infiltrate of chest radiograph; positive tuberculin skin test reaction; positive sputum culture for mycobacterium tuberculosis or acid-fast bacilli on smear of sputum

Infectious mononucleosis

Malaise and fever with lymphadenopathy, splenomegaly and maculopapular rash; heterophil aglutination test positive; large lymphocytes in blood smear

Sarcoidosis

Malaise fever and dyspnoea with erythema nodosum, parotid gland enlargement, hepatosplenomegaly and lymphadenopathy; bilateral hilar and right paratrachial lymphadenopathy in X-Ray; elevated ESR, hypercalcemia and hypercalciuria

Hodgkin disease

Fever, weight loss, drenching night sweats and generalised pruritis; painless lymphadenopathy; pathological diagnosis by lymph node biopsy

General Management

If the fever is mild and no other problems are present, patient can be advised to drink much fluids and to take rest.

  1. Avoid antibiotics[3]
  2. Removal of excess clothing or blankets
  3. Keeping the environment to be comfortable and cool.
  4. Taking sponge bath may help to cool a person with a fever.
  5. Avoidance of using cold baths or alcohol rubs.
  6. Drinking cool liquids, as tolerated.
  7. Placing the ice packs in the armpits, behind the neck, and in the groin in case of high temperature

Prognosis

An untreated fever that lasts longer than 48 to 72 hours may lead to upper respiratory infections like sinusitis, pharyngitis, Sore throat, tonsillitis, and laryngitis. Other complications are pneumonia, ear infections, gastroenteritis, etc. (these complications are as a result of impaired immunity) Most viral fevers recover completely in a week although fatigue may persist for a few weeks.

CAM therapies for viral fever

Ayurveda

Homeopathy

Many cases coming to homoeopaths are subsequent to antibiotic administration. Antibiotics do not treat viral infections, and thus are ineffective against the viral fever. Treatment of viral fever with antibiotics can be counterproductive, as it can promote the production of drug resistant bacteria, and can even promote infections by killing off normal bodily flora. Experienced allopathic physicians also treat viral fevers symptomatically. Homoeopathy has good scope in viral fevers as it induces body’s own immune system to fight against the viruses.

Homoeopathic remedies frequently used in viral fever

Aconitum napellus · Fever caused by exposure to dry cold air with or without during perspiring · Fever with great fear and anxiety of mind · Restlessness – must change the position often · Skin dry and hot during fever; face red or pale and red alternatively · Burning thirst for large quantities of cold water · Worse: in warm room, when rising from bed, evening and night · Better in open air

Arsenicum album · Restlessness at both physical and mental level; changes his place from one bed to another · Great fear and thinks useless to take medicine · Fever with great thirst for cold water; drinks much at short interval · Cannot bear the smell or sight of food · Great prostration

Acetanilidum (Antifebrinum) 3x · 1 tablet every 15 minutes as SOS to reduce high fevers · Usually not more than 6 tablets should be given in a day

Baptisia tinctoria · Fever with pain and soreness all over the body · Fever from septic conditions · Surface of body feels chill and flashes of heat over the face · Chill all day, with fever at night

Belladonna · Fever with head hot and painful · Hands and feet become very cold · Sudden alternations of heat and chill both without thirst, with sleepiness in the daytime · Flushed face, dry mouth and throat with headache are the key symptoms in fever · Worse: noise, after 3pm, night especially after mid night · Better: rest, standing or sitting erect, warm room

Eupatorium perfoliatum · Severe bone pain with fever · Bruised feeling as if broken the parts; all over body · Chill at 9am one day and at noon the next day · Bitter vomiting at close of chill; drinking hastens chill and causes vomiting · 1 drop 1x works like specific

Ferrum phosphoricum · Fever during early stage · Soft pulse during fever · Fever with catarrhal inflammation · Chill at 1pm

Gelsemium · Shivering all over body, so that always wants to be held · Slow, full and soft pulse · Alternate chilliness, heat and sweat stages, but lasting for a long time · Headache and soreness of muscle with prostration · Thirstlessness · Chilliness extends from sacrum to occiput

Homoeopathic remedies used if indicated symptoms call for

Aethusa cynapium · Fever in children · Complete absence of thirst · Fever in children with milk intolerance · Fever in children during dentition

Bryonia alba · Excessive dryness of mucous membrane with great thirst for large quantities of water at long intervals · Fever with disordered stomach, white tongue, bitter taste in mouth, vomiting · Worse by least motion · Better by rest

Cinchona officinalis · Febrile chill over the whole body from time to time during the whole day, especially on the forehead, which has cold sweat upon it · Shaking chill over the whole body, without thirst · Sensation of internal coldness in the upper abdomen after every swallow of drink, and renewed on every inspiration · Increased warmth of the whole body, with distended veins, and with easily dilating pupils · Sweats profusely all over body on being covered or during sleep

Pulsatilla · Symptoms ever changing · Fever with pain drawing, tearing and erratic types, shifts from one place to other · Pain accompanied with chilliness · Thirstlessness · Fever with gastric difficulties due to eating rich food like cake, pastry, pizza, etc. · Worse: warm close room, evening and warm application · Better: open air

Pyrogenium · Bed feels too hard during fever · Septic fever · Fever could not controlled by best selected remedy · Restlessness; must move constantly · Tongue flabby, clean and smooth as if varnished · Fever after puerperal infection

Rhus toxicodendron · Fever with physical restlessness · Dry tongue with red tip · Intermittent fever with chill and dry cough · Internal and external heat of the head and shivering over the body with stretching, drawing, weakness in the limbs · Headache like a dullness and compression in the side of the occiput together with violent cough · Worse: cold, wet and rainy weather, getting wet while perspiring, rest · Better: warm and dry weather, wrapping up, motion

Veratrum album · Chill and shivering with the frequent stools · Face cold, collapsed · Alternations of coldness and heat in the back · Redness and heat of the face, with slight febrile shivering · Cold perspiration breaks out over the whole head and chest

Many physicians prescribe bio-combinations and specialities either alone or along with other homeopathic medicines. Some of the frequently prescribed are listed below:

Bio-combinations

Bio-combination no. 5 · Fever due to coryza · White or gray coated tongue during fever · Thick and white discharge from the nose

Bio-combination no. 6 · Fever with cold and cough · Rattling hallow cough and painful respiration · Pain in chest and bronchitis

Bio-combination no. 8 · Fever due to gastric disturbances · Diarrhoea predominantly with fever · Gastric derangement due to fat or too rich food · White coated tongue during fever · Prostration and convalescence

Bio-combination no. 11 · Initial stages of inflammatory diseases, all kinds of fever, chill and following pneumonia · Viral fever and subsequent complication with pleurisy and affections tend to suppurate

Naturopathy

References

  1. Doctor NDTV Viral Fever
  2. WebHealthCentre.com Viral Fever
  3. After dengue scare, viral fever fear grips Capital
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