Fever classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Classification

Pyrexia (fever) can be classed as:

• Low grade: 38–39°C (100.4–102.2°F)
• Moderate: 39–40°C (102.2–104.0°F)
• High-grade: 40–42°C (104.0–107.6°F)
• Hyperpyrexia: Over 42°C (107.6°F)

The last is clearly a medical emergency because it approaches the upper limit compatible with human life.

Febricula is a mild fever of short duration, of indefinite origin, and without any distinctive pathology.

Pattern of Fever

The pattern of fever generally offers little diagnostic value in ascertaining the etiology of fever. Previously described fever patterns include:

• Sustained fever (suggestive of brucellosis, drug fever, lobar pneumonia, tularemia, typhoid, typhus)
• Remittent fever (suggestive of tuberculosis, mycoplasma pneumonia, malaria, legionellosis)
• Intermittent fever (suggestive of malaria, kala-azar, pyaemia)

• Double quotidian fever (suggestive of Still's disease, legionellosis, miliary tuberculosis, kala-azar)
• Quotidian fever (suggestive of Plasmodium falciparum or Plasmodium knowlesi malaria)
• Tertian fever (suggestive of Plasmodium vivax or Plasmodium ovale malaria)
• Quartan fever (suggestive of Plasmodium malariae malaria)
• Alternate-day fever (suggestive of response to antipyretic dosage schedule)

• Hyperpyrexia (suggestive of intracranial hemorrhage, septicemia, Kawasaki disease, thyroid storm, drug fever)
• Hectic or spiking pattern (suggestive of biliary or urinary tract infection, endocarditis)
• Irregular pattern (suggestive of factitious fever)
• Pel-Ebstein pattern (suggestive of Hodgkin's lymphoma)
• Picket fence pattern (suggestive of acute mastoiditis complicated by transverse sinus thrombosis)
• Saddleback pattern (suggestive of dengue fever, leptospirosis, poliomyelitis, human granulocytic ehrlichiosis)
• Wunderlich curve pattern (suggestive of typhoid fever)