Lack of fever during acute infections

[forestglip]

I very rarely get sick, but when I do, I don't seem to get a fever. I haven't measured my temperature while sick since I was little, so I can't be sure, but I don't get any "hot" feeling. Even when I was sick for a month straight with something downright awful and my lymph node had me this close to going to the ER from the pain, no fever that I could feel.

Is this maybe common in people with ME/CFS or long COVID?

 

[Hutan]

Quoting two posts relevant to this:

I have no idea if it is common or not. I had no fever at all during glandular fever (which was my trigger), even though I had a whole range of other symptoms, including some less common ones, like the swollen eyelids that even obscured my vision one morning. My lymph nodes were so swollen that my neck was wider than my head (not an exaggeration), I had really bad lower back pain (due to the lymph nodes there I guess), etc etc. I was feeling pretty awful and I wouldn't call it super mild but I still had no fever at all.

I did have debilitatingly high fever during my two bouts of influenza before my ME/CFS and some less debilitating fever during my covid infection after my ME/CFS onset.

I've never had a fever in 33 years of ME and I've experienced a lot of viral infections. My ME onset was a sudden viral onset, sore throat/ear vertigo. high antithyroid antibodies, strep throat but never a fever.

I never had a fever when I contracted COVID 2 years ago and I was quite sick for several weeks. I started feeling better one month later only to worsen again after I went for a 45 minute walk. Only my legs were affected during that time around.

 

[Kitty]

Is a high fever is all that common anyway? I can only remember two episodes in a lifetime, one with measles and the other with 'flu. I didn't have ME/CFS when I got measles, but did when I got 'flu.

I've probably had an elevated temperature at times, but what I'd call fever is so pronounced you hardly need a thermometer – the burning hot chest is enough. Severe Covid aside, most common viral infections don't seem to produce a lot of fever.

Some people seem especially prone to bacterial throat infections, though, and maybe they get it more frequently?


ETA: I chose 'never or rarely' in the poll, but I'm not sure it's actually abnormal. Friends and relatives without ME/CFS rarely get burning fevers either.

 

[forestglip]

ETA: I chose 'never or rarely' in the poll, but I'm not sure it's actually abnormal. Friends and relatives without ME/CFS rarely get burning fevers either.

Okay, maybe I overestimated how common it is in general.

 

[Sean]

Not any more than pre-ME/CFS.

Only happened twice in recent years. Once with a nasty flu, and once from the first of two Shingrix vaccinations for shingle, and they were both relatively mild fevers (ETA: and may have been nothing more than an exaggerated form of the hot-cold flushes or temperature sensitivity/inadequate thermal regulation that can occur in ME/CFS).

Don't usually get it with a cold/flu, and don't get them much either since getting ME/CFS, though that may be due to social isolation, and in recent times masking up when out in public.

 

[Nightsong]

To be honest I don't know: being housebound and seeing very few people, I very rarely get colds or flu.

This reminds me of something very obscure. At the Westcare conference way back in 1995, in the discussion, James Mowbray reflected briefly on a group of patients whom he claimed did not produce an adequate fever response. I assumed it was just wrong; it seemed an extremely unusual claim that I don't recall seeing mentioned anywhere else & the other participants had clearly not heard of such a thing or contradicted him. I posted the proceedings of the conference here a few years ago:

https://s4me.info/threads/first-wor...ology-in-cfs-1995-ed-sykes-and-tyrrell.23362/

If this did occur in more than a small number of pwME, though, it would surely be fairly well known by now. I wonder if sometimes people mistake PEM for an acute infection before they become accustomed to the dynamics of ME? In my experience PEM can feel very flu-like.

 

[Kitty]

Okay, maybe I overestimated how common it is in general.

Bear in mind I inherited my terminology and understanding of its meaning from people born in the 1920s. I've no medical training, and meanings change.

I describe fever as a burning head and chest that's often flushed red in lighter skinned people, but that doesn't mean you do.

 

[forestglip]

This reminds me of something very obscure. At the Westcare conference way back in 1995, in the discussion, James Mowbray reflected briefly on a group of patients whom he claimed did not produce an adequate fever response. I assumed it was just wrong; it seemed an extremely unusual claim that I don't recall seeing mentioned anywhere else & the other participants had clearly not heard of such a thing or contradicted him. I posted the proceedings of the conference here a few years ago (p30-33 of the 2nd PDF, there may be other references):

https://s4me.info/threads/first-wor...ology-in-cfs-1995-ed-sykes-and-tyrrell.23362/

Impressive memory. Quoted from that document:

James Mowbray

A very long time ago. I saw a group of 30 patients with a Fatigue Syndrome from the practice of a GP in Notting Hill. This group of patients were homogeneous, all had the same boringly similar set of symptoms, and a number of them were convinced they had infections. We gave them all clinical thermometers and temperature charts and they produced in the next month a thousand temperature records. Not one of those was above 37.6, even though this was in the winter and you would have expected them to have had a lot of intercurrent infections. A few years later when I found some evidence of infection. I went back and checked those results. It is true, they do not produce fevers; they do not produce a fever even if they get appendicitis, which I've seen two patients.

Also, they cannot be induced to produce a fever if you give them endotoxin. We did this as a deliberate attempt to treat their abnormal levels of TNF and IL-1. (They had slightly raised TNF levels.)

[...] So since these patients do not respond to IL-1, you may have to look at soluble receptor, or an antagonist, or the fact that the receptors may be decreased in number. And the methods for doing that are not all that good when the receptor you’re interested in is the brain. We have been able to show however that in these patients IL-1 was normally produced by exercise, by endotoxin, and that subjects did not respond to it by either producing fever or producing metencephalin from leukocytes.

Denman: This may be true of your patients but a prominent symptom in my patients is an exaggerated febrile response to intercurrent infections. They bring me self-recorded temperature charts.

Lishman: I'm puzzled to know whether they can produce fever or not. Has anybody got other information on that?

Klimas: A number of people have reported that their basal temperature is 1 degree lower than it should be. Tony Komaroff reported this, as well as other investigators. In my clinical experience, my patients are able to mount a measurable fever in response to an infection.

Mowbray: I am surprised, as our patients just don't. Even one with an appendix abscess was not operated on, as he did not register a fever.

There is more to his talk and the discussion, which is less directly related to fever. It's on page 62 of the second PDF in Nightsong's linked post above.

 

[Turtle]

In 33 ME/CFS years I didn't have a fever after it began. But when it started with EBV and pneumonia I had a really high fever, for three days. Not measured but around 40 C or more.
The day before I had moved in with my boyfriend, luckily we had been living together for several months before that.

14 years before ME/CFS I had a very bad flu, 40.4 C fever. I think that laid the groundwork for my ME/CFS.

 

[Mij]

I know we discussed this before but I thought I would bring it up here if that's ok. Who gets the flu or a cold? I don't know for sure if I've ever had the flu or a cold. The first 12 years never. But as ME went on I can't really say for sure if how I felt was from the flu or a cold.

I got COVID and the symptoms were very obvious that I had COVID the day after I went out for a brief period and then got a vaccine on the same day without knowing I had COVID. That was brutal.

 

[Joan Crawford]

I had high fever aged 11 which is likely linked to tick bite and was labelled as 'summer flu' at the time. My temp was high (39/40C) and I did not recall what happened for a week or so, before it subsided and normalised. To this day I do not know why I was not hospitalised (I think my mum was a tad doctor-phobic). A GP saw me at home - I don't recall several visits but I do recall a follow up visit when I was in bed recovering. My mum died two years later so I am not able to ask her more about this time. I went back to school in the autumn term - weaker but largely recovered. And then I developed slowly other symptoms, starting with migraine and chronic fungal infections, recurrent tonsillitis, some PEM, variable weakness etc over time. Until late 20s when I collapsed.

Since that time in early teens, I do not make fevers for bacterial, parasitic, or fungal infections, only for some viral infections, but not all. The immunologist I saw did not find this unusual in someone with my history, symptoms, ongoing endless debilitating opportunistic infections, and test results (low b cell, low IgG subgroups 1&3, MDL deficiency, complete absence of secretory IgA, lowish serum IgA, inability to make antibodies to any serovar of pneumococcus, etc). Perhaps they see this clinical picture quite often.

Examples of other infections/consequences:

- Over a long time I had chronic UTI/kidney infections that I developed a large kidney stone. The clinical pathologist identified that this was 100% due to infection. The urologist was clear that the stone had been growing for a long time. I did not make fevers to these bacterial UTI/kidney infections.

- Before identifying and managing my lowered immunity with daily antimicrobials I would develop debilitating sinus or tonsil infection at the drop of a hat - no fevers from these bacterial infections either. And I would be incredibility debilitated and unable to do pretty much anything until the infection was treated. Tough when you don't make a fever - it defies what most doctors probably think about infections. However, most get that not making a fever might be part of my lowered immunity picture. The opportunistic infections are kept at bay with daily cotrimoxazole and I am a lot more functional and was able to return to work in 2016. And I was able to make antibodies to the pneumonovax vaccine too, so that's a positive.

 

[forestglip]

I know we discussed this before but I thought I would bring it up here if that's ok. Who gets the flu or a cold? I don't know for sure if I've ever had the flu or a cold. The first 12 years never. But as ME went on I can't really say for sure if how I felt was from the flu or a cold.

I got COVID and the symptoms were very obvious that I had COVID the day after I went out for a brief period and then got a vaccine on the same day without knowing I had COVID. That was brutal.

I wish my memory was better for before COVID, but since 2019, I think I've had four or five times where I had runny nose, sore throat, worse fatigue lasting at least a week. I think for all but one the COVID test was positive.

 

[Wyva]

I agree with some other comments above that this largely depends on what kind of infection you have. I'm not sure it is a good idea to try to quantify this in percentages. Most often people will get the common cold probably (at least up to the past few years), which doesn't induce fever so much as far as I know. So it is possible to catch the cold all the time, be ill and never have a fever if that person doesn't catch other, more fever-triggering infections, especially if those are less easy to catch. If one catches influenza or covid or something else more commonly associated with fever, it may throw off the percentages simply because of the nature of the symptoms of the infection.

Edit: so I guess the better question is how often people get fever compared to their pre-ME/CFS life while also taking into account the type of infections they probably had and their typical symptoms (fever or not).

 

[Mij]

@forestglip

But does the flu/cold circulate all year round? It's common for me to have a mild sore throat, worse fatigue, deep aching et on a regular basis even in mid July. I live alone and don't spend a lot time around people.

I'd be at the doctors every month if I thought I had an actual infection.

 

[duncan]

Like many others, I rarely am exposed because I cannot get out much. But I do get the rare fever on occasion. However, I'm not sure if it would clinically qualify as such since my baseline temp is relatively low (96.9 F vs 98.6F). So a fever might look like a non-event to any doctor or nurse. I know many others would report similar low temps.

 

[Mij]

@duncan

The ME doctor I saw in the early 90s told me that most pwME feel as though they have a fever but their actual temperature is low. It's our bodies natural mechanism of trying to increase our core temperature.

 

[Mij]

My temp during delayed PEM is around 95.5 for three days but I feel hot and dehydrated.

 

[Arnie Pye]

As a child I got fevers with the common childhood illnesses (measles, mumps, rubella, chicken pox, tonsillitis). The only ones I remember are measles where I was extremely ill and my temperature went up to 105.5 F. Also I got tonsillitis a lot and that would usually create a fever of 103 - 104 F.

As an adult I still get fevers but they are a) not very high, and b) don't last long. As an example, my husband and I both got a viral infection at the same time some years ago and his fever went up to 104F and stayed high for 4 or 5 days. Mine went up to 102F and it only stayed high for 2 or 3 days. In the aftermath of that infection my husband got better very quickly while I stayed feeling ill for a couple of weeks.

I have secondary/central hypothyroidism and have since birth (I think) or possibly it became obvious as I approached puberty, I can't remember now. My pituitary is completely flat and doesn't produce enough TSH for my needs. I suspect some of my other pituitary hormones might be low too, but they've never been tested.

The thyroid controls body temperature, and so low body temperature in those who have hypothyroidism is very common. In my 20s I would sometimes have body temperature of about 94F, and on average my temperature would be about 96 F. I am now post-menopausal and my hypothyroidism is treated. My body temperature is now usually around 97.4 F.

I got a longer lasting than usual fever when I had my first attack of Covid. It went as high as about 103F (from memory - it might have been higher) and it took about 7 - 10 days to get high then reduce to my "normal". This was the longest high temperature I'd had in decades. It had an interesting and welcome side effect. Before Covid I suffered from excruciating mouth ulcers, and had done for many years. I think the prolonged fever killed off whatever was causing the pain. After Covid I still have ulcers but the extreme pain is no more and the number has dropped a lot.

I haven't picked an answer for the poll because I don't know which one to pick.

 

[forestglip]

But does the flu/cold circulate all year round?

It's much lower, but not zero:

Nature

I haven't picked an answer for the poll because I don't know which one to pick.

I think I'd count any significant increase in temperature compared to your normal, during what is obviously an infection, for the purpose of this poll. As a fraction of all "obvious infections" since ME began, or at least as far back as you can remember.

I agree with some other comments above that this largely depends on what kind of infection you have. I'm not sure it is a good idea to try to quantify this in percentages. Most often people will get the common cold probably (at least up to the past few years), which doesn't induce fever so much as far as I know. So it is possible to catch the cold all the time, be ill and never have a fever if that person doesn't catch other, more fever-triggering infections, especially if those are less easy to catch. If one catches influenza or covid or something else more commonly associated with fever, it may throw off the percentages simply because of the nature of the symptoms of the infection.

Edit: so I guess the better question is how often people get fever compared to their pre-ME/CFS life while also taking into account the type of infections they probably had and their typical symptoms (fever or not).

Sure, I just wanted to make the question simple so that it's most inclusive of everyone. For example, I barely remember frequency or type of illnesses before ME 15 years ago. And of the infections I remember, I don't have information on the type of infection, other than COVID. I wanted to see if there was possibly a very large trend toward "never" here, which might say something even with the limitations you mentioned.

 

[MrMagoo]

My baseline temp is 36.2, this is normal in women. The “standard” 37.5c is a myth.
Sometimes when I’m unwell it increases up to 37.5
I had flu and Covid this year and hit 39
I’ve only hit 39 three or four times before in my life pre-ME