Fever in Adults: Signs & Symptoms

How does fever present in adults?

A fever is temporary as the body temperature rises due to an infection or any other secondary cause. It is a sign that something is going on within the body that needs to be investigated.

Usually, adults with a fever may feel uncomfortable and it is not much of a concern unless the temperature reaches 103°F or higher.

Symptoms

Symptoms of fever in adults

Symptoms of fever in adults include sweating, chills and shivering, headache, muscle aches, loss of appetite, irritability, dehydration, and a sense of general weakness.

Other symptoms would depend on the cause of the fever. Some examples are:

Cause	Symptoms
Dysentery or gastroenteritis	Vomiting Diarrhea (with or without presence of blood)
Upper respiratory tract infection	Cough Runny nose Sore throat Sinus or nasal congestion
Urinary tract infection	Painful urination Back pain Increased frequency in urination
Skin or soft tissue infection	Focus of infection like a rash or abscess

Recognizing “red flag” symptoms
Adults with fever must be referred for immediate medical attention if there is accompanying:

severe headache

unusual skin rash

unusual sensitivity to bright light

stiff neck or if there is pain when they bend the head forward

mental confusion

persistent vomiting

difficulty in breathing or chest pain

abdominal pain

convulsions or seizures
Questions to ask patients
Immune status

Is the patient immunocompromised (eg, as a result of leukemia, chemotherapy, steroid use, HIV infection, or liver disease)?

Medical history

Does the patient have a history of prior medical illnessess or conditions?

Patients with a known illness may have a fever caused by their underlying illness (eg, tumor fever from lymphoma or a fever from a lupus flare). However, these are diagnoses of exclusion because infectious causes must first be considered and ruled out. Relatedly, some illnesses predispose patients to infectious complications (eg, abdominal abscess as a complication of Crohn’s disease and endocarditis in a patient with an aortic valve replacement).

Medication history

Is the patient taking prescription or over-the-counter medications?

The medication history should be aimed at discovering drugs that cause immunosuppression (eg, steroids) or those that may result in drug fever (eg, neuroleptics, anticholinergics, anesthetics, antibiotics).

Social history

What is the patient’s travel history?

Is there a history of injection drug use or other HIV risk factors?

What is the patient’s sexual history?

Does the patient have pets or frequent animal contact?

What are his or her occupation and hobbies?

This information may lead to expanding the differential diagnosis to include diseases common in the developing world, HIV-related infections, sexually transmitted infections, tick-borne illnesses, endemic fungal disease, complications such as endocarditis that are common in injection drug users, and so on.