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Fever of unknown origin in the elderly
K M Wakefield1, S T Henderson, J G Streit
1Department of Family and Community Medicine, University of Kansas School of Medicine, Wichita.
Primary Care
|June 1, 1989
Summary
Fever, a key sign of the acute-phase response, is triggered by interleukin-1 (IL-1). This molecule initiates prostaglandin synthesis, raising the body's temperature set point and causing fever during infection or inflammation.
Area of Science:
- Immunology
- Physiology
- Pathology
Background:
- Fever is a common host response to various stimuli like infection and inflammation.
- The acute-phase response involves systemic changes in metabolic, endocrine, neurologic, and immunologic functions.
- Interleukin-1 (IL-1) is a key mediator initiating the acute-phase response.
Purpose of the Study:
- To elucidate the role of IL-1 in mediating fever and other acute-phase responses.
- To explain the mechanisms by which IL-1 influences thermoregulation and systemic changes.
- To highlight the relevance of these mechanisms in conditions like fever of unknown origin (FUO).
Main Methods:
- The study focuses on the molecular and physiological pathways initiated by IL-1.
- It describes IL-1 production by phagocytic cells and its hormonal action.
- The mechanism of prostaglandin synthesis and its effect on the hypothalamus is detailed.
Main Results:
- IL-1 triggers prostaglandin E2 synthesis in the hypothalamus, raising the thermostatic set point.
- This leads to heat conservation and production, resulting in fever.
- IL-1 also influences bone marrow, increasing neutrophil counts and contributing to anemia through reduced serum iron.
Conclusions:
- Fever is a complex response mediated by IL-1, involving thermoregulatory and systemic changes.
- The acute-phase response, driven by IL-1, underlies many observed changes in feverish states, including FUO.
- Understanding these mechanisms is crucial, even in cases where fever is less pronounced, such as in the elderly.