For decades, we’ve been suppressing fever without truly understanding the consequences beyond the obvious alleviation of symptoms. Lowering a fever with medication has become routine and extremely prevalent in this country by both parents and doctors alike. It doesn’t matter whether it’s the sickest patients in the intensive care unit or a sniffling child at home, taking antipyretic medicine has become the first line of treatment.
Even when drug treatment isn’t directly aimed at lowering a high temperature, fever is still likely to be reduced since the most common medicines used to treat infectious disease symptoms contain an anti-fever component. (Emerg Med J 2010 Nov;27(11):829– 33) (Arch Intern Med 2000 Feb;160(4):449–56)
The commonly held belief in medicine today is that treating a fever does not slow the resolution of common viral and bacterial infections. However, neither of these beliefs are true, nor have they always been accepted practice.
As far back as Hippocrates, fever was considered a natural and beneficial part of the healing process.
Only in the mid-1800s, after the invention of the mercury-filled clinical thermometer, did it become commonplace to start “fighting” fevers by lowering them.
Fever starts when the immune system detects an infection and produces specific proteins called pyrogens (pyro means fire or heat). Pyrogens act on the part of the brain called the hypothalamus to raise the body temperature’s set point. Our normal temperature is considered to be around 98.6º F but, with fever, it can rise to 102º or, in extreme cases, 106–108º.
Several components of the immune system work more efficiently at higher temperatures.
T-lymphocytes are better able to locate and accumulate at the site of infections. Higher temperatures moderate the potentially dangerous effects of cytokines, the proteins that coordinate the immune system’s response to infections. We also know that, at higher temperatures, many forms of bacteria can’t survive and many viruses find it difficult to replicate.
Researchers in London investigated the effects of fever on the bacterium that causes meningitis (Neisseria meningitidis B). They compared number of bacteria in the blood at normal body temperature to the number after several hours at a body temperature of 104º. The bacteria count dropped 90 percent at the higher temperature. (BMJ 2010 Jan 26;340:c450)
The ability of the body to lower levels of bacteria in the early stages of infection helps to determine whether the patient will recover or not. Strangely, there aren’t very many studies to illustrate this point. My guess is that people have been routinely reducing fevers for more than 150 years, so few have even considered these types of studies. However, the benefits of fever haven’t gone unnoticed by many doctors.
Dr. Gavin Barlow, an infectious disease consultant with the Hull and East Yorkshire Hospitals in the UK, recently reported that he was always less concerned about the outcome of pneumonia patients who were admitted with a fever compared to those without a fever. After examining the records of more than 400 patients, it was obvious that the more feverish the patient was on admission, the better their chances of survival.
He discovered that, of those with an admitting temperature of below 96.8º, one-third died within 30 days of admission. However, in that same period, just 8 percent of patients with higher than normal temperatures died. And not a single patient with a fever of 104º or higher died. After reviewing the records of patients with other non-pneumonia bloodstream infections, he found similar results. (Clin Microbiol Infect 2013 Oct;19(10):955–60)
In another study, researchers at the University of Miami stopped a clinical trial of 82 critically ill patients who were randomized to get either the standard treatment of fever-reducing drugs if their temperatures rose above 101.5º, or only if temps reached 104º. As the study progressed, there were seven deaths in the standard treatment group but only one among those allowed to have fever. Although it was a small study, the researchers felt the benefits of allowing a fever to run its course naturally were so dramatic that they couldn’t risk more deaths by continuing to give the other patients feverreducing drugs. (Surg Infect 2005 Winter;6(4):369–75)
Fever as Cure
In the late 1920s and 1930s, there was a great deal of success using pyrotherapy—fever as cure. Inducing fever was common practice, for patients with syphilis in particular. Before the development of antibiotics, syphilis was a potentially fatal disease and there weren’t any other viable treatments other than artificially induced fevers. Doctors in this country had cure rates of about 80 percent using Kettering hypertherms (cabinets with hot air blowers) that raised the body temperature to around 105º. They found that keeping the body at that temperature for five hours could stabilize syphilis. Permanent recovery required 50 hours or more.
Around the time pyrotherapy was gaining ground in the late 1930s, antibiotics came on the scene. Pyrotherapy became nothing more than a historical footnote and everyone went back to treating fevers instead of letting nature run its course.
I’m not suggesting that all fevers are good. A high temperature after a head injury or stroke can be harmful to the brain due to an increase in inflammation and the release of additional free radicals.
Rather, the problem stems from assuming all fevers are bad and need to be treated. Again, at higher temperatures, both bacterial and viral replication is less efficient and our immune systems operate more efficiently.
And there is another factor that is often overlooked. Fever suppression increases the rate and duration of what is called viral shedding.
Shedding refers to release of new viral progeny following successful reproduction—an “active” time when the disease is most contagious.
Longer shedding time, combined with feeling better after taking fever-reducing meds, contributes to spreading the infection when people return to school or work while they are still infectious. That’s why researchers are now estimating that the use of painkillers to treat the flu increases its transmission by 5 percent.
It stands to reason that similar transmission increases would occur with other pathogens and contribute to epidemics.
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Although this article may contain factual information, the information contained in this article has probably not been evaluated by the FDA nor is it in any way intended to be medical advice.
Unfortunately I must recommend that for any change in medical or health behavior or for any change in the way you use prescribed drugs by your healthcare providers or before acting upon any of the advice given in this or any other article, that you consult with your licensed healthcare provider or physician.
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