How to get rid of a recurrent fever: Understanding Causes and Treatment

According to the American Academy of Family Physicians, recurrent fevers are defined as three or more febrile episodes in a six-month period. To effectively know how to get rid of a recurrent fever, it is crucial to identify and address the root cause, which can range from simple infections to complex inflammatory syndromes.

Quick Summary

Recurrent fevers require proper diagnosis to uncover underlying causes, such as infection, inflammation, or genetic conditions. Treatment involves addressing the specific illness, often with medication, alongside supportive care to manage symptoms during episodes.

Key Points

• Identify the cause: The key to managing a recurrent fever is to get a medical diagnosis to identify the underlying cause, as treatment is highly specific to the condition.

• Undergo comprehensive diagnosis: Diagnosis involves a detailed medical history, physical exam, and laboratory tests like CBC and inflammatory markers to rule out infections, autoimmune diseases, and autoinflammatory syndromes.

• Follow tailored medical treatment: Treatment for recurrent fevers can range from antibiotics for infections to targeted medications like colchicine or biologics for autoinflammatory diseases.

• Provide supportive care at home: Simple strategies like staying hydrated, resting adequately, and using lukewarm compresses can provide symptom relief during fever episodes.

• Know when to seek urgent medical care: Always consult a doctor if a recurrent fever is high, persists, or is accompanied by severe symptoms like confusion, stiff neck, or breathing difficulties.

• Keep a fever diary: Recording the frequency, duration, and other symptoms of fever episodes can provide your doctor with crucial information for diagnosis.

What is a recurrent fever?

Unlike a typical fever caused by a cold or flu, which resolves within a few days, a recurrent fever follows a pattern of elevated temperature episodes interspersed with periods of normal temperature. Medical professionals define recurrent fevers as three or more febrile episodes over a six-month period, with at least seven symptom-free days between attacks. They differ from persistent fevers, which remain high for an extended duration without returning to normal.

The pattern, duration, and accompanying symptoms can provide important clues about the underlying health issue. While many recurrent fevers are caused by self-limiting viral infections, especially in young children, they can also signal more serious, long-term conditions.

Common causes of a recurrent fever

Identifying the cause of a recurrent fever is the first step toward effective treatment. A wide range of conditions can lead to fevers that come and go.

Infections

• Viral Infections: Some viruses, like the Epstein-Barr virus (EBV), can cause intermittent fevers that last weeks. Children in daycare may also experience frequent viral illnesses that appear as recurrent fevers.
• Bacterial Infections: Chronic or poorly treated bacterial infections can lead to recurring fevers. Examples include tuberculosis, osteomyelitis (bone infection), and endocarditis (heart valve infection).
• Relapsing Infections: Certain infections like malaria, brucellosis, and tickborne relapsing fever can cause characteristic fevers that disappear and return in cycles.

Autoimmune and inflammatory diseases

• Autoimmune Conditions: These occur when the immune system mistakenly attacks the body's own tissues. Diseases like systemic lupus erythematosus (lupus) and rheumatoid arthritis can trigger recurring fever during flare-ups.
• Autoinflammatory Syndromes: These are genetic disorders that cause unprovoked episodes of inflammation and fever. PFAPA syndrome (Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis) and Familial Mediterranean Fever (FMF) are two of the most common examples.

Other causes

• Medication-Induced Fever: Certain drugs, particularly some antibiotics, can cause a fever that resolves upon discontinuation of the medication.
• Cancer: Some cancers, such as Hodgkin lymphoma and leukemia, can cause fevers as a symptom.
• Hypothalamic Dysfunction: Rare conditions affecting the hypothalamus, the brain's temperature control center, can lead to recurrent fever.

Diagnosing the underlying cause

To get rid of a recurrent fever, a proper medical diagnosis is essential. Your doctor will use a systematic approach to identify the root cause.

The diagnostic process

1. Detailed Medical History: A doctor will ask about the fever's pattern (duration, frequency, regularity), associated symptoms (rashes, joint pain, ulcers), travel history, and family history of inflammatory diseases. Keeping a fever diary can be very helpful.
2. Physical Examination: A thorough exam can reveal clues like a skin rash, enlarged lymph nodes, or signs of inflammation.
3. Laboratory Tests: Common tests include a complete blood count (CBC) and inflammatory markers like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Blood, urine, and other cultures may be performed to check for infections.
4. Imaging: In some cases, imaging like X-rays or CT scans may be necessary to find sources of infection or inflammation.
5. Genetic Testing: If an autoinflammatory syndrome is suspected, genetic testing can confirm the diagnosis, especially for inherited conditions like FMF.

Medical treatment options

Treating a recurrent fever directly depends on the identified underlying cause. A healthcare provider can determine the appropriate course of action.

• For Infections: If a specific bacterial infection is identified, antibiotics are prescribed. Antiviral or antiparasitic medications are used for other types of infection.
• For Autoinflammatory Syndromes: Targeted medications are used to manage flares and prevent complications. This includes colchicine for FMF and corticosteroids for PFAPA syndrome. Biologic therapies, such as IL-1 inhibitors, may be used for certain severe autoinflammatory diseases. Tonsillectomy has also been shown to help resolve PFAPA in some children.
• For Autoimmune Diseases: Treatment focuses on managing the primary condition with anti-inflammatory drugs, corticosteroids, or immunosuppressants.

Managing symptoms at home

While treating the root cause is crucial, supportive care can help you feel more comfortable during a fever episode.

Home care strategies

• Stay Hydrated: Drink plenty of fluids like water, herbal teas, or clear broths. This is essential to prevent dehydration, which can worsen fever symptoms.
• Get Plenty of Rest: Allow your body to rest and heal. Avoid strenuous activity during a fever episode.
• Use OTC Medications: Over-the-counter fever reducers like acetaminophen (Tylenol) or ibuprofen (Advil) can help lower your temperature and reduce discomfort. Always follow dosage instructions carefully.
• Apply Cool Compresses: A cool, damp cloth on the forehead, neck, or wrists can provide temporary relief. A lukewarm sponge bath can also help.
• Wear Light Clothing: Dress in light, breathable fabrics and use a light blanket to avoid trapping body heat. Do not over-bundle, as this can increase temperature.

When to see a doctor

While many fevers are benign, a recurrent fever should always be medically evaluated. Consult a doctor, especially if:

• The fevers last longer than 48-72 hours in adults.
• The fever is very high (above 103°F or 39.4°C).
• The fever is accompanied by other severe symptoms like a stiff neck, severe headache, confusion, or difficulty breathing.
• You have a weakened immune system or a serious medical illness.
• You recently traveled internationally.

Recurrent fever causes: a comparison

Condition	Typical Onset	Fever Pattern	Associated Symptoms
Infections (Viral, Bacterial)	Any age	Irregular, depends on pathogen and immune response	Varies: cough, sore throat, fatigue (viral); cough, bone/joint pain (bacterial)
PFAPA Syndrome	Early childhood (before age 5)	Highly regular, often every 3-8 weeks, lasting 3-7 days	Aphthous mouth ulcers, pharyngitis, cervical lymphadenitis
Familial Mediterranean Fever (FMF)	Typically before age 20	Recurrent attacks, lasting 12-72 hours	Abdominal pain, chest pain, arthritis, skin rash
TRAPS (TNF Receptor-Associated Periodic Syndrome)	Early to late childhood, or adulthood	Prolonged attacks, lasting up to 3-4 weeks	Peritonitis, migratory muscle pain, rash
Rheumatoid Arthritis (RA)	Any age	Intermittent, often during flare-ups	Joint inflammation, pain, stiffness, fatigue

Conclusion

A recurrent fever is a clear signal that something is amiss within the body and requires prompt medical attention to identify the cause. While some episodes can be managed with rest and hydration, resolving the root problem—whether an ongoing infection, an autoimmune response, or a genetic condition—is the only way to truly get rid of a recurrent fever. By collaborating with a healthcare provider and adhering to the prescribed treatment plan, it is possible to regain control over your health and prevent future fever episodes.

For more in-depth medical information on pediatric recurrent fever, consult this review article from the NIH: Pediatric recurrent fever and autoinflammation from the perspective of an immunologist.

Frequently Asked Questions

What is the most common cause of recurrent fever in children?

In young children, the most common cause is PFAPA syndrome (Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis), an autoinflammatory condition. However, frequent, self-limiting viral infections are also very common.

When should I be concerned about a recurrent fever?

You should seek medical advice for recurrent fevers that are very high, last longer than 48-72 hours, or are accompanied by severe symptoms such as a stiff neck, severe headache, confusion, or difficulty breathing.

Can stress cause recurrent fevers?

While not a primary cause, emotional stress can sometimes trigger flare-ups of certain autoinflammatory or autoimmune conditions, which can lead to fever episodes.

Are recurrent fevers contagious?

The contagiousness depends entirely on the cause. If the recurrent fever is due to a viral or bacterial infection, it may be contagious. If it's caused by an autoimmune or autoinflammatory condition, it is not.

Can I use over-the-counter medication to treat a recurrent fever?

Over-the-counter medications like acetaminophen and ibuprofen can help manage discomfort and temporarily reduce fever during an episode. However, they do not treat the underlying cause, and you should always consult a doctor for a proper diagnosis.

What is the difference between a recurrent fever and a persistent fever?

A recurrent fever involves multiple episodes of fever with periods of normal temperature in between. A persistent or prolonged fever is one that remains elevated for a longer-than-normal duration, typically over a week.

What kind of tests are done to diagnose recurrent fever?

A doctor may order a complete blood count (CBC), inflammatory markers (CRP, ESR), blood or urine cultures, imaging scans, and potentially genetic tests if an autoinflammatory syndrome is suspected.