Pathophysiology

Fever is defined as a rise in deep body temperature associated with a resetting of the body's thermostat. 1 This thermostat is located in the preoptic region of the anterior hypothalamus near the floor of the third ventricle. Exogenous fever-producing substances (pyrogens)—such as bacteria, bacterial endotoxin, antigen-antibody complexes, yeast, viruses, and etiocholanolone—may stimulate the formation and release of endogenous pyrogens. Endogenous pyrogens are produced by neutrophils, monocytes, hepatic Kupffer cells, splenic sinusoidal cells, alveolar macrophages, and peritoneal lining cells and are believed to induce the synthesis of prostaglandins in the hypothalamus. Endogenous pyrogens include interleukin 1, interleukin 6, and tumor necrosis factor. 2 The body's thermostat is then reset at a higher setting, and the patient, whose own temperature is below that of the body's thermostat, experiences a chill. Peripheral vasoconstriction, shivering, central pooling, and behavioral activity (e.g., putting on a sweater or drinking hot tea) lead to an increase in body temperature.

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