Other cells that produce fever-inducing cytokines include keratinocytes and endothelial, B, mesangial, epithelial, and glial cells. Prostaglandin E 2 synthesis appears to play a critical role. An ongoing debate exists over whether to treat a fever that occurs with an infectious disease. In children at risk for seizures, fever should be treated. Antipyretic therapy also should be considered for febrile adults with preexisting cardiac or pulmonary insufficiency because fever can increase O 2 demands.
Fever can also cause mental status changes in patients with dementia.
Although corticosteroids also reduce fever, they should not be used expressly for this purpose because of their other effects on the immune system. This definition was formulated to compare retrospective and prospective clinical studies and should not be regarded as absolute. It has been suggested that the definition be modified to 2 wk of fever and either 3 days of hospital investigation or three outpatient visits without discovering the source of fever. Assessment should include observation of the fever pattern, detailed history and physical examination, laboratory tests, and noninvasive and invasive procedures. FUO in children is discussed under Miscellaneous Infections in Ch.