A fever indicates an elevated body temperature, signaling the body’s response to an infection or inflammation. While a single fever episode is common, recurrent fevers represent a distinct pattern of repeated temperature elevations over time. These episodes are separated by intervals where body temperature returns to normal and symptoms subside, suggesting an underlying condition rather than a temporary illness.
Understanding Recurrent Fevers
Recurrent fevers involve multiple episodes of elevated body temperature occurring intermittently over weeks or months. This pattern typically includes three or more unexplained fever episodes within six months, with at least seven days separating each episode. A defining feature is “fever-free intervals,” where the individual feels well and their temperature is normal. This distinguishes them from chronic low-grade fevers or prolonged single episodes; the individual experiences distinct periods of illness followed by periods of wellness.
The duration of individual fever episodes varies, and intervals can be regular or irregular. Predictable periodicity helps healthcare professionals identify potential underlying causes.
Common Causes of Recurring Fevers
Recurrent fevers stem from infectious, inflammatory/autoimmune, and genetic conditions. Persistent or frequently recurring infections, such as chronic sinusitis, recurrent urinary tract infections, or certain viral infections like Epstein-Barr virus (EBV), can cause repeated fever episodes. In some regions, parasitic infections like malaria also contribute.
Inflammatory and autoimmune conditions involve the immune system mistakenly targeting its own tissues, leading to inflammation and fever. Conditions like Juvenile Idiopathic Arthritis or Systemic Lupus Erythematosus can manifest with recurring fevers as part of their systemic inflammatory response. These conditions often involve widespread inflammation affecting various body systems.
Genetic or autoinflammatory syndromes, also known as periodic fever syndromes, are inherited disorders where the innate immune system is dysregulated. These conditions cause recurrent inflammation and fever without an infectious trigger. Examples include Familial Mediterranean Fever (FMF), common in individuals of Mediterranean and Middle Eastern descent, and Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis (PFAPA) syndrome, often seen in young children. Other genetic syndromes include Tumor Necrosis Factor Receptor-Associated Periodic Syndrome (TRAPS) and Mevalonate Kinase Deficiency (MKD), also known as Hyperimmunoglobulin D Syndrome (HIDS). These genetic conditions result from specific gene variants that lead to uncontrolled inflammatory responses.
Diagnosis and Evaluation
Determining the cause of recurrent fevers involves a comprehensive diagnostic process undertaken by healthcare professionals. A detailed medical history is an important first step, reviewing fever patterns, associated symptoms like rashes, joint pain, or abdominal discomfort, and any family history of similar conditions. Travel history and exposure to illnesses also provide clues.
A physical examination identifies signs of underlying conditions, such as swollen lymph nodes, joint swelling, or skin changes. Laboratory tests assess inflammation and detect potential infections or autoimmune markers. Common blood tests include C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), which indicate inflammation, and complete blood counts. Specific tests may also check for infections or markers of autoimmune diseases.
If a genetic autoinflammatory syndrome is suspected, genetic testing can identify specific gene variants associated with these conditions. Imaging studies, such as X-rays or ultrasounds, might evaluate specific organs or rule out certain causes. The diagnostic process aims to systematically exclude common causes before investigating rarer conditions.
Treatment Approaches
Managing recurrent fevers primarily focuses on addressing the underlying cause, as treatment strategies vary significantly by diagnosis. During fever episodes, symptomatic relief is often provided to improve comfort. This includes fever-reducing medications like ibuprofen or acetaminophen, adequate rest, and good hydration.
For recurrent fevers caused by infections, targeted therapies like antibiotics for bacterial infections or antiviral medications for certain viral infections are prescribed. If an inflammatory or autoimmune condition is identified, immune-modulating medications are used. These include anti-inflammatory drugs, corticosteroids, or biologic therapies that block inflammatory pathways.
For genetic periodic fever syndromes, specific medications manage the condition and prevent complications. Colchicine, for instance, is often prescribed for Familial Mediterranean Fever (FMF) to reduce inflammation and prevent long-term issues. Other autoinflammatory syndromes may benefit from medications like canakinumab, which targets specific inflammatory proteins. Management often involves collaboration with specialists, such as rheumatologists, infectious disease specialists, or geneticists, to ensure a tailored and effective treatment plan.