Temperature Regulation and the Pathogenesis of Fever

Recommendations

Info

non of the febrile response; or what determines the magnitude of expression of individual cytokines in response to various stimuli; or how the upper limit of the febrile range is set. [93] Figure 47-4 Hypothetical model for the febrile response. (From Mackowiak PA. Concepts of fever. Arch Intern Med. 1998;158:1870–1881.) ACUTE-PHASE RESPONSE As noted previously, a cytokine-mediated rise in the core temperature is but one of many features of the febrile response. Numerous other physiologic reactions, collectively referred to as the acute-phase response, are mediated by members of the same group of pyrogenic cytokines that activate the thermal response of fever. Such reactions include a host of behavioral, physiologic,
iochemical, and nutritional alterations ( Table 47–1 ). [108] Stimuli capable of inducing an acute-phase response include bacterial and (to a lesser extent) viral infections, trauma, malignant neoplasms, burns, tissue infarction, immunologically mediated and crystal-induced inflammatory states, strenuous exercise, and childbirth. [94][109] There is also evidence that major depression, [110] schizophrenia, [111] and psychological stress [112] are capable of inducing an acute-phase response. Table 47-1 -- Acute-Phase Physiologic Reactions Neuroendocrine Changes Fever, somnolence, and anorexia Increased secretion of corticotropin-releasing hormone, corticotropin, and cortisol Increased secretion of arginine vasopressin Decreased production of insulin-like growth factor I Increased adrenal secretion of catecholamines Hematopoietic Changes Anemia of chronic disease Leukocytosis Thrombocytosis Metabolic Changes Loss of muscle and negative nitrogen balance Decreased gluconeogenesis Osteoporosis Increased hepatic lipogenesis Increased lipolysis in adipose tissue Decreased lipoprotein lipase activity in muscle and adipose tissue Cachexia Hepatic Changes Increased metallothionein, inducible nitric oxide synthase, heme oxygenase, manganese superoxide dismutase, and tissue inhibitor of metalloproteinase-1 Decreased phosphoenolpyruvate carboxykinase activity Changes in Nonprotein Plasma Constituents Hypozincemia, hypoferremia, and hypercupremia Decreased plasma retinol concentrations Increased plasma glutathione concentrations
Page 1 and 2: Temperature Regulation and the Path
Page 3 and 4: Likewise, proper positioning of the
Page 5 and 6: infrared TM thermometers, have made
Page 7 and 8: Thermoregulation has also been repo
Page 9 and 10: Figure 47-2 Mean oral temperatures
Page 11 and 12: young adults (six male and three fe
Page 13 and 14: Figure 47-3 Sagittal view of the br
Page 15: to induce fever. On the basis of th
Page 19 and 20: α1-Protease inhibitor α1-Antichym
Page 21 and 22: Nevertheless, the febrile response
Page 23 and 24: TNF-α acts to lower, rather than t
Page 25 and 26: in mortality. [167] Covert and Reyn
Page 27 and 28: Although clinicians have long had a
Page 29 and 30: induce shivering. [227] However, ca
Page 31 and 32: validity of this contention. Moreov

Temperature Regulation and the Pathogenesis of Fever

Create successful ePaper yourself

Delete template?

Save as template?