As many of you (who have time to read my notes) know, I have a little fascination with pediatric fever. I like the topic, reading about the body's response to infections is very interesting and the more I read about it the more I believe that treating fever does more harm that good (in most cases anyway). The ability of the body to heal it self can not be undermined. Just think about coagulation homeostasis, what a complex and yet perfectly balanced system that keeps us from bleeding to death and not dying from clotting. In the same way, the generating of fever is part of the immune system's response to infections improving chemotaxis of white cells, killer T-cell action, antibody production and many other protective immune functions... could the body be wrong by increasing body temperature? - I don't think so.
Few days ago I was searching for some articles about pediatric fever and came across this blog
talking about how fever was used to treat neurosyphilis in the
1910's and how a Nobel prize winner cured some patients from
paralytic syphilis by infecting them with the high-fever illness, malaria!
Gonorrhea was also treated in the hyperthermia chamber with
high cure rates. Another clear example that treating fever may cause more harm than good is the post vaccination period in children. It is very common to have parents rushing their kids to the ED because of fever after getting vaccinated. There is a very well done study done in the Czech Republic that evaluated the effect of antipyretics on the immunogenicity of vaccines (http://www.sciencedirect.com/science/article/pii/S0140673609612083) The conclusion was that antipyretic use was associated with lower antibody levels for many vaccines, decreasing the protective effect of the immunizations. Hmmm, maybe we should start telling parents not to treat fever!
These examples invariably lead to the question... How
(and when) did fever become a cause of panic and the evil symptom modern
medicine aims to treat? As more and more bacterias develop effective
ways of resistance to multiple antibiotics and less and less new
effective antibiotics are developed, I just wonder... will the days when
induced hyperthermia become an effective therapy be back anytime soon? I
believe they will.. just as induced hypothermia has become standard of
care in post-cardiac arrest patients, induced hyperthermia will take the
medicine world by storm in a not-too-far distant future. Although too many questions remained unanswered on type of infections that will benefit, degree and length of hyperthermia, whole body vs partial, technique to increase body temperature, protocols, etc. Therapeutic hyperthermia will bring some heat to the traditional thinking of total fever control for infectious diseases. I just need to
develop a machine that
safely increase temperature to a level enough to kill the bugs and yet
prevent the brain from cooking. Anyone wants to take this with me?