Fever

Normal
Axillary temperature 36~37 .0 C
Sublingual temperature 36.7~37.7 C

rectal temperature 36.9~37.9 C

 Concept pyrogen set point thermoregulatory center temperature

of

the body

physiological T

T
pathological T

sport pregnancy luteal phase hyperthermia set point fever

Hyperthermia :

thermogenesis thermolysis dysfunction of thermoregulatory center

 Causes and pathogenesis of fever Pyrogen and activator of fever Activator : the substance can activate the cells that can produce the pyrogen. pyrogen: the substance can cause fever

Activators of fever
microbe: G- LPS, ET G+ peptidoglycan virus: enveloped virus 1. Extragenou

particle:transfuse response

pyrogen
2. internal production immune complexes etiocholanolone

Endogenou pyrogen(EP)
interleukin-1(IL-1) :MC,fibroblast IL-6:T,B lymphocyte,tumor cell TNF : TNF M TNF (lymphotoxin) active T interferon ( IFN ): T lymphocyte

Producing and releasing of EP

LPS

LPS joint
pro

trigger NF-B
Start transcription ,EP express
cell of producing EP

sCD14
LPS LPS joint
pro LPS sCD14 complexes

Mechanism : increase of set point 1.the pathway: EP entry temperature center

Pathways of EP signal transduction to the thermoregulation center

a. blood
Activator

brain barrier
Producing EP Cell of Activator EP
blood brain barrier

SP

Thermoregulation center

a.OVLT(organum vasculosum laminace terminalis

OVLT
MC POAH neuron

capillary EP

third ventricles of brain optic chiasma

c. vago: 2.The mechanism: increase of set point a. Warm sensitive neuron: thermolysis b. Cold sensitive neuron: thermogenesis

Imbalance: Normal: warm sensitive neuron cold sensitive neuron

Thermoregulation mechanism of fever . Thermoregulation center

1. The positive regulation preoptic anterior hypothalamus, POAH 2. The negative regulation medial amygdaloid nucleus,MAN ventral septal area,VSA

Positive regulation mediators

1.PGE2: warm sensitive neuron cold sensitive neuron
SP

Effective medicine:Asprin,buprofen (Fenbid)

2.CRH(corticotrophin releasing hormone)

EP (IL-1, IL-6 ) CRH media fever TNF, IL-1 PGE2 media fever

3. cAMP : SP EP hypothalamus: Na+ /Ca2+

cAMP SP

4. Na+ /Ca2+ : 5. NO: a. Activate metabolism Brown fat b. Inhibit Negative regulation mediators c. OVLT POAH T

Negative regulation mediators

Negative feedback: Febrile ceiling: < 42
endogenous cryogens AVP -MSH
T center T

period and metabolism of fever

The period of febrile: 1.the fervescence period characteristic: thermogenesis>thermolysis
chill brown adipose tissue(scapula ,large vessle of thoracicand cervical metabolic rate

Thermogenesis

Manifestation:
pale , gooseflesh, chill warm sensitive neuron (POAH)

Chill center
Chill cold sensitive neuron (POAH) cold stimuli

Chill center
Chill skin T

Up

Chill Rubro nucleus

Down Lateral spinothalamic tract

Rubrospinal tract

Reticulospinal tract

anterior motor cells

2.the persistent febrile period

The temperature reaches the new set point
Thermogenesis = thermolysis : SP on higher level Manifestation: febrile , headache metabolic rate and pulse rate anorexia()

3.The defervescence period

characteristic: Thermogenesis < thermolysis SP is reset to the normal level

Manifestation: the skin is warm and flush, sweat

fervescence persistent defervescence set point 39 38 37 time period period period

metabolism change of fever

1. Glycometabolism Glycogenolysis Glycogen storage 2. Fat metabolism lipodieresis Fat storage Ketosis magersucht 3. proteometabolism Protein catatabolism, negative nitrogen 4. water\eletrolyte metabolism\vitamin

metabolism T 1

metabolism rate

13%

acute phase response WBC

Physiological changes:
1.CNS: headach , dizzy,drowsiness, febrile convulsion: 24h
inheritance hypoxia discharge

2.immunity system IL-1: activator of lymphocyte IL-6differentiation factor IFN: humoral factor TNF: anti-tumor

3.Digestion system Sympathetic digestive juice EP hypothalamus nauseated,vomit abdorminal distention constipation

4. circulation system HR 1 HR 18/min CO induce heart failure 5. Respiratory system

principal of treatment 1.medicine

Inhibit production of pyrogen: glucocorticoid: inhibit IL-6 and TNF Inhibit production of PGs: salicylic mezolin

2. physics: brain
1g water 2.5KJ(lose)

50% 1~2%