Types of fever is a frequently asked viva question but a concise and complete answer is not available for it anywhere. I’ve tried to come up with a complete list which I have gotten verified by a Medicine SR and partly by a prof. However, if any errors are found, feel free to inform and I’ll add the corrections.
Based on pattern of fever
| Type | Character | Example |
| Continued/ Persistent | Diurnal variation <1°C (1.5°F) in 24 hrs. Does not touch baseline. | Lobar pneumonia, Miliary TB, meningitis, Acute Rheumatic Fever, SLETyphoid: Step ladder fever (rising temperature over the course of each day that drops by the subsequent morning)Borellia- low grade Relapsing Fever. |
| Intermittent | Diurnal variation, Temperature touches baseline at least once a day | EBVQuotidian: daily. Eg: Double infection of p.vivax, UTI, Septicemia, Amoebic liver abscess, TBDouble quotidian: 2 peaks in one day. Eg: Kala-azar, Gonococcal endocarditis, Still’s diseaseTertian: Fever peaks every other day (one spike in 2 days). Eg: Benign tertian: (Plasmodium vivax, P. ovale rarely); Malignant tertian (P.falciparum)Quartan: Fever peaks every 3rd day (gap of 2 days) Eg: P. malariae. (rare in india) |
| Remittent | Diurnal variation >=1°C, temperature does not touch baseline | Amoebic liver abscess, Acute bronchopneumonia, acute tonsillitis, Septicemia, Empyema thoracis |
| Periodic | Temperature returns to normal for days before rising again | Hodgkin’s disease: Pel-Ebstein fever(3 weeks of fever then 3 weeks normal)Brucellosis: Undulant fever (the fever is typically undulant, rising and falling like a wave)Dengue: Saddleback fever (fever abates for a day and then returns) |
The use of antipyretic and antibiotic drugs has made these patterns unusual today.
Note:
- Continuous step ladder pattern of fever is classical of typhoid fever.
- High grade fever: Temp >100°F, or if it’s fever with chills.
Based on fall of fever on treatment
- Fall by Lysis (Slowly comes down) Eg: Typhoid. Takes 5 days to become afebrile. Malaria- One more cycle of fever occurs after rx.
- Fall by Crisis (Give med- Falls- Doesn’t rise again) Eg: Pneumonia
| Hypothermia | <35C | Eg: Hypothyroid, Severe Sepsis |
| Hyperthermia | >104 (42C), Set point is normal | Heat stroke, Drugs: Malignant Hyperthermia- Succinylcholine for anesthesia Neuroleptic malignancy (excess muscle breakdown, pain, renal failure)- Antipsychotics |
| HyperPyrexia | Set Point Reset, so temp rises upto that point and falls |
Causes of fever other than infections: Malignancy, Connective tissue disorder, Hyperthyroid, All drugs (except digitalis), Thrombosis (like in brain, DVT), thrombophlebitis, Bleed in brain or abdomen, Blood transfusion, serum sickness, Mediterranean fever