• A. Sahib El-Radhi


The chapter begins with the definition of fever as a body temperature of 1 °C (1.8 °F) or greater above the mean at the site of temperature recording. For example, the range of body temperature at the axilla is 34.7–37.4 °C, with a mean of 36.4 °C; 1 °C above the mean is 37.4 °C. The following degrees of temperature are accepted as fever: rectal temperature ≥38.0 °C, oral temperature ≥37.6 °C, axillary temperature ≥37.4 °C and tympanic membrane ≥37.6 °C.

Fever arises when macrophages and other cells secrete endogenous pyrogens in response to external pyrogens such as bacteria or viruses. These endogenous pyrogens (also called cytokines), in particular IL-1 and IL-6, act via complicated mechanisms to raise the hypothalamic set points to cause fever.

Fever is an extremely common presentation, most frequently due to self-limited viral infection and sometimes to uncomplicated bacterial infection that resolves within a week. Fever can be a manifestation of a serious underlying disease.

Recurrent fever, relapsing fever and periodic fever syndromes are described with some details. They are now up to date with most recent scientific evidence.

Complications directly related to fever are rare. Dehydration is the most common complication that can easily be treated with extra fluid intake. Morbidity and mortality are closely linked to the severity of the underlying disease and not to the level of fever.

Fever is then divided into three main categories: fever with localized signs, fever without localized signs and persistent fever of unknown cause (PUO). The most common febrile illnesses encountered in paediatric practice belong to fever with localization. In this category, fever is usually of short duration, either because it settles spontaneously after a common viral infection or because a specific treatment, such as an antibiotic, has been administered. Diagnosis is usually suggested by the history and physical examination and confirmed by simple investigation, such as a chest X-ray. As children younger than 36 months experience the highest rate of febrile illnesses with localizing signs, discussion of this subject is added. The two most important causes of fever without localization are urinary tract infection and bacteraemia. Urine specimen should always be submitted for culture in children without localization.

Drug fever and foetal malformation are the final topics in this chapter.


Definitions of fever Periodic and relapsing fevers Auto-inflammatory diseases Fever classifications Drug fever 


Periodic Fever

  1. 1.
    Torreggiani S, Filocamo G, Esposito S. Recurrent fever in children. Int J Mol Sci 2016 17(4): 448–463 Published online 2016 Mar 25. doi: CrossRefGoogle Scholar
  2. 2.
    Bachove I, Chang C. Anakinra and related drugs targeting interleukin-1 in the treatment of cryopyrin-associated periodic syndromes. Open Access Rheumatol. 2014;6:15–25.PubMedPubMedCentralGoogle Scholar

Manifestations of Fever

  1. 3.
    O’Dempsey TJ, Laurence BE, TF MA, Todd JE, Lamont AC, Greenwood BM. The effect of temperature reduction on respiratory rate in febrile illnesses. Arch Dis Child. 1993;68:492–5.CrossRefGoogle Scholar

Potential Complications

  1. 4.
    Dubois EF. Why are fever temperatures over 106 °F rare? Am J Med Sci. 1949;217:361–8.CrossRefGoogle Scholar
  2. 5.
    Tautner BW, Caviners AC, Gerlacher GR, et al. Prospective evaluation of the risk of serious bacterial infection in children who present to the emergency department with hyperpyrexia (temperature of 106 oF). Pediatrics. 2006;118:34–40.CrossRefGoogle Scholar
  3. 6.
    Pomerance JJ, Richardson J. Hyperpyrexia as a sign of intraventricular haemorrhage in the neonate. Am J Dis Child. 1973;126:854–5.PubMedGoogle Scholar

Fever with Localized Signs

  1. 7.
    Lieberman E, Lang J, Richardson DK, et al. Intrapartum maternal fever and neonatal outcome. Pediatrics. 2000;105:8–13.CrossRefGoogle Scholar
  2. 8.
    Greenwell EA, Wyshak G, Ringer SA, et al. Intrapartum temperature elevation, epidural use and adverse outcome in term infants. Pediatrics. 2012;129(2):e447–54.CrossRefGoogle Scholar
  3. 9.
    O’Shea JS. Assessing the significance of fever in young infants. Clin Pediatr. 1978;17:854–6.CrossRefGoogle Scholar
  4. 10.
    McCarthy PL, Dolan TF. The serious implication of high fever in infants during their first three months. Clin Pediatr. 1876;15:794–6.CrossRefGoogle Scholar
  5. 11.
    Teele DW, Pelton SI, Grant MJA, et al. Bacteraemia in febrile children under 2 years of age: results of cultures of blood of 600 consecutive febrile children seen in a “walk in” clinic. J Pediatr. 1975;87:227–300.CrossRefGoogle Scholar
  6. 12.
    Biondi E, Evans R, Mischler M. Epidemiology of bacteraemia in febrile infants in the United States. Pediatrics. 2013;132(6):990–6.CrossRefGoogle Scholar

Persistent Fever of Unknown Origin

  1. 13.
    Pertersdorf RO, Besson PB. Fever of unexplained origin: report of 100 cases. Medicine. 1961;40:1–30.CrossRefGoogle Scholar

Fetal Malformation and Fever

  1. 14.
    Ivarsson SA, Henriksson P. Septic shock and hyperthermia as possible teratogenic factors. Acta Paediatrica Scand. 1984;73(73):855–6.Google Scholar
  2. 15.
    Fraser FC, Skelton J. Possible teratogenicity of maternal fever. Lancet. 1978;3:634.CrossRefGoogle Scholar
  3. 16.
    Pleet H, Graham JM, Smith D. Central nervous system and facial defects associated with maternal hyperthermia at four to 14 weeks gestation. Pediatrics. 1981;67:785–9.PubMedGoogle Scholar
  4. 17.
    Edwards MJ. Congenital defects in Guinea pigs. Acta Pathol. 1967;84:42–8.Google Scholar
  5. 18.
    Clarren SK, Smith DW, Ward HR, et al. Hyperthermia-a prospective evaluation of a possible teratogenic agent in man. J Pediatr. 1979;95:81–3.CrossRefGoogle Scholar
  6. 19.
    Andersen AN, Vastrup P, Wohlfahrt J, et al. Fever in pregnancy and risk of fetal death: a cohort study. Lancet. 2002;360:1552–6.CrossRefGoogle Scholar
  7. 20.
    Agopain AJ, Lupo PJ, Tinker SC, et al. Working towards a risk prediction model for neural tube defects. Birth Defects Res A Clin Mol Teratol. 2012;94(3):141–6.CrossRefGoogle Scholar
  8. 21.
    Duong HT, Hashmi SS, Ramadhani T. Maternal use of hot tube and major structural defects. Birth Defects Res A Clin Mol Teratol. 2011;91:836–41.CrossRefGoogle Scholar
  9. 22.
    Rapola J, Saxon L, Granroth G. Anencephaly and the sauna. Lancet. 1978;2:1162.CrossRefGoogle Scholar

Drug Fever

  1. 23.
    Patel RA, Gallagher JC. Drug fever. Pharmacotherapy. 2010;30(1):57–69.CrossRefGoogle Scholar
  2. 24.
    Lazear D. The truth about drug fever. Drugs & Therapy. 2011;25(6):1–4.Google Scholar
  3. 25.
    Liberek A, Luczak G, Korzan M, et al. Tolerance of interferon-alpha therapy in children with chronic hepatitis B. J Paediatr Child Health. 2004;40:265–9.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • A. Sahib El-Radhi
    • 1
  1. 1.Chelsfield Park HospitalOrpingtonUK

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