Journal of Tropical Diseases & Public Health

Intermittent Fever

Intermittent fever refers to a fever that recurs at regular intervals, with the body temperature rising and then returning to normal or below normal. Unlike continuous fever, intermittent fever has clearly defined periods of normal temperature between fever spikes.

Causes of Intermittent Fever

1. Malaria:
   One of the most common causes of intermittent fever is malaria. In malaria, the fever typically follows a pattern depending on the species of Plasmodium:
   • Plasmodium vivax and Plasmodium ovale cause fever every 48 hours (tertian fever).
   • Plasmodium malariae causes fever every 72 hours (quartan fever).
   • Plasmodium falciparum can cause fever that does not follow a clear pattern but may still be intermittent.
2. Tuberculosis (TB):
   TB can also cause intermittent fever, particularly in its more chronic form. The fever in TB is often described as low-grade and occurring in the evening.
3. Sepsis:
   Infections that lead to sepsis may cause intermittent fever. The fever pattern can vary depending on the nature and severity of the infection.
4. Autoimmune Diseases:
   Diseases like systemic lupus erythematosus (SLE) and rheumatoid arthritis can cause fever that comes and goes.
5. Brucellosis:
   A bacterial infection that causes intermittent fever, among other symptoms such as joint pain and sweating.

Symptoms Accompanying Intermittent Fever

• Chills and Sweating: Commonly occur during the fever cycle, particularly in malaria. Patients often experience severe chills followed by high fever and sweating as the temperature drops.
• Fatigue and Weakness: Recurrent episodes of fever can lead to general body weakness and exhaustion.
• Headache and Muscle Pain: Common symptoms that may accompany the fever.
• Nausea and Vomiting: Particularly in infectious causes such as malaria or brucellosis.

Diagnosis and Tests

1. Blood Tests:
   Blood tests can help identify infections such as malaria, brucellosis, or sepsis. In malaria, a blood smear or a rapid diagnostic test (RDT) is used to detect Plasmodium parasites.
2. Chest X-ray and Sputum Test:
   These tests are useful if tuberculosis is suspected as the cause of the intermittent fever.
3. Culture Tests:
   For suspected bacterial infections, cultures of blood, urine, or other body fluids may be required to identify the causative organism.
4. Immunological Tests:
   For autoimmune diseases like lupus, specific antibodies such as ANA (antinuclear antibodies) may be tested.

Treatment

The treatment of intermittent fever depends on its underlying cause:

• Malaria: Treated with antimalarial drugs like chloroquine, artemisinin-based combination therapies (ACTs), or other drugs depending on the species and resistance patterns of the Plasmodium parasite.
• Tuberculosis: Requires a long course of antibiotics such as isoniazid, rifampin, ethambutol, and pyrazinamide.
• Sepsis: Involves the administration of intravenous antibiotics and supportive care to treat the underlying infection.
• Autoimmune Diseases: Treated with immunosuppressive drugs and corticosteroids to reduce inflammation.

Prevention

• Malaria Prevention: In malaria-endemic regions, use of insecticide-treated bed nets, anti-malarial medications (as prophylaxis), and reducing exposure to mosquitoes are crucial.
• Vaccination: Vaccines are available for certain diseases like tuberculosis (BCG vaccine) that can cause intermittent fever.
• Sanitation and Hygiene: Preventing infections that can cause sepsis and fever is vital. This includes practicing good hygiene, vaccination, and avoiding contaminated food or water.