Märtha Sund-Levander, Christina Forsberg, Lis Karin Wahren
Normal oral, rectal, tympanic and axillary body temperature in adult men and women: a systematic literature review.
Scand J Caring Sci. 2002 Jun;16(2):122-8.
Abstract/Text
Normal oral, rectal, tympanic and axillary body temperature in adult men and women: a systematic literature review The purpose of this study was to investigate normal body temperature in adult men and women. A systematic review of data was performed. Searches were carried out in MEDLINE, CINAHL, and manually from identified articles reference lists. Studies from 1935 to 1999 were included. Articles were classified as (1) strong, (2) fairly strong and (3) weak evidence. When summarizing studies with strong or fairly strong evidence the range for oral temperature was 33.2-38.2 degrees C, rectal: 34.4-37.8 degrees C, tympanic: 35.4- 37.8 degrees C and axillary: 35.5-37.0 degrees C. The range in oral temperature for men and women, respectively, was 35.7-37.7 and 33.2-38.1 degrees C, in rectal 36.7-37.5 and 36.8-37.1 degrees C, and in tympanic 35.5-37.5 and 35.7-37.5 degrees C. The ranges of normal body temperature need to be adjusted, especially for the lower values. When assessing body temperature it is important to take place of measurement and gender into consideration. Studies with random samples are needed to confirm the range of normal body temperature with respect to gender and age.
Shu-Hua Lu, Angela-Renee Leasure, Yu-Tzu Dai
A systematic review of body temperature variations in older people.
J Clin Nurs. 2010 Jan;19(1-2):4-16. doi: 10.1111/j.1365-2702.2009.02945.x. Epub 2009 Nov 3.
Abstract/Text
AIM: The purpose of this systematic review was to determine the extent to which the research literature indicates body temperature norms in the geriatric population.
OBJECTIVES: The specific questions addressed were to examine normal body temperature values in persons 60 years of age and older; determine differences in temperature values depending on non-invasive measurement site and measurement device used; and, examine the degree and extent of temperature variability according to time of day and time of year.
BACKGROUND: The traditional 'normal' temperature of 98.6 degrees F/37 degrees C may in fact be lower in older people due to the ageing process. Age-associated changes in vasomotor sweating function, skeletal muscle response, temperature perception and physical behaviours may influence the ability to maintain optimum temperature.
DESIGN: A systematic literature review.
METHODS: A search of multiple databases yielded 22 papers which met inclusion criteria. Studies were included which focused on temperature measurement, sampled persons 60 years of age and older, collected data from non-invasive temperature measurement sites and which used a prospective study design. Studies were independently appraised using a structured appraisal format.
RESULTS: Temperature normal values by site were rectal 98.8 degrees F/37.1 degrees C, ear-based 98.3 degrees F/36.8 degrees C, urine 97.6 degrees F/36.5 degrees C, oral 97.4 degrees F/36.3 degrees C and axillary 97.1 degrees F/36.2 degrees C. Temperature exhibited a 0.7 degrees F/0.4 degrees C diurnal and 0.2 degrees F/0.1 degrees C circannual variation.
CONCLUSIONS: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C, ear-based 0.3 degrees F/0.2 degrees C, oral 1.2 degrees F/0.7 degrees C, axillary 0.6 degrees F/0.3 degrees C lower than adults' acceptable value from those traditionally found in nursing textbooks.
RELEVANCE TO CLINICAL PRACTICE: Given the fact that normal body temperature values were consistently lower than values reported in the literature, clinicians may need to re-evaluate the point at which interventions for abnormal temperatures are initiated.
入來正躬、土家 清、金野郁雄、内野欽司、川島美勝 健常日本人の口腔温 日生気誌 25（3）：163-171、1998.
P A Mackowiak, S S Wasserman, M M Levine
A critical appraisal of 98.6 degrees F, the upper limit of the normal body temperature, and other legacies of Carl Reinhold August Wunderlich.
JAMA. 1992 Sep 23-30;268(12):1578-80.
Abstract/Text
OBJECTIVE: To evaluate critically Carl Wunderlich's axioms on clinical thermometry.
DESIGN: Descriptive analysis of baseline oral temperature data from volunteers participating in Shigella vaccine trials conducted at the University of Maryland Center for Vaccine Development, Baltimore.
SETTING: Inpatient clinical research unit.
PARTICIPANTS: One hundred forty-eight healthy men and women aged 18 through 40 years.
MAIN MEASUREMENTS: Oral temperatures were measured one to four times daily for 3 consecutive days using an electronic digital thermometer.
RESULTS: Our findings conflicted with Wunderlich's in that 36.8 degrees C (98.2 degrees F) rather than 37.0 degrees C (98.6 degrees F) was the mean oral temperature of our subjects; 37.7 degrees C (99.9 degrees F) rather than 38.0 degrees C (100.4 degrees F) was the upper limit of the normal temperature range; maximum temperatures, like mean temperatures, varied with time of day; and men and women exhibited comparable thermal variability. Our data corroborated Wunderlich's in that mean temperature varied diurnally, with a 6 AM nadir, a 4 to 6 PM zenith, and a mean amplitude of variability of 0.5 degrees C (0.9 degrees F); women had slightly higher normal temperatures than men; and there was a trend toward higher temperatures among black than among white subjects.
CONCLUSIONS: Thirty-seven degrees centigrade (98.6 degrees F) should be abandoned as a concept relevant to clinical thermometry; 37.2 degrees C (98.9 degrees F) in the early morning and 37.7 degrees C (99.9 degrees F) overall should be regarded as the upper limit of the normal oral temperature range in healthy adults aged 40 years or younger, and several of Wunderlich's other cherished dictums should be revised.
Cheston B Cunha
Prolonged and perplexing fevers in antiquity: malaria and typhoid fever.
Infect Dis Clin North Am. 2007 Dec;21(4):857-66, vii. doi: 10.1016/j.idc.2007.08.010.
Abstract/Text
Fever of unknown origin is a topic that has enduring interest to physicians. Prolonged fevers of infectious etiology were of particular concern to the ancient physician. This overview of prolonged fevers in antiquity focuses on malaria and typhoid fever as the primary infectious causes. By studying texts from Mesopotamian, Greek, and Roman physicians and observers of disease, it is possible to determine the likely etiology of many of these ancient plagues. The historical import of these diseases should not be overlooked, and it is for this reason that the prolonged fevers of antiquity have profound significance and enduring interest.
Burke A Cunha
Fever of unknown origin: clinical overview of classic and current concepts.
Infect Dis Clin North Am. 2007 Dec;21(4):867-915, vii. doi: 10.1016/j.idc.2007.09.002.
Abstract/Text
Fever of unknown origin (FUO) refers to disorders that present with prolonged and perplexing fevers that are difficult to diagnose. This article presents a clinical overview of classic and current causes of FUOs, which may be due to infectious, rheumatic/inflammatory, neoplastic, or miscellaneous disorders. Comprehensive but nonfocused diagnostic testing is ineffective and should be avoided. The FUO workup should be directed by the key history, physical, and laboratory findings in clinical presentation. The clinical syndromic approach in the differential diagnosis of FUOs is emphasized, and the diagnostic importance and significance of fever patterns are discussed.
Jill Tolia, Leon G Smith
Fever of unknown origin: historical and physical clues to making the diagnosis.
Infect Dis Clin North Am. 2007 Dec;21(4):917-36, viii. doi: 10.1016/j.idc.2007.08.011.
Abstract/Text
Fever of unknown origin (FUO) has fascinated and perplexed clinicians for over a century. No published guidelines exist on the approach to FUO, and studies have demonstrated that a diagnosis is never established in up to 30% of cases. A comprehensive history and physical examination are the keys to establishing a diagnosis in patient with FUO. This article provides a systematic approach to the diagnosis of FUO by delineating the most important elements of a comprehensive history and physical examination.
Burke A Cunha
Fever of unknown origin: focused diagnostic approach based on clinical clues from the history, physical examination, and laboratory tests.
Infect Dis Clin North Am. 2007 Dec;21(4):1137-87, xi. doi: 10.1016/j.idc.2007.09.004.
Abstract/Text
The causes of fevers of unknown origin (FUOs) are diverse and may be the result of infectious rheumatic or inflammatory, neoplastic, or miscellaneous disorders. This article reviews the focused diagnostic approach to FUOs, emphasizing relevant history, physical examination, and selected laboratory tests using a clinical syndrome approach. Laboratory tests should be guided by the most likely diagnoses based on the presenting clinical syndrome. Considered in concert, nonspecific laboratory tests may provide important diagnostic clues. Using a sequential diagnostic approach, a focused evaluation diagnoses all but the rarest or most obscure causes of FUO.
Jason J Bofinger, David Schlossberg
Fever of unknown origin caused by tuberculosis.
Infect Dis Clin North Am. 2007 Dec;21(4):947-62, viii. doi: 10.1016/j.idc.2007.08.001.
Abstract/Text
Tuberculosis is an important cause of fever of unknown origin. Travel, age, dialysis, diabetes, birth in a country with a high prevalence of tuberculosis, and immunoincompetence are among the most salient risks. Associated physical findings, radiologic evaluation, and hematologic and endocrinologic abnormalities may provide clues to the diagnosis. Both noninvasive and invasive diagnostic modalities are reviewed. Because diagnosis may be elusive, therapeutic and diagnostic trials of antituberculous therapy should be considered in all patients with fever of unknown origin who defy diagnosis.
Elisabeth Botelho-Nevers, Didier Raoult
Fever of unknown origin due to rickettsioses.
Infect Dis Clin North Am. 2007 Dec;21(4):997-1011, ix. doi: 10.1016/j.idc.2007.08.002.
Abstract/Text
Most common rickettsioses do not fill the criteria for fever of unknown origin, with fever often inferior to lasting less than 1 week. Q fever, scrub typhus, murine typhus, human monocytic ehrlichiosis, and Bartonellosis could fill these criteria, however, notably in uncommon presentations. Moreover, in patients returning from tropical areas or from geographic endemic areas for rickettsiosis, or in patients in contact with animals or ticks, theses etiologies should be kept in mind by physicians challenged to diagnose cause of fever. In this context, even without confirmation of diagnosis, treatment with doxycycline should be used.
Thierry Zenone
Fever of unknown origin in rheumatic diseases.
Infect Dis Clin North Am. 2007 Dec;21(4):1115-35, x-xi. doi: 10.1016/j.idc.2007.08.006.
Abstract/Text
Noninfectious inflammatory diseases (connective tissue diseases, vasculitis syndromes, granulomatous diseases) emerged as the most frequent cause of fever of unknown origin in western countries. Among these diseases, giant cell arteritis and polymyalgia rheumatica are the most frequent specific diagnosis in the elderly and adult-onset Still's disease the most frequent in younger patients. This article focuses on noninfectious inflammatory diseases as a cause of classic fever of unknown origin (mainly rheumatic diseases, such as vasculitis and connective tissue diseases).
