Infectious

Non- Infectious

Sepsis
Bacterial infections
-cellulitis
-cholecystitis/cholangitis
-pneumonia
-osteomyelitis
-urinary tract infections
-abscesses
-meningitis
-otitis/sinusitis
-carditis
Viral infections
Parasitic infections
Arthropod infections
Fungal infections

Seizures
Hyperthyroidism
Neuroleptic malignant syndrome
Serotonin syndrome
Heat stroke
Sympathomimetic use
Anticholinergic overdose
Malignant hyperthermia
Intracranial hemorrhage/hematoma
Malignancies
Autoimmune
Pulmonary embolism
Cerebrovascular accident,
thrombosis

Table 1: Infectious and/or Non-İnfectious Causes of Fever

 

Blood Cultures Warranted

Blood Cultures Unnecessary

Conditions/Empyrical Diagnoses

Sepsis
meningitis
Complicated pyelonephritis
endocarditis
nosocomial pneumonia
Facial/periorbital cellulitis

cellulitis (except facial)
simple pyelonephritis and urinary tract infections
Community-acquired pneumonia
Upper respiratory tract infections
Simple wound infections

Table 2: Conditions that Necessitate and do not Necessitate Blood Cultures

Treatment

Explanatory notes

Tepid sponging, wetting

The efficiency increases with the body surface area wetted. Repeat wetting can be necessary to augment effect. Warm showers will boost reduction in the temperature.

Fanning

The effect resembles wetting, albeit milder.

Hydration

The fluid losses (both insensible and those resulted from poor intake) should be replaced. Overhydration is not proved beneficial.

Drug treatment

Ideally, should be considered after the abovementioned treatments have been proved ineffective.

-Paracetamol

1 gr paracetamol can be infused to alleviate fever acutely, though the daily dose is 2 gr for adults (around 1-1.5 gr in school-age children). Beware of using in neonates till 3 months old.

-Other non-steroidal anti-inflammatory drugs (NSAID)

Ibuprofen is one of the most commonly used NSAID, and sometimes in association with paracetamol. Do not exceed 1.2 gr. These group of drugs may increase risk of serious cardiovascular thrombotic events,
Diclofenac has comparable antipyretic efficacy with other NSAIDS in rectal, inramuscular or oral use (1 mg/kg by rectal)[36].

Table 3: The arsenal of treatment of the febrile patient in the acute setting