Fever is a common symptom of infection or inflammation, characterized by an elevated body temperature (typically >37.5°C axillary or >38°C orally). In Ghana, fever often signals endemic diseases like malaria, typhoid, or tuberculosis, requiring a systematic approach to identify the underlying cause and provide appropriate management.
🌡️ Overview and Pathophysiology
Fever results from the body's immune response to pyrogens, resetting the hypothalamic thermostat:
Causes
- Infectious: Malaria, typhoid, TB, viral infections
- Non-Infectious: Autoimmune diseases, malignancy, heat stroke
- Risk Factors: Endemic exposure, immunosuppression
Mechanisms
- Pyrogens: Endogenous (IL-1, IL-6) or exogenous (bacterial toxins)
- Response: Increased heat production, vasoconstriction
- Key Point: Fever aids immune defense but can lead to complications if severe
🔍 Clinical Presentation
Fever presentation varies with underlying cause:
Symptoms
General: Chills, sweats, fatigue, headache
Specific: Cough (TB), abdominal pain (typhoid), joint pain (malaria)
Children: Irritability, poor feeding
Signs
Vital: Temperature >37.5°C axillary, tachycardia, tachypnea
Systemic: Pallor (anemia), lymphadenopathy, rash
Other: Splenomegaly, hepatomegaly (depending on cause)
- Temperature >40°C or persistent >48 hours
- Altered consciousness, seizures
- Dehydration, severe weakness, or respiratory distress
🧪 Diagnosis
Identify the cause through targeted investigations:
Investigations
First-Line: Full Blood Count (FBC), malaria RDT/microscopy
Further Tests: Blood culture, Widal test (typhoid), chest X-ray (TB)
Supportive: Urinalysis, stool R/E, inflammatory markers (CRP/ESR)
💊 Treatment
Management targets the underlying cause and symptom relief.
Non-Pharmacological
Temperature Control: Tepid sponging, light clothing
Hydration: Oral rehydration salts (ORS) or IV fluids if dehydrated
Rest: Encourage adequate rest and nutrition
Paracetamol
- Dose: 10-15 mg/kg every 6-8 hours (max 60 mg/kg/day)
- Route: Oral or rectal
- Indication: Fever relief
Ibuprofen
- Dose: 5-10 mg/kg every 6-8 hours (max 40 mg/kg/day)
- Route: Oral
- Indication: Fever and pain relief (avoid in dehydration)
Specific Therapy
- Malaria: Artemether-Lumefantrine or Artesunate-Amodiaquine (see malaria guidelines)
- Typhoid: Ciprofloxacin 500 mg 12 hourly x 7-10 days
- TB: Refer to TB treatment protocol
- Avoid aspirin in children due to Reye’s syndrome risk
- Escalate if no improvement after 48 hours or worsening symptoms
- Monitor for dehydration and electrolyte imbalance
🤰 Special Populations
Adjust management based on age and condition:
Children
Focus: Weight-based dosing, monitor for seizures
Red Flags: Fever >39°C, lethargy, or refusal to feed
Pregnancy
Caution: Use paracetamol; avoid ibuprofen unless benefits outweigh risks
Investigation: Rule out malaria, UTI
🚨 Referral Criteria
- Fever >40°C or persistent >48 hours despite treatment
- Signs of severe infection (e.g., sepsis, meningitis)
- Children with seizures or dehydration
Initiate empiric treatment and transfer to higher facility if needed.
🧠 Key Takeaways
- ✅ Assess Cause: Investigate underlying infection (e.g., malaria, typhoid)
- ✅ Symptom Relief: Paracetamol or ibuprofen; tepid sponging
- ✅ Hydrate: Ensure adequate fluid intake
- ✅ Monitor: Watch for red flags, escalate if no improvement
- ✅ Special Care: Adjust for children and pregnant women
- ✅ Refer: For severe or persistent cases