In clinical practice, some patients often request antibiotic treatment for fever from their doctors or on their own. In fact, from a medical point of view, not all febrile symptoms require antibiotic treatment. Some febrile diseases are ineffective when treated with antibiotics, and if they are used blindly, they may delay the disease and delay the best time for treatment.
1, viral upper respiratory tract infection Because of viral infection, the white blood cell count is often normal or low, accompanied by an elevated lymphocyte ratio. The clinical diagnosis can be made on the basis of upper respiratory symptoms and signs (cough, sneezing, runny nose), combined with a low or even low white blood cell count in peripheral blood and no abnormalities on chest x-ray. If necessary, virus isolation or virus serology may be performed to determine the pathogen. Rest, drink plenty of hot water and take Tylenol cold tablets by mouth with strong stretching is sufficient. No need to use antibiotics.
2, rheumatic fever Acute rheumatic fever is most common in children and adolescents aged 5-15 years, most patients have a history of pharyngitis or tonsillitis and other upper respiratory tract infections 1-5 weeks before the onset. Most patients have irregular mild or moderate fever, but there are also those with flaccid fever or persistent low-grade fever, accelerated pulse rate and profuse sweating, often out of proportion to body temperature. Diagnostic criteria include.
(1) Signs of streptococcal infection 1 week before onset: pharyngitis, tonsillitis or scarlet fever; positive ASO; or positive skin test for hemolytic streptococcal antigen.
(2) Systemic symptoms: progressive pallor, weakness and sweating, palpitations, wandering arthralgia, and fever for more than 2 weeks.
(3) Cardiac manifestations: persistent sinus tachycardia without other causes, diminished first heart sound, secondary systolic murmur in the apical region, or enhanced third heart sound; prolonged PR interval or QT interval and ST segment changes on ECG.
(4) Other manifestations: increased sedimentation, positive C-reactive protein; diagnostic aspirin therapy is effective; aspirin 100mg/kg per day, orally for 3-5 days, body temperature decreases, symptoms improve, and body temperature no longer increases during the drug administration.
3. Rheumatic connective tissue diseases Rheumatic connective tissue diseases are often combined with fever, mainly including systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, etc.
Systemic lupus erythematosus (SLE) is more common in women, especially in women of childbearing age between 20 and 40 years old. Most patients in the active phase have systemic symptoms. Approximately 90% of patients develop fever of various fever types during the course of the disease, with low- and moderate-grade fever being particularly common. Diagnostic criteria include.
(1) Zygomatic erythema: fixed erythema, flat or elevated, in the prominent part of both cheekbones.
(2) Discoid erythema: flaky, elevated erythema on the skin, adherent with keratotic debridement and follicular plugs; old lesions may develop atrophic scarring.
(3) photosensitivity: marked reaction to sunlight, causing a rash, known from the medical history or observed by the physician.
(4) Oral ulcers, observed by a physician, in the mouth or nasopharynx, usually painless
(5) Arthritis: non-erosive arthritis involving 2 or more peripheral joints with pressure, swelling or effusion.
(6) Plasmacytitis: pleurisy or pericarditis.
(7) renal lesions: urine protein >0,5g/24h or ++++, or tubular pattern (erythrocytes, hemoglobin, granules, or mixed tubular pattern)
(8) Neurological lesions: seizures or psychosis, except for drugs or known metabolic disorders
(9) Hematologic disorders: hemolytic anemia, or leukopenia, or lymphocytopenia, or thrombocytopenia
(10) Immunologic abnormalities: positive anti-ds-DNA antibodies, or positive anti-Sm antibodies, or positive antiphospholipid antibodies (including the presence of one of three positive cardiolipin antibodies, lupus anticoagulant, or false positive syphilis serology tests lasting at least 6 months)
(11) Antinuclear antibodies: abnormal titers of antinuclear antibodies at any time and in the absence of drug-induced “drug-induced lupus”. If four or more of the above 11 items are met, SLE can be diagnosed after excluding infections, tumors and other connective tissue diseases, with a sensitivity and specificity of 95% and 85%, respectively.
Rheumatoid arthritis occurs at any age, with 80% of cases occurring between 35 and 50 years of age, and about three times more women than men. It tends to start slowly and insidiously, with a low-grade fever for a few weeks before the onset of significant joint symptoms. A few patients may have high fever, malaise, general malaise, weight loss, and other symptoms, followed by the gradual onset of typical joint symptoms. Diagnostic criteria include.
(1) Morning stiffness in or around the joints lasting at least 1 hour.
(2) Soft tissue swelling or effusion in at least three joint areas at the same time.
(3) Swelling in at least 1 of the wrist, metacarpophalangeal, and proximal phalangeal joint areas.
(4) Symmetrical arthritis.
(5) The presence of rheumatoid nodules.
(6) Positive serum rheumatoid factor.
(7) Radiographic changes (at least osteoporosis and joint space narrowing).
The diagnosis of rheumatoid arthritis is made when four of the above seven items are met (the duration of the first to fourth items is at least 6 weeks).
There are two peaks in the age of onset of dermatomyositis, namely 10-15 years and 45-60 years, with a higher incidence in women than men. The main clinical manifestation is symmetrical proximal muscle weakness of the extremities, and systemic symptoms may include fever, arthralgia, malaise, and weight loss. The diagnosis should have.
(1) symmetrical proximal muscle weakness of the extremities.
(2) elevated muscle enzyme profile.
(3) electromyography showing myogenic changes.
(4) abnormal muscle biopsy.
(5) characteristic skin manifestations.
All of the above 5 are typical of dermatomyositis. Only the first 4 items are considered polymyositis. Before diagnosis, myotonic dystrophy, granulomatous myositis, infection, recent use of various drugs and toxins, rhabdomyolysis, metabolic diseases, endocrine diseases, myasthenia gravis, etc. should be excluded.
4.Tumor hematological system diseases
Some hematologic malignancies, such as leukemia and lymphoma, often have fever as an early manifestation.
Acute leukemia: half of the patients have fever as the early manifestation. The fever may be low or as high as 39-40°C or more, accompanied by chills and sweating. Although leukemia itself can be febrile, high fever often indicates secondary infection. The diagnosis of leukemia is generally not difficult based on clinical manifestations, blood picture and bone marrow picture characteristics. Most patients with leukocytosis, which exceeds 10×109/L or more, are called leukocytoclastic leukemia. There are also patients with normal or reduced leukocyte counts, which can be as low as <1, 0×109/L, called leukocytosis without leukocytosis. Blood smear sorting examination reveals varying numbers of primitive and naive cells. Bone marrow image is the main basis for the diagnosis of acute leukemia and is a mandatory test, and the WHO classification defines bone marrow primitive cells ≥ 20% as the diagnostic criteria for acute leukemia.
Chronic myeloid leukemia: middle-aged onset is common, with more males than females. Patients in the chronic phase generally have symptoms of hypermetabolism such as malaise, low-grade fever, excessive sweating or night sweats, and weight loss, but often the most significant sign is splenomegaly with a markedly increased white blood cell count and marked to extremely active bone marrow hyperplasia with granulocytes predominating. Fever, weakness, progressive weight loss, skeletal pain, and progressive anemia and hemorrhage are often present during the accelerated phase. Peripheral blood or bone marrow primitive cells ≥10% and peripheral blood basophils >20%.
Chronic lymphocytic leukemia: Patients are mostly elderly, with a slow onset and mostly without conscious symptoms. Early symptoms may include malaise and fatigue, followed by loss of appetite, wasting, fever, and night sweats. The peripheral blood is persistently lymphocytic, with leukocytes >10×109/L and lymphocytes accounting for more than 50%. The bone marrow picture has nucleated cells with markedly active or extremely active proliferation, with lymphocytes ≥40%, mainly mature lymphocytes.
5.Lymphoma: Painless progressive lymph node enlargement or local mass is a common clinical manifestation of lymphoma, but it is often accompanied by systemic symptoms such as fever, emaciation and night sweats. Lymph node print or lymph node puncture smear should be done for diagnosis. Based on the results of histopathological examination, the diagnosis of lymphoma and classification and typing diagnosis can be made.
6.Drug fever
Some medications can also cause fever in some cases. Some of the more common fever-causing drugs include antibiotics, sulfonamides, isoniazid, propylthiouracil, para-aminosalicylic acid, and phenytoin sodium. Virtually any drug can cause fever, including those that have been used for a long time before and have not been a problem. Clinical features include.
(1) They usually appear 7-10 days after drug administration, or as short as 48-72 hours.
(2) No specific fever pattern.
(3) May be accompanied by manifestations such as drug rash and muscle and joint pain.
(4) Mild elevation of serum transaminases.
(5) Eosinophil count can be mildly to moderately increased later in the course of the disease.
(6) The fever usually resolves 24-72 hours after the drug is stopped, but the time of fever resolution is related to the rate of drug metabolism and excretion.
Fever may occur during the course of all the above diseases, but if antibiotics are applied blindly, they are often ineffective and even delay the disease. Therefore, we caution that not all fevers need oral antibiotic treatment. If fever symptoms appear, you should go to a regular hospital in time to make a correct diagnosis as early as possible and develop an effective treatment plan to recover your health as soon as possible.