Ginier-Gillet Mathieu, Esparcieux Aurelie
Grenoble Faculty of Medicine, Grenoble Alpes University, La Tronche, France.
Department of Internal Medicine and Infectious Diseases, Clinique de l'Infirmerie Protestante de Lyon, Caluire-et-Cuire, France.
Int J Gen Med. 2021 May 25;14:2063-2068. doi: 10.2147/IJGM.S306423. eCollection 2021.
Prolonged and unexplained fevers in young adults are uncommon, especially when access to diagnostic tests is simplified. Therefore, the definition of unexplained fever depends on the volume of tests performed. However, low-grade fever has not been a priority in research. Management of low-grade fever [eg, an oral temperature of ≥37.8°C (100°F) and <38.3°C (101°F) at any time of the day] is not codified. The presented case of a 37-year-old nurse with an intermittent fever for three months, with no clear diagnostic evidence and no elevated markers of inflammation, illustrates "habitual hyperthermia" (HH)-retained after ordering tests sequentially in town and at the hospital. HH was made known by Prof. H.A. Reimann (1897-1986) an American virologist, although the diagnostic criteria are fallible. The article reviews the criteria and then discusses how to select diagnostic tests in family practice for prolonged fever in young adults without clinical signs of orientation. Given the polymorphism of febrile illnesses, the principle of parsimony must be transgressed, and in the event of an early suspicion of HH, surveillance is a rule to be further amended.
青壮年长期不明原因发热并不常见,尤其是在诊断检查途径变得简化的情况下。因此,不明原因发热的定义取决于所进行检查的数量。然而,低热在研究中并未受到重视。低热(例如,一天中任何时候口腔温度≥37.8°C(100°F)且<38.3°C(101°F))的管理方法尚未规范化。本文介绍了一名37岁护士间歇性发热三个月的病例,没有明确的诊断证据且炎症指标未升高,该病例在先后在镇上和医院进行一系列检查后确诊为“习惯性体温过高”(HH)。“习惯性体温过高”由美国病毒学家H.A. 赖曼教授(1897 - 1986)发现,尽管其诊断标准并非绝对可靠。本文回顾了相关标准,然后讨论了在家庭医疗中如何为无临床定位体征的青壮年长期发热选择诊断检查。鉴于发热性疾病的多样性,必须突破简约原则,并且如果早期怀疑为HH,持续监测是一项需进一步修订的规则。