What Does It Mean If a Fever Comes and Goes?

According to research from AFC Urgent Care, intermittent fevers, those that rise and fall over time, can stem from numerous underlying causes. What does it mean if a fever comes and goes? This pattern is your body's clear signal that it is actively engaged in a recurring battle against an infection, inflammation, or another underlying health issue.

Quick Summary

An intermittent fever, or a temperature that comes and goes in cycles, is often a key symptom of an underlying infection, chronic illness, or autoimmune condition. The pattern of elevated temperature alternating with periods of normal temperature reflects your body's ongoing immune response.

Key Points

• Intermittent Fever Definition: A fever that comes and goes is known as an intermittent fever, where temperature spikes and then returns to normal in episodes.

• Common Causes: The most frequent reasons for fluctuating fevers include infections (viral, bacterial, parasitic), autoimmune diseases, and rare genetic conditions called Hereditary Periodic Fever Syndromes (HPFS).

• Symptom Tracking is Key: Recording the timing, duration, and accompanying symptoms of your fever is essential for a doctor to make an accurate diagnosis.

• When to See a Doctor: Seek medical attention if a fever is high, persists for more than a few days, or is accompanied by severe symptoms like confusion, a stiff neck, or difficulty breathing.

• Diagnosis Guides Treatment: Your doctor will use medical history, a physical exam, and tests like blood work to find the underlying cause, which will determine the correct treatment approach.

• Fever is a Symptom: Remember that the fever itself is a symptom, not a disease. Effective treatment relies on addressing the root cause, whether it's an infection or an inflammatory condition.

Understanding Intermittent Fever Patterns

An intermittent fever is a specific type of fever pattern where the body temperature spikes and then returns to a normal level, only to rise again later. It's different from a persistent fever, which stays consistently elevated. The rhythm and duration of the fever cycles can provide important clues to a healthcare provider about the potential cause.

Patterns of Fluctuating Fevers

• Quotidian Fever: A temperature spike occurs every 24 hours. This pattern is characteristic of some types of malaria and Adult-onset Still's disease.
• Tertian Fever: Fever spikes happen every 48 hours. This is typically seen in malaria caused by Plasmodium vivax and Plasmodium ovale.
• Quartan Fever: A fever that returns every 72 hours, which can be caused by certain strains of malaria.

Common Infectious Causes

Infections are among the most frequent causes of a fever that comes and goes. The cyclical nature reflects the lifecycle of the pathogen or the body's continued attempts to fight it off.

Viral Infections

Some viruses can cause prolonged or recurring fevers that last for weeks or months, such as:

• Epstein-Barr virus (EBV): Commonly known for causing mononucleosis, EBV can lead to fatigue and fevers that reappear over time.
• Cytomegalovirus (CMV): Another common virus that can produce intermittent fever, especially in those with weakened immune systems.
• Dengue Fever: A mosquito-borne virus that can cause fevers and flu-like symptoms that subside and then return.
• COVID-19: Some individuals experience a low-grade, persistent or intermittent fever as part of a post-viral syndrome, or 'long COVID'.

Bacterial Infections

If not fully eradicated, some bacterial infections can also cause fevers to return. Proper treatment is essential to break the cycle.

• Urinary Tract Infections (UTIs): Untreated or recurring UTIs can cause a fever that keeps coming back.
• Tuberculosis (TB): This bacterial infection can present with a persistent, low-grade evening fever, along with night sweats and weight loss.
• Abscesses: Pockets of pus caused by bacterial infections can hide in the body, leading to a persistent or recurring fever until they are drained or treated.

Parasitic Infections

For those who have traveled to certain regions, parasitic infections should be considered.

• Malaria: The classic example of an intermittent fever, malaria causes cyclical bouts of fever and chills that correspond with the parasite's reproduction cycle in the blood.

Chronic Inflammatory and Autoimmune Conditions

Sometimes, the immune system mistakenly attacks healthy tissue, causing systemic inflammation that results in fluctuating fevers. These conditions often cause fevers during a flare-up.

• Systemic Lupus Erythematosus (SLE): An autoimmune disease that can trigger inflammation and intermittent fevers, along with fatigue, joint pain, and rashes.
• Rheumatoid Arthritis (RA): In some cases, RA, known for causing joint stiffness and pain, can also lead to recurring fevers as a symptom of systemic inflammation.
• Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis, characterized by digestive tract inflammation, can sometimes cause intermittent fevers.
• Adult-onset Still's disease (AOSD): A rare inflammatory condition in adults that can cause a daily, high fever spike.

Hereditary Periodic Fever Syndromes (HPFS)

HPFS are a group of rare, genetic autoinflammatory disorders that cause recurrent fevers without an infectious cause.

• PFAPA Syndrome: Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis is the most common HPFS in children, characterized by regular episodes of fever, mouth sores, sore throat, and swollen lymph nodes.
• Familial Mediterranean Fever (FMF): A genetic condition that can cause fever and painful inflammation in the abdomen, chest, or joints.
• TRAPS: Tumor necrosis factor receptor-associated periodic syndrome can cause fever along with a painful rash, chills, and muscle pain.

For more information on these conditions, consult resources like the Cleveland Clinic on SAIDs, which covers many of the conditions formerly known as periodic fever syndromes.

Other Potential Causes

Less common, but still important, causes for recurring fevers include:

• Medications: A drug fever can be a side effect of certain medications, where a low-grade fever occurs days to weeks after starting a new drug.
• Malignancy: Certain cancers, particularly lymphomas and leukemias, can cause an unexplained, intermittent fever as an early symptom.
• Stress: Chronic emotional stress can sometimes lead to a psychogenic fever, which doesn't respond to typical fever-reducing medications but may respond to anti-anxiety treatments.

Tracking Your Symptoms for an Accurate Diagnosis

Keeping a record of your symptoms is crucial for helping your doctor pinpoint the cause. Note the following details:

Symptom	Infectious Cause (e.g., UTI, Malaria)	Autoimmune Cause (e.g., Lupus, RA)	HPFS Cause (e.g., PFAPA)
Fever Pattern	Can be intermittent, constant, or cyclical (e.g., 48-hour cycle with malaria)	Often correlates with flare-ups and may be low-grade	Occurs in predictable, recurring episodes, often with symptom-free periods in between
Accompanying Symptoms	Specific to the infection, like cough, pain with urination, sore throat, or respiratory issues	Systemic symptoms like joint pain, rashes, and fatigue are common	A specific cluster of symptoms repeats with each fever episode (e.g., mouth sores, sore throat, swollen glands)
Triggers	Exposure to pathogens from travel, contaminated food/water, or exposure to illness	Stress, sun exposure, or hormone fluctuations can trigger flares	Often none identifiable, or sometimes triggered by minor events like a cold or stress

When to See a Doctor

While many fevers resolve on their own, certain signs warrant a medical evaluation.

1. Fever over 103°F (39.4°C): A high fever requires prompt medical attention, especially if it doesn't respond to medication.
2. Fever lasting more than 72 hours: Persistent fever is a sign of an ongoing issue that needs diagnosis.
3. Recurring fever: If your fever goes away and comes back, or if you have repeated short-lived fevers without other symptoms, a doctor should be consulted.
4. Severe accompanying symptoms: Seek immediate care if the fever is accompanied by a severe headache, stiff neck, confusion, chest pain, difficulty breathing, or an unexplained rash.

Diagnostic Steps and Treatment Approaches

Diagnosing the cause of an intermittent fever involves a systematic approach.

1. Medical History: Your doctor will ask about your fever pattern, travel history, medication use, and other symptoms.
2. Physical Examination: A thorough exam will look for signs of infection or inflammation.
3. Diagnostic Tests: Blood tests (e.g., complete blood count, inflammatory markers), urine tests, and sometimes imaging (X-rays, CT scans) are used to identify infections or chronic conditions. Genetic testing may be performed to confirm an HPFS.

Treatment is entirely dependent on the underlying cause identified during diagnosis.

• Infections: Antibiotics for bacterial infections, and supportive care for viral illnesses. Antimalarial drugs are used for malaria.
• Autoimmune Conditions: Anti-inflammatory medications, corticosteroids, or immunosuppressants may be prescribed.
• HPFS: Medications like colchicine, steroids, or biologics may be used to manage symptoms and prevent complications.

Final Thoughts

Experiencing a fever that comes and goes is a sign that your body is managing a condition that needs attention. While a simple viral infection is a possibility, ignoring persistent or recurring fever patterns is not recommended. Understanding your fever pattern and seeking professional medical advice can lead to a proper diagnosis and the correct treatment, ensuring a better health outcome and peace of mind.

Frequently Asked Questions

How long should I wait before seeing a doctor for a fever that comes and goes?

You should see a doctor if your fever lasts for more than three days, is higher than 103°F, or if you have recurring fevers with no clear cause. Infants and the elderly should be seen sooner.

Can a recurring fever be caused by a virus?

Yes, some viral infections, such as the Epstein-Barr virus (EBV), cytomegalovirus (CMV), or even some post-viral syndromes like long COVID, can cause fevers that come and go over an extended period.

Could an autoimmune disease cause a fever to come and go?

Yes, autoimmune disorders like lupus and rheumatoid arthritis can trigger systemic inflammation that results in recurring or intermittent fevers, especially during flare-ups.

What is a periodic fever syndrome?

Periodic fever syndromes (HPFS or SAIDs) are a group of rare, genetic autoinflammatory conditions that cause recurrent fevers, often starting in childhood. They are not caused by infections.

What is a drug fever?

A drug fever is a side effect of certain medications that can cause a low-grade, persistent or intermittent fever. The fever usually appears about 7 to 10 days after starting the medication.

What other symptoms should I watch for with a fluctuating fever?

Keep an eye out for severe headaches, stiff neck, confusion, chest pain, difficulty breathing, or a new rash, as these may signal a more serious condition.

How is the cause of an intermittent fever diagnosed?

Diagnosis typically involves a thorough medical history, a physical exam, and diagnostic tests such as blood work, urine tests, or imaging. Genetic testing may be required for specific cases.

Is an intermittent fever contagious?

The fever itself is not contagious. However, if the underlying cause is an infectious disease like the flu, that illness can be contagious. If it's caused by an autoimmune or genetic condition, it is not contagious.