ICD 10. CLASS XVIII. SYMPTOMS, SIGNS AND DEVIATIONS FROM THE NORM, IDENTIFIED DURING CLINICAL AND LABORATORY STUDIES, NOT CLASSIFIED OTHERWISE (R50-R99)
COMMON SYMPTOMS AND SIGNS (R50-R69)
R50 Fever of unknown origin
Excludes: fever of unknown origin (during) (at):
childbirth ( O75.2)
newborn ( P81.9)
puerperal fever NOS ( O86.4)
R50.0 Fever with chills. Fever with rigor
R50.8 Persistent fever
R50.9 The fever is unstable. Hyperthermia NOS. Pyrexia NOS
Excludes: malignant hyperthermia due to anesthesia ( T88.3)
R51 Headache
Facial pain
Excluded: atypical pain in the face ( G50.1)
migraine and other headache syndromes ( G43-G44)
trigeminal neuralgia ( G50.0)
R52 Pain not elsewhere classified
Included: pain that cannot be attributed to any specific organ or part of the body
Excluded: chronic pain personality syndrome ( F62.8)
headache ( R51)
pain (in):
stomach ( R10. -)
back ( M54.9)
mammary gland ( N64.4)
chest ( R07.1-R07.4)
ear ( H92.0)
pelvic area ( H57.1)
joint ( M25.5)
limbs ( M79.6)
lumbar region ( M54.5)
pelvic and perineal areas ( R10.2)
psychogenic ( F45.4)
shoulder ( M75.8)
spine ( M54. -)
throat ( R07.0)
language ( K14.6)
dental ( K08.8)
renal colic ( N23)
R52.0 Acute pain
R52.1 Constant, unrelieved pain
R52.2 Other constant pain
R52.9 Unspecified pain. Generalized pain NOS
R53 Malaise and fatigue
Asthenia NOS
Weakness:
NOS
chronic
neurotic
General physical exhaustion
Lethargy
Fatigue
Excluded: weakness:
congenital ( P96.9)
senile ( R54)
exhaustion and fatigue (due to) (with):
nervous demobilization ( F43.0)
excessive stress ( T73.3)
dangers ( T73.2)
thermal effects ( T67. -)
neurasthenia ( F48.0)
pregnancy ( O26.8)
senile asthenia ( R54)
fatigue syndrome ( F48.0)
after suffering a viral disease ( G93.3)
R54 Old age
Senile age)
Old age) without mention of psychosis
Senile:
asthenia
weakness
Excluded: senile psychosis ( F03)
R55 Fainting [syncope] and collapse
Brief loss of consciousness and vision
Loss of consciousness
Excluded: neurocirculatory asthenia ( F45.3)
orthostatic hypotension ( I95.1)
neurogenic ( G90.3)
shock:
NOS ( R57.9)
cardiogenic ( R57.0)
complicating or accompanying:
abortion, ectopic or molar pregnancy ( O00
-O07
, O08.3
)
labor and delivery ( O75.1)
postoperative ( T81.1)
Stokes-Adams attack ( I45.9)
fainting:
sinocarotid ( G90.0)
thermal ( T67.1)
psychogenic ( F48.8)
unconscious state NOS ( R40.2)
R56 Convulsions, not elsewhere classified
Excluded: convulsions and paroxysmal attacks (with):
dissociative ( F44.5)
epilepsy ( G40-G41)
newborn ( P90)
R56.0 Cramps with fever
R56.8 Other and unspecified seizures. Paroxysmal seizure (motor) NOS. Seizure (convulsive) NOS
R57 Shock, not elsewhere classified
Excludes: shock (caused by):
anesthesia ( T88.2)
anaphylactic (due to):
NOS ( T78.2)
adverse reaction to foods ( T78.0)
whey ( T80.5)
complicating or accompanying abortion, ectopic or molar pregnancy ( O00-O07, O08.3)
exposure to electric current ( T75.4)
as a result of lightning strike ( T75.0)
obstetric ( O75.1)
postoperative ( T81.1)
mental ( F43.0)
septic ( A41.9)
traumatic ( T79.4)
toxic shock syndrome ( A48.3)
R57.0 Cardiogenic shock
R57.1 Hypovolemic shock
R57.8 Other types of shock. Endotoxic shock
R57.9 Unspecified shock. Peripheral circulatory failure NOS
R58 Bleeding, not elsewhere classified
Bleeding NOS
R59 Enlarged lymph nodes
Included: swollen glands
Excluded: lymphadenitis:
NOS ( I88.9)
spicy ( L04. -)
chronic ( I88.1)
mesenteric (acute) (chronic) ( I88.0)
R59.0 Localized enlargement of lymph nodes
R59.1 Generalized enlargement of lymph nodes. Lymphadenopathy NOS
Excludes: human immunodeficiency virus [HIV] disease manifesting as persistent generalized lymphadenopathy ( B23.1)
R59.9 Enlarged lymph nodes, unspecified
R60 Edema, not elsewhere classified
Excludes: ascites ( R18)
hydrops fetalis NOS ( P83.2)
hydrothorax ( J94.8)
edema:
angioedema ( T78.3)
cerebral ( G93.6)
associated with birth trauma ( P11.0)
during pregnancy ( O12.0)
hereditary ( Q82.0)
larynx ( J38.4)
in case of malnutrition ( E40-E46)
nasopharynx ( J39.2)
newborn ( P83.3)
throats ( J39.2)
pulmonary ( J81)
R60.0 Localized edema
R60.1 Generalized edema
R60.9 Unspecified edema. Fluid retention NOS
R61 Hyperhidrosis
R61.0 Localized hyperhidrosis
R61.1 Generalized hyperhidrosis
R61.9 Hyperhidrosis, unspecified. Excessive sweating. Night sweats
R62 Lack of expected normal physiological development
Excludes: delayed puberty ( E30.0)
R62.0 Delayed developmental stages. Delay in skills appropriate to the stage of physiological development
Ability Delay:
speak
walk
R62.8 Other types of delay in expected normal physiological development
Flaw:
weight gain
growth
Infantilism NOS. Insufficient growth. Delayed physical development
Excludes: developmental delay as a result of disease caused by HIV ( B22.2)
delayed physical development due to malnutrition ( E45)
R62.9 Lack of expected normal physiological development, unspecified
R63 Symptoms and signs related to food and liquid intake
Excludes: bulimia NOS ( F50.2)
eating disorders of non-organic origin ( F50. -)
malnutrition ( E40-E46)
R63.0 Anorexia. Loss of appetite
Excluded: anorexia nervosa ( F50.0)
psychogenic loss of appetite ( F50.8)
R63.1 Polydipsia. Excessive thirst
R63.2 Polyphagia. Excessive appetite. Overeating NOS
R63.3 Difficulty feeding and introducing food. Feeding problems NOS
Excluded: problems feeding a newborn ( P92. -)
eating disorder in infancy and childhood of non-organic origin ( F98.2)
R63.4 Abnormal weight loss
R63.5 Abnormal weight gain
Excluded: excessive weight gain during pregnancy ( O26.0)
obesity ( E66. -)
R63.8 Other symptoms and signs related to food and fluid intake
R64 Cachexia
Excluded: wasting syndrome as a result of disease caused by HIV ( B22.2)
malignant cachexia ( C80)
nutritional insanity ( E41)
R68 Other general symptoms and signs
R68.0 Hypothermia not associated with low ambient temperature
Excludes: hypothermia (caused by):
NOS (random) ( T68)
anesthesia ( T88.5)
low ambient temperature ( T68)
newborn ( P80. -)
R68.1 Nonspecific symptoms characteristic of infants. Excessive baby crying. Excitable child
Excluded: neonatal cerebral excitability ( P91.3)
teething syndrome ( K00.7)
R68.2 Dry mouth, unspecified
Excludes: dry mouth caused by:
dehydration ( E86)
[Sjögren's] sicca syndrome ( M35.0)
decreased secretion of the salivary glands ( K11.7)
R68.3 Fingers shaped like drumsticks. Club nails
Excluded: this is a congenital condition ( Q68.1)
R68.8 Other specified general symptoms and signs
R69 Unknown and unspecified causes of disease
Soreness NOS. Undiagnosed disease without specifying the location or affected system
DEVIATIONS FROM NORMAL RECOGNIZED DURING BLOOD STUDIES
IN THE ABSENCE OF AN ESTABLISHED DIAGNOSIS (R70-R79)
Excluded: deviations from the norm (if):
O28. -)
coagulation ( D65— D68)
lipids ( E78. -)
platelets ( D69. -)
leukocytes classified elsewhere ( D70-D72)
deviations from the norm identified during diagnostic blood tests, classified in other headings - see Alphabetical index
hemorrhagic and hematological disorders in the fetus and newborn ( P50-P61)
R70 Accelerated erythrocyte sedimentation and plasma [blood] viscosity abnormalities
R70.0 Accelerated erythrocyte sedimentation
R70.1 Plasma [blood] viscosity abnormality
R71 Red blood cell abnormality
Red blood cell abnormality:
morphological NOS
volumetric NOS
Anisocytosis. Poikilocytosis
Excluded: anemia ( D50-D64)
polycythemia:
benign (familial) ( D75.0)
newborn ( P61.1)
secondary ( D75.1)
true ( D45)
R72 Abnormality of leukocytes, not elsewhere classified
Abnormal leukocyte differentiation NOS
Excluded: leukocytosis ( D72.8)
R73 Increased blood glucose
Excluded: diabetes mellitus ( E10-E14)
during pregnancy, childbirth and postpartum
period ( O24. -)
neonatal disorders ( P70.0-P70.2)
post-surgical hypoinsulinemia ( E89.1)
R73.0 Deviations in the results of the glucose tolerance test
Diabetes:
chemical
latent
Impaired glucose tolerance. Prediabetes
R73.9 Hyperglycemia, unspecified
R74 Deviations from normal levels of enzymes in serum
R74.0 Nonspecific increase in transaminase or lactic acid hydrogenase levels
R74.8 Other nonspecific abnormalities in serum enzyme levels
Abnormal level:
acid phosphatase
alkaline phosphatase
amylase
lipases [triacylglycerol lipases]
R74.9 Abnormal levels of unspecified enzymes in serum
R75 Laboratory detection of human immunodeficiency virus [HIV]
Inconclusive test for HIV detected in children
Excluded: asymptomatic infectious status caused by a virus
human immunodeficiency [HIV] ( Z21)
disease caused by human immunodeficiency virus [HIV] ( B20-B24)
R76 Other abnormalities detected by immunological examination of serum
R76.0 High antibody titer
Excluded: isoimmunization during pregnancy ( O36.0-O36.1)
effect on the fetus or newborn ( P55. -)
R76.1 Abnormal reaction to a tuberculin test. Abnormal Mantoux test results
R76.2 False-positive serological test for syphilis. False-positive Wasserman reaction
R76.8 Other specified deviations from the norm identified during immunological examination of serum
High level of immunoglobulins NOS
R76.9 Abnormality detected by immunological examination of serum, unspecified
R77 Other abnormalities of plasma proteins
Excluded: changes in plasma protein metabolism ( E88.0)
R77.0 Abnormal albumin
R77.1 Deviation from the norm of globulin. Hyperglobulinemia NOS
R77.2 Abnormal alpha-fetoprotein
R77.8 Other specified plasma protein abnormalities
R77.9 Plasma protein abnormality, unspecified
R78 Detection of drugs and other substances not normally present in the blood
Excludes: mental and behavioral disorders associated with psychoactive substance use
(F10-F19)
R78.0 Detection of alcohol in blood
If it is necessary to clarify the alcohol concentration, use an additional code for external reasons ( Y90. -)
R78.1 Detection of opiates in the blood
R78.2 Detection of cocaine in the blood
R78.3 Detection of a hallucinogen in the blood
R78.4 Detection of other drugs in the blood
R78.5 Detection of psychotropic substances in the blood
R78.6 Detection of a steroid agent in the blood
R78.7 Detection of abnormalities in the content of heavy metals in the blood
R78.8 Detection of other specified substances not normally present in the blood
Detection of abnormal lithium levels in the blood
R78.9 Detection of an unspecified substance not normally present in the blood
R79 Other abnormal blood chemistry
Excluded: disturbances of water-salt or acid-base balance ( E86-E87)
asymptomatic hyperuricemia ( E79.0)
hyperglycemia NOS ( R73.9)
hypoglycemia NOS ( E16.2)
neonatal ( P70.3-P70.4)
specific indicators indicating violations:
amino acid metabolism ( E70-E72)
carbohydrate metabolism ( E73-E74)
lipid metabolism ( E75. -)
R79.0 Deviations from normal levels of minerals in the blood
Deviations from the content norm:
cobalt
copper
gland
magnesium
minerals NEC
zinc
Excluded: deviation from the standard lithium content ( R78.8)
disorders of mineral metabolism ( E83. -)
neonatal hypomagnesemia ( P71.2)
nutrition related mineral deficiency ( E58-E61)
R79.8 Other specified deviations from the norm in the chemical composition of the blood. Blood gas imbalance
R79.9 Deviation from the norm of the chemical composition of the blood, unspecified
DEVIATIONS FROM NORMAL REVEALED DURING URINE STUDY
IN THE ABSENCE OF AN ESTABLISHED DIAGNOSIS (R80-R82)
O28. -)
abnormalities identified during diagnostic urine tests, classified elsewhere
— see Alphabetical index
specific indicators indicating a violation:
amino acid metabolism ( E70-E72)
carbohydrate metabolism ( E73-E74)
R80 Isolated proteinuria
Albuminuria NOS
Bence Jones proteinuria
Proteinuria NOS
Excluded: proteinuria:
during pregnancy ( O12.1)
isolated with a specified morphological lesion ( N06. -)
orthostatic ( N39.2)
persistent ( N39.1)
R81 Glycosuria
Excludes: renal glycosuria ( E74.8)
R82 Other abnormalities revealed by urine examination
Excludes: hematuria ( R31)
R82.0 Hiluria
Excludes: filarial chyluria ( B74. -)
R82.1 Myoglobinuria
R82.2 Bile pigments in urine
R82.3 Hemoglobinuria
Excluded: hemoglobinuria:
due to hemolysis from external causes NEC ( D59.6)
paroxysmal nocturnal [Marchiafava-Micheli] ( D59.5)
R82.4 Acetonuria. Ketonuria
R82.5 Increased levels of drugs, medications and biological substances in the urine
Elevated levels in urine:
catecholamines
indolylacetic acid
17-ketosteroids
steroids
R82.6 Abnormal levels of substances in the urine that enter the body primarily for non-medical purposes
Abnormal levels of heavy metals in urine
R82.7 Deviations from the norm identified during microbiological examination of urine
Positive Culture Research
R82.8 Deviations from the norm identified during cytological and histological examination of urine
R82.9 Other and unspecified abnormalities detected by urine examination
Cells and casts in the urine. Crystalluria. Melanuria
DEVIATIONS FROM NORMAL IDENTIFIED WHEN STUDYING OTHER FLUIDS, SUBSTANCES AND TISSUE OF THE BODY, IN THE ABSENCE OF AN ESTABLISHED DIAGNOSIS (R83-R89)
Excluded: deviations from the norm identified by:
antenatal examination of the mother ( O28. -)
research:
blood, in the absence of an established diagnosis ( R70-R79)
urine, in the absence of an established diagnosis ( R80-R82)
deviations from the norm identified during diagnostic tests
studies classified elsewhere
— see Alphabetical index
Below is the classification by the fourth character used in the headings ( R83-R89):
0 Abnormal enzyme levels
.1 Abnormal hormone levels
.2 Abnormal content of other drugs, medications and biological substances
.3 Abnormal levels of substances ingested primarily for non-medical purposes
.4 Deviations from the norm identified during immunological studies
.5 Deviations from the norm identified during microbiological studies
Positive culture results
.6 Deviations from the norm identified during cytological studies
Deviations from the norm identified during smear examination
Pap test
.7 Deviations from the norm identified during histological studies
.8 Other deviations from the norm. Deviations from the norm identified during chromosome studies
.9 Unspecified deviations from the norm
R83 Abnormalities identified during examination of cerebrospinal fluid
R84 Deviations from the norm identified during the study of preparations from the respiratory system and chest
- bronchial washings
- nasal discharge
- pleural fluid
- sputum
- throat swabs
Excludes: bloody sputum ( R04.2)
R85 Deviations from the norm identified during the study of preparations from the digestive organs and abdominal cavity
Deviations from the norm identified during the study:
peritoneal fluid
saliva
Excluded: stool changes ( R19.5)
R86 Deviations from the norm identified during the study of preparations from the male genital organs
Deviations from the norm identified during the study:
prostate secretions
sperm and seminal fluid
Abnormal sperm
Excluded: azoospermia ( N46)
oligospermia ( N46)
R87 Deviations from the norm identified during the study of preparations from the female genital organs
Deviations from the norm identified during the study:
secretions and smears from:
cervix
vagina
vulva
Excluded: carcinoma in situ ( D05-D07.3)
dysplasia:
cervix ( N87. -)
vagina ( N89.0-N89.3)
vulva ( N90.0-N90.3)
R89 Deviations from the norm identified during the study of preparations from other organs, systems and tissues
Deviations from the norm identified during the study:
nipple discharge
synovial fluid
wound discharge
DEVIATIONS FROM NORMAL IDENTIFIED WHEN OBTAINING DIAGNOSTIC CASES
IMAGES AND RESEARCH IN THE ABSENCE OF AN ESTABLISHED DIAGNOSIS (R90-R94)
Included: nonspecific deviations from the norm identified (by):
computed axial tomography [CAT scan]
magnetic resonance imaging [MRI]
positron emission tomography (PET)
thermography
ultrasound [echogram] examination
x-ray examination
Excluded: deviations from the norm identified during antenatal examination of the mother ( O28. -)
deviations from the norm identified during diagnostic studies, classified in other headings
— see Alphabetical index
R90 Abnormalities identified during diagnostic imaging during examination of the central nervous system
R90.0 Intracranial space-occupying lesion
R90.8 Other abnormalities identified during diagnostic imaging studies of the central nervous system. Changed echoencephalogram
R91 Abnormalities detected during diagnostic imaging during lung examination
Coin lesion NOS
Lung consolidation NOS
R92 Abnormalities detected during diagnostic imaging during breast examination
R93 Deviations from the norm identified when obtaining a diagnostic image during the examination of other organs and areas of the body
R93.0 Deviations from the norm identified when obtaining a diagnostic image during the examination of the skull and head, not classified elsewhere
Excluded: intracranial space-occupying lesion ( R90.0)
R93.1 Deviations from the norm identified when obtaining a diagnostic image during the study of the heart and coronary circulation
Changed:
echocardiogram NOS
heart shadow
R93.2 Deviations from the norm identified when obtaining a diagnostic image during the study of the liver and bile ducts. Lack of gallbladder contrast
R93.3
digestive tract
R93.4 Deviations from the norm identified when obtaining a diagnostic image during an examination of the urinary organs
Filling defect:
bladder
kidneys
ureter
Excludes: renal hypertrophy ( N28.8)
R93.5 Abnormalities identified during diagnostic imaging during examination of other areas of the abdomen, including the retroperitoneum
R93.6 Deviations from the norm identified when obtaining a diagnostic image during the examination of the extremities
Excluded: changes in the skin and subcutaneous tissue ( R93.8)
R93.7 Deviations from the norm identified when obtaining a diagnostic image during the study of other departments
musculoskeletal system
Excluded: changes identified when obtaining a diagnostic image of the skull ( R93.0)
R93.8 Deviations from the norm identified when obtaining a diagnostic image during the study of other specified body structures. Changes in the skin and subcutaneous tissue identified during radiological examination
Mediastinal shift
R94 Deviations from the norm identified during functional studies
Included: abnormal results:
radioisotope research
scintigraphy
R94.0 Deviations from the norm identified during functional studies of the central nervous system
Altered electroencephalogram [EEG]
R94.1 Deviations from the norm identified during functional studies of the peripheral nervous system and
separate sense organs
Changed:
electromyogram [EMG]
electrooculogram [EOG]
electroretinogram [ERG]
response to nerve stimulation
visual stimulus-evoked potential
[PZR]
R94.2 Deviations from the norm identified during functional tests of the lungs
Reduced:
ventilation capacity of the lungs
vital capacity
R94.3 Deviations from the norm identified during functional studies of the cardiovascular system
Modified(s):
electrocardiogram (ECG)
indicators of electrophysiological intracardiac studies
photocardiogram
vectorcardiogram
R94.4 Deviations from the norm identified during the study of kidney function. Abnormal renal function test results
R94.5 Abnormalities detected during liver function tests
R94.6 Deviations from the norm identified during the study of thyroid function
R94.7 Deviations from the norm identified during the study of the function of other endocrine glands
Excluded: abnormal results of a glucose tolerance test ( R73.0)
R94.8 Deviations from the norm identified during functional studies of other organs and systems
Change:
basal metabolic rate
bladder function test results
functions of spleen function test results
INACCURATELY MARKED AND UNKNOWN CAUSES OF DEATH (R95-R99)
Excluded: fetal death of unknown cause ( P95)
obstetric death NOS ( O95)
R95 Sudden death of an infant
R96 Other sudden death of unknown cause
Excluded: sudden cardiac death as described ( I46.1)
sudden death of an infant ( R95)
R96.0 Instant death
R96.1 Death that occurs less than 24 hours after the onset of symptoms and has no other explanation
Death which is known not to have been violent or instantaneous and for which the cause cannot be determined
Death without signs of illness
R98 Death without witnesses
Discovery of a corpse under circumstances that do not allow the cause of death to be established. Discovery of a corpse
An increase in body temperature is an important symptom of many diseases, but in some cases it is not possible to determine the exact origin of the fever.
Need to know that Fever of unknown origin according to ICD 10 has code R50. The International Classification of Diseases, Tenth Revision, is used by medical practitioners to prepare medical documentation. Fever of unknown origin is considered a serious pathological condition that requires timely diagnosis and proper treatment, therefore, with a prolonged increase in body temperature, you should consult a doctor and undergo a comprehensive examination.
Clinical picture and features of the disease
Most often, the cause of fever is an infection or inflammatory process in the human body. However, with fever of unknown origin (FUN), high temperature is often the only symptom, and nothing else bothers the patient. It is important to understand that temperature rise is not without reason Therefore, a number of additional studies should be carried out and the patient should be monitored over time to establish an accurate diagnosis.
Low-grade fever of unknown etiology can develop against the background of the following diseases:
- infectious diseases with an atypical or latent course;
- development of malignant neoplasms;
- systemic connective tissue diseases;
- pathologies of the central nervous system.
An increase in body temperature may be the only manifestation of the above pathologies in the early stages. A diagnosis can be made and fever code R50 can be used if a temperature above 38 degrees has been observed for 3 weeks or more, and conventional research methods have not helped to establish the exact cause of hyperthermia.
Differential diagnosis
In ICD 10, fever of unknown origin is in the section of general symptoms and signs, which means that it can occur in a variety of diseases of different etiologies. The doctor's task is to exclude both common and rare causes of hyperthermia.
Low-grade fever (ICD-10 code – R50) is a slight increase in body temperature, which lasts for at least several weeks. The temperature rises within 37-37.9 degrees. When microbes enter the human body, it responds with an increase in temperature and various symptoms, depending on the progress of the disease.
People may especially often encounter this kind of problem in winter, during the period when infections become more active. Microorganisms try to enter the human body, but unsuccessfully, pushing away from the immune barrier. And this kind of collision can provoke a slight increase in temperature, in other words, a long-term low-grade fever.
Fever in infectious diseases is observed for a maximum of 7-10 days in the patient. If the indicators are delayed for a long period of time, it is necessary to consult a doctor, because only he can determine the presence of serious infectious or non-infectious diseases occurring in the body.
After contacting a specialist regarding a prolonged increase in temperature, compared with the clinical manifestations of the disease, the most effective treatment will be prescribed. If the temperature decreases, it means that the treatment has been chosen correctly, and the low-grade fever goes away. If the temperature does not drop, then it is necessary to adjust the patient’s treatment.
Long-term low-grade fever is a slightly elevated body temperature that lasts for months and sometimes years. It is observed in people of all ages, from one-year-old children to the elderly. In women, this problem occurs three times more often than in men, and the peak of exacerbation occurs between the ages of twenty and forty years.
Low-grade fever in children occurs in a similar way, however, it may not have clinical manifestations.
Etiology
Prolonged fever can be of various etiologies:
- changes in hormonal levels during pregnancy;
- lack of physical activity;
- weakened immune system;
- thermoneurosis;
- the presence of infections in the body;
- cancer;
- the presence of autoimmune diseases;
- presence of toxoplasmosis;
- vegetative-vascular dystonia;
- presence of tuberculosis;
- presence of brucellosis;
- helminthiasis;
- inflammatory processes in the body;
- sepsis;
- diseases of the endocrine system;
- anemia;
- long-term medication use;
- AIDS;
- intestinal diseases;
- viral hepatitis;
- psychogenic factor;
- Addison's disease.
The most common cause of low-grade fever is the course of the inflammatory process in the body caused by a number of infectious diseases:
- ARVI;
- bronchitis;
- tonsillitis;
- otitis;
- pharyngitis.
With hyperthermia of this kind, there are additional complaints about health, but when taking antipyretic drugs it becomes much easier.
Low-grade fever of an infectious nature manifests itself during exacerbation of the following chronic pathologies in the body:
- pancreatitis;
- colitis;
- gastritis;
- cholecystitis;
- cystitis;
- urethritis;
- pyelonephritis;
- inflammation of the prostate;
- inflammation of the uterine appendages;
- non-healing ulcers in older people, in people with diabetes.
Post-infectious low-grade fever can last for a month after the disease is cured.
An increase in temperature due to toxoplasmosis, which can be contracted from cats, is also a common problem. Some products (meat, eggs) that have not undergone heat treatment can also become a source of infection.
The presence of malignant neoplasms in the body also causes low-grade fever due to the entry into the blood of endogenous pyrogens - proteins that provoke an increase in human body temperature.
Due to intoxication of the body with indolent hepatitis B, C, a febrile state is also noted.
There have been cases of increased body temperature when taking a certain group of drugs:
- thyroxine preparations;
- antibiotics;
- neuroleptics;
- antihistamines;
- antidepressants;
- antiparkinsonian;
- narcotic painkillers.
Low-grade fever with VSD can occur in children, adolescents, and adults due to a hereditary factor or injuries received during childbirth.
Classification
Depending on the change in the temperature curve, the following forms of the disease are distinguished:
- intermittent fever (alternating decrease and increase in body temperature by more than 1 degree over several days);
- relapsing fever (temperature fluctuation of more than 1 degree over 24 hours);
- persistent fever (increased temperature for a long period of time and by less than a degree);
- undulating fever (alternating constant and remitting fever with normal temperature).
Low-grade fever of unknown origin can be divided into the following types:
- classic – a form of the disease that is difficult to diagnose;
- hospital - manifests itself within 24 hours from the moment of hospitalization;
- an increase in temperature due to a decrease in the content of enzymes in the blood that are responsible for the immune system;
- HIV-associated fevers (cytomegalovirus, mycobacteriosis).
Treatment must be carried out under the supervision of doctors who can diagnose the disease and prescribe the most effective treatment.
Symptoms
Prolonged low-grade fever is characterized by the following symptoms:
- lack of appetite;
- weakness;
- disruption of the gastrointestinal tract;
- skin redness;
- rapid breathing;
- increased sweating;
- unbalanced emotional state.
However, the main symptom is the presence of elevated temperature over a long period of time.
Diagnostics
A timely visit to a qualified specialist reduces the risk of possible complications of the problem.
During the appointment, the doctor must:
- analyze the clinical picture of the patient;
- find out the patient's complaints;
- check with the patient about the presence of chronic diseases;
- find out whether surgical interventions were performed and on which organs;
- conduct a general examination of the patient (examination of the skin, mucous membranes, lymph nodes);
- Auscultate the heart muscle and lungs.
Also, to establish the cause of the temperature, patients are required to undergo tests such as:
- general blood test;
- general urinalysis;
- biochemical blood test;
- sputum examination;
- tuberculin test;
- serological blood test;
- radiography;
- ultrasound diagnostics;
- computed tomography;
- echocardiography.
Consultations with specialists in various fields will be required (to confirm or refute the presence of certain diseases), namely:
- neurologist;
- hematologist;
- oncologist;
- infectious disease specialist;
- rheumatologist;
- phthisiatrician.
If the doctor does not have enough research results, an additional examination and analysis of an amidopyrine test is carried out, that is, simultaneous measurement of temperature in both armpits and in the rectum.
Treatment
Treatment is aimed at eliminating the underlying factor that provoked low-grade fever.
- compliance with outpatient regimen;
- drinking plenty of water;
- avoid hypothermia;
- do not drink cold drinks;
- maintain moderate physical activity;
- maintaining proper nutrition.
Also, if the temperature increases significantly, the clinician prescribes anti-inflammatory drugs, such as:
- Antigrippin;
- TeraFlu;
- Maximum;
- Fervex.
Patients will benefit from spending time in the fresh air, hydrotherapy, and physiotherapy. According to indications, if low-grade fever is caused by nervousness, sedatives may be prescribed.
General inspection:
- examination of the skin and mucous membranes, joints;
- examination of lymph nodes, abdomen;
- examination of ENT organs, mammary glands;
- auscultation (listening to noises) of the lungs, heart;
- examination of the urogenital organs, rectum.
Laboratory research methods:
- general blood and urine analysis;
- cerebrospinal fluid examination;
- biochemical blood test;
- sputum examination;
- serological blood test (detection of foreign proteins in blood serum).
Instrumental research methods:
- radiography;
- computed tomography (CT);
- echocardiography.
Specialist consultations:
- neurologist: exclude suspicion of meningitis;
- hematologist: if hemoblastosis is suspected, perform a spinal cord puncture;
- oncologist: search for focal pathology, biopsy of enlarged lymph nodes;
- infectious disease specialist: suspicion of an infectious process, need for isolation;
- rheumatologist: presence of articular syndromes;
- phthisiatrician: all people with low-grade fever for more than two weeks are subject to examination for tuberculosis (a persistent increase in body temperature to low-grade levels is one of the symptoms of tuberculosis).
- It is also possible to consult a hematologist or infectious disease specialist.
Long-term low-grade fever, non-infectious
Diagnostic criteria of non-infectious origin, which have independent significance, are:
- absence of deviations during a thorough and comprehensive examination, including a general blood test, biochemical blood tests, etc.;
- absence of body weight deficiency;
- dissociation between heart rate and degree of increase in body temperature;
In recent years, the prevailing point of view is that latent foci of infection are not the etiological factor of long-term low-grade fever. The rationale for this point of view is that any latent inflammatory infection is not accompanied by a prolonged increase in body temperature in 100% of cases.
The connection between persistent bacterial infection has not been proven ( ENT, pulmonary pathology) and increased body temperature.
Inflammatory foci of chronic infection in diseases with impaired heat exchange occur with the same frequency as in long-term low-grade fever. The most modern antibiotics in any doses and for any duration of their use do not have any effect on elevated body temperature in patients. Salicylates (aspirin, paracetamol) are ineffective in patients with prolonged low-grade fever.
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The etiology and pathogenesis of long-term low-grade fever, which has independent significance, can be presented as follows. More often viral-bacterial infection is the initial factor leading to disruption of heat exchange associated with heat retention in the body during normal heat production. Subsequently, the original cause disappears, but the heat transfer disturbance remains. An increased shift in the regulation of heat exchange in the hypothalamus appears to persist in individuals with altered reactivity of heat-regulating centers. Functional disorders in the hypothalamic region through hormonal and metabolic changes lead to a decrease in nonspecific protective factors, and this is one of the reasons why patients with prolonged low-grade fever are susceptible to frequent respiratory diseases. As a result, patients seem to form a vicious circle regarding long-term disturbances in heat exchange. Therapy allows you to break this circle and normalize body temperature.
The highest center for the regulation of the autonomic functions of the body, the place of interaction between the nervous and endocrine systems is the hypothalamus.
Its nerve centers regulate metabolism, ensuring homeostasis and thermoregulation.
ical manifestations associated with hypothalamic disorders are diverse. One of the manifestations may be a fairly persistent and long-lasting low-grade fever. If you suspect the diencephalic nature of prolonged low-grade fever, consultation is advisable a neurologist, possibly an endocrinologist, taking into account the close connection of the hypothalamus with the endocrine system.
Persistent low-grade fever is often observed in women in menopause, which sometimes occurs quite severely and with a very varied clinical picture - neuro-vegetative, psycho-emotional and metabolic-endocrine disorders. Well-chosen hormone therapy, along with improving the general condition of patients, also helps to normalize body temperature.
In the initial stage hyperthyroidism low-grade fever may be its only manifestation, and only later tachycardia, increased excitability, irritability, trembling of fingers, weight loss, eye symptoms, etc. are added. The diagnosis is confirmed by ultrasound of the thyroid gland, determination of TSH and thyroid hormones in the blood, sometimes by testing the function of the gland with radioactive iodine. Consultation with an endocrinologist is advisable.
Hyperthermic syndrome is a sharp increase in body temperature above 37 degrees and in children is often accompanied by convulsions of varying intensity: from mild involuntary movements to severe convulsions. This process is associated with problems in the thermoregulation of the human body, for which a department in the brain, the hypothalamus, is responsible.
Normally, a person’s body temperature should be in the range from 35.9 to 37.2 °C. This indicator is individual for everyone. It increases due to the work of the immune system, which resists in response to a bacterial or viral infection. Sometimes the body reacts with a thermal shock for a long period, and the reason cannot be found out. This phenomenon in medicine is called “hyperthermic syndrome” or fever of unknown origin (ICD 10 code - R50).
The peculiarity of the symptom is the difficulty of determining the etiology. An elevated temperature may persist for 20 days or more, and various types of medical examinations and tests may not give the expected results.
Causes and symptoms
Most often, hyperthermia is observed in children when the body is damaged by viral infections or when the body overheats (when caring parents overdo it with dressing the child). In adults, hyperthermic syndrome can be caused by stroke, various hemorrhages, and tumor formation. Fever can also be caused by:
- malfunction of internal organs and systems;
- the use of the enzyme monoamine oxidase (MOA) can cause excessive heat accumulation in the body;
- the body's response to microbial antigens;
- transfer of anesthesia;
- restoration of organ functions after clinical death.
Often hyperthermic syndrome is accompanied by hallucinations and delusions. In another degree of severity, paleness of the skin or the adoption of a marble pattern due to vascular spasm, irregular heartbeat, shortness of breath, chills, rapid breathing (due to oxygen starvation).
In adult patients, fever can manifest itself with the above-mentioned manifestations against the background of an exacerbation of a chronic disease. Under the influence of anesthesia, hyperthermia and convulsions can occur 1-1.5 hours after the start of the anesthetic injection and are accompanied by an increase in blood pressure, tachycardia and a steady increase in muscle tone.
Patients of early childhood experience a violation of heat transfer with an increase in temperature to 41 o C and is accompanied by rapid heartbeat and difficulty breathing, pallor of the skin, decreased urine output, agitation, disturbances in the acid-base balance, convulsions, and blood clotting inside the vessels.
Dangerous manifestations of hyperthermic syndrome are dehydration, cerebral edema, and the development of Ombredan syndrome.
The latter develops in children under one year of age some time (from 10 hours to 3 days) after surgery. The cause of malignant thermoregulation disorder is the effect of anesthetics on the child’s body (in particular on the hypothalamus) in combination with tissue trauma, which leads to the accumulation of pyrogens.
In older children, thermoregulation disorders develop due to:
For symptoms of hyperthermic syndrome, it is necessary to provide the patient with all conditions that help lower body temperature and alleviate the condition. In parallel with the provision, call a doctor. To find out the cause of hyperthermic syndrome, a thorough diagnosis of the whole organism and adequate treatment of the disease is necessary.
Types
There are two main types of fever in children:
Pink or red
This type is characterized by a pink tint to the skin and a uniformly hot body. In this situation, it is necessary to cool the patient (undress, wipe with a napkin or towel dipped in cool water). Then provide the patient with plenty of warm fluids and give an antipyretic drug.
Experts consider this type of fever to be prognostically favorable.
White
This type of fever is characterized by pale skin and asymmetric hyperthermia, in which the body is hot but the extremities remain cold. The white color of the body indicates the presence of vascular spasm. In this condition, it is necessary to ensure that the body is warmed by drinking plenty of hot water and wrapping it up. Once the blood vessels dilate, the fever turns red.
White fever is a pathological manifestation of the disease that requires emergency care.
Fever of unknown origin (syn. LNG, hyperthermia) is a clinical case in which elevated body temperature is the leading or only clinical sign. This condition is indicated when the values persist for 3 weeks (in children - longer than 8 days) or more.
Possible causes may include oncological processes, systemic and hereditary pathologies, drug overdose, infectious and inflammatory diseases.
Clinical manifestations are often limited to an increase in temperature to 38 degrees. This condition may be accompanied by chills, increased sweating, attacks of suffocation and pain in various locations.
The object of the diagnostic search is the root cause, therefore the patient is required to undergo a wide range of laboratory and instrumental procedures. Primary diagnostic measures are necessary.
The treatment algorithm is selected individually. If the patient's condition is stable, treatment is not required at all. In severe cases, a trial regimen is used, depending on the suspected pathological provocateur.
According to the International Classification of Diseases, Tenth Revision, fever of unknown origin has its own code. The ICD-10 code is R50.
Etiology
A febrile state that lasts no more than 1 week indicates an infection. It is assumed that prolonged fever is associated with the course of some serious pathology.
Fever of unknown origin in children or adults may be the result of an overdose of drugs:
- antimicrobial agents;
- antibiotics;
- sulfonamides;
- nitrofurans;
- anti-inflammatory drugs;
- medications prescribed for gastrointestinal diseases;
- cardiovascular medications;
- cytostatics;
- antihistamines;
- iodine preparations;
- substances that affect the central nervous system.
The medicinal nature is not confirmed in cases where temperature values remain high within 1 week after discontinuation of the medication.
Classification
Based on the nature of the course, fever of unknown origin occurs:
- classical - against the background of pathologies known to science;
- nosocomial - occurs in persons who are in the intensive care unit for more than 2 days;
- neutropenic - there is a decrease in the number of neutrophils in the blood;
- HIV-associated.
According to the level of temperature increase in LNG there are:
- subfebrile - varies from 37.2 to 37.9 degrees;
- febrile - 38–38.9 degrees;
- pyretic - from 39 to 40.9;
- hyperpyretic - above 41 degrees.
Based on the type of changes in values, the following types of hyperthermia are distinguished:
- constant - daily fluctuations do not exceed 1 degree;
- weakening - variability throughout the day is 1–2 degrees;
- intermittent - there is an alternation of a normal state with a pathological one, the duration is 1–3 days;
- hectic - there are sharp jumps in temperature indicators;
- wavy - the thermometer readings gradually decrease, after which they increase again;
- perverted - indicators are higher in the mornings than in the evenings;
- incorrect - has no patterns.
Duration of fever of unknown origin can be:
- acute - persists no longer than 15 days;
- subacute - the interval is from 16 to 45 days;
- chronic - more than 1.5 months.
Symptoms
The main, and in some cases the only, symptom of fever of unknown origin is an increase in body temperature.
The peculiarity of this condition is that the pathology over a fairly long period of time can be completely asymptomatic or with erased symptoms.
Main additional manifestations:
- muscle and joint pain;
- dizziness;
- feeling of lack of air;
- increased heart rate;
- chills;
- increased sweating;
- pain in the heart, lower back or head;
- lack of appetite;
- stool disorder;
- nausea and vomiting;
- weakness and weakness;
- frequent mood changes;
- strong thirst;
- drowsiness;
- pale skin;
- decreased performance.
External signs occur in both adults and children. However, in the second category of patients, the severity of associated symptoms may be much higher.
Diagnostics
To identify the cause of fever of unknown origin, a comprehensive examination of patients is required. Before carrying out laboratory and instrumental studies, primary diagnostic measures are required, carried out by a pulmonologist.
The first step in establishing a correct diagnosis includes:
- studying medical history - to look for chronic diseases;
- collection and analysis of life history;
- a thorough physical examination of the patient;
- listening to a person using a phonendoscope;
- measurement of temperature values;
- a detailed survey of the patient regarding the first time of occurrence of the main symptom and the severity of concomitant external manifestations and hyperthermia.
Laboratory research:
- general clinical and biochemical blood tests;
- microscopic examination of feces;
- general urine analysis;
- bacterial seeding of all human biological fluids;
- hormonal and immunological tests;
- bacterioscopy;
- serological reactions;
- PCR tests;
- Mantoux test;
- tests for AIDS and.
Instrumental diagnosis of fever of unknown origin involves the following procedures:
- radiography;
- CT and MRI;
- skeletal system scan;
- ultrasonography;
- ECG and EchoCG;
- colonoscopy;
- puncture and biopsy;
- scintigraphy;
- densitometry;
- EFGDS;
- MSCT.
Consultations with specialists from various fields of medicine are necessary, for example, gastroenterology, neurology, gynecology, pediatrics, endocrinology, etc. Depending on which doctor the patient sees, additional diagnostic procedures may be prescribed.
Differential diagnosis is divided into the following main subgroups:
- infectious and viral diseases;
- oncology;
- autoimmune diseases;
- systemic disorders;
- other pathologies.
Treatment
When a person’s condition is stable, experts recommend refraining from treating fever of unknown origin in children and adults.
In all other situations, trial therapy is performed, the essence of which will differ depending on the alleged provocateur:
- for tuberculosis, anti-tuberculosis substances are prescribed;
- infections are treated with antibiotics;
- viral diseases are eliminated with the help of immunostimulants;
- autoimmune processes are a direct indication for the use of glucocorticoids;
- for gastrointestinal diseases, in addition to medications, diet therapy is prescribed;
- if malignant tumors are detected, surgery, chemotherapy and radiotherapy are indicated.
If drug-induced LNG is suspected, it is necessary to discontinue the medications the patient is taking.
As for treatment with folk remedies, it must be agreed with the attending physician - if this is not done, the possibility of worsening the problem cannot be ruled out, and the risk of complications increases.
Prevention and prognosis
To reduce the likelihood of developing a pathological condition, it is necessary to adhere to preventive recommendations aimed at preventing the occurrence of a possible provoking disease.
Prevention:
- maintaining a healthy lifestyle;
- complete and balanced nutrition;
- avoiding the influence of stressful situations;
- preventing any injuries;
- constant strengthening of the immune system;
- taking medications in accordance with the recommendations of the clinician who prescribed them;
- early diagnosis and comprehensive treatment of any pathologies;
- Regularly undergoing a complete preventive examination at a medical institution with visits to all specialists.
Fever of unknown origin has an ambiguous prognosis, which depends on the underlying cause. A complete lack of therapy is fraught with the development of complications of one or another underlying disease, which often ends in death.
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