Habitual Hyperthermia: An Interpretive Paradigm of the 20th Century? Not Really

Abstract

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.

Keywords: habitual hyperthermia; low-grade fever; patient-centered care; primary health care; pyrexia of unknown origin; undifferentiated febrile illness.

Figure 1

An example of decision tree for managing prolonged febrile illness in young adults in family practice.