Background
“Humanity has but three great enemies: fever, famine, and war, and of these by far the greatest, by far the most terrible, is fever.” (William Osler)
Generation of fever
Sepsis
Fever associated with inflammation
Drug-induced fever
Class | Examples of causes |
---|---|
Antimicrobial agents | β-lactam antibiotics (piperacillin, cefotaxime) Sulphonamides |
Malignant hyperthermia | Suxamethonium Volatile anaesthetic agents |
Neuroleptic malignant syndrome | Dopamine antagonists (chlorpromazine, haloperidol) Atypical agents (serotonin and dopamine antagonists) (olanzapine, risperidone, paliperidone, aripiprazole, quetiapine) |
Serotonin syndrome | Antidepressants (monoamine oxidase inhibitors, tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, bupropion) Opioids (tramadol, pethidine, fentanyl, pentazocine, buprenorphine oxycodone, hydrocodone) Central nervous system stimulants (MDMA, amphetamines, sibutramine, methylphenidate, methamphetamine, cocaine) Psychedelics (5-methoxy-diisopropyltryptamine, lysergide) Herbs (St John’s Wort, Syrian rue, Panax ginseng, nutmeg, yohimbine) Others (tryptophan, l-dopa, valproate, buspirone, lithium, linezolid, chlorpheniramine, risperidone, olanzapine, antiemetics (ondansetron, granisetron, metoclopramide), ritonavir, sumatriptan) |
Propofol infusion syndrome | Propofol |
Anticholinergic agents | Anticholinergics (atropine, glycopyrrolate), Antihistamines (chlorpheniramine), Antipsychotics (olanzapine, quetiapine), Antispasmodics (oxybutynin), Cyclic antidepressants (amitriptyline, doxepin) Mydriatics (tropicamide) |
Sympathimometic agents | Prescription drugs (e.g. bronchodilators) Non-prescription drugs (e.g. ephedrine in cold remedies) Illegal street drugs (e.g. cocaine, amphetamines, methamphetamine (‘ecstasy’), mephedrone) Dietary supplements (e.g. ephedra alkaloids) |
Piperazine compounds | Anti-emetic (cyclizine) Anti-helminths Legal ‘club drugs’ (‘Legal X’, ‘Legal E’, ‘Frenzy’) |
Synthetic cathinones | Street drugs (mephedrone, ‘meow-meow’) Bupropion (anti-depressant and anti-smoking agent) |
Fever after brain injury
Endocrine fever
Mechanisms of damage from fever
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Direct cellular damage
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Local effects, e.g. stimulation of cytokines and inflammatory response
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Systemic effects, e.g. gut bacterial translocation