Fever and Night Sweats

oPatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

See also separate article Ill and Feverish Child.

Fever is a common sign that on its own is usually little help in making a diagnosis. Persistent high fever needs urgent treatment. Fever over 42.2°C (108°F) produces unconsciousness and leads to permanent brain damage if sustained. Fever can be classified as:

  • Low: 37.2-38°C (99°-100.4°F).
  • Moderate: 38.1-40°C (100.5°-104°F).
  • High: >40°C (104°F).

Fever may also be described as:

  • Remitting - the most common type with daily temperatures fluctuating above the normal range.
  • Intermittent - daily temperature drops into the normal range and then rises back above normal. If temperature fluctuates widely causing chills and sweating, it is called a hectic fever.
  • Sustained - persistent raised temperature with little fluctuation.
  • Relapsing - alternating feverish and afebrile periods.
  • Undulant - gradual increase in temperature, which stays high for a few days then gradually reduces.

Fever may also be described in terms of its duration; brief (<3 weeks), or prolonged. The term pyrexia of unknown origin (PUO) is used to describe a condition where no underlying cause can be found.[1]

Night sweats are common and there is a long list of possible causes, mostly benign but important to diagnose in order to manage effectively. Serious causes of night sweats can usually be excluded by a thorough history, examination and simple investigations if required.[2]

Most cases of fever are due to self-limiting viral infections, especially upper respiratory tract infections and childhood exanthemas.
Urinary tract infections are also common but more severe infections (eg meningitis, pneumonia, osteomyelitis, septic arthritis, AIDs) should always be considered. Recent foreign travel should prompt consideration of referral to secondary care for full investigations for tropical infections, eg malaria.

Non-infection causes of fever include connective tissue disorders, allergy, thyrotoxicosis and malignancy. Disorders of thermoregulation: temperature can suddenly rise up to as high as 41.7°C (107°F) in a life-threatening condition such as heatstroke, thyroid storm, neuroleptic malignant syndrome, malignant hyperthermia and in certain disorders of the central nervous system.

Causes of fever include:

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Prolonged fever

Prolonged fever is used to describe a raised temperature persisting for at least 3 weeks (persistent, remittent or intermittent). Possible causes of a prolonged fever include:

  • Night sweats are usually defined as episodes of significant nighttime sweating that soak the bedclothes or bedding. This is a fairly common symptom.
  • Although uncomfortable, nighttime sweating typically isn't a sign of a serious underlying medical condition. It may be triggered by something as simple as too warm a room or too many blankets on the bed.

Causes of night sweats

Medical causes of night sweats include:[2]

  • Immediate assessment includes measurement of temperature, assessment of the likely underlying cause, wellbeing of the patient and signs of dehydration.
  • Need to know the complete medical history, including immunosuppressive treatments or disorders, infection, trauma, surgery, any medication.
  • Recent travel may suggest more exotic causes of fevers.

Temperature measurement

  • Infrared ear thermometers or thermometers placed in the axilla should be used.
  • Oral measurements are affected by mouth breathing, liquids, and respiratory rate.
  • There are diurnal, menstrual, and exercise-induced variations in normal body temperature.

Investigations are often unnecessary in primary care when the cause of an infection is clear from the history and examination. Possible investigations may include:

The patient admitted to hospital will often require a much more extensive list of investigations when exploring the underlying cause of fever, including:

  • The most important aspect of management is the identification and appropriate management of the underlying cause. However, in the case of self-limiting viral infections, the only management required is advice and reassurance.
  • Do not prescribe oral antibiotics to a child with fever without apparent source.[3] 
  • If meningococcal disease is suspected, give parenteral antibiotics at the earliest opportunity (either benzylpenicillin or a third-generation cephalosporin).[3] 

Immediate hospital treatment of a child with a very high fever

  • Children with shock: give immediate intravenous fluid bolus of 0.9% sodium chloride (20 ml/kg). Give further boluses as necessary.
  • Give oxygen if there are signs of shock, oxygen saturation of less than 92%, or as clinically indicated.

Simple explanations for patients and their relatives

  • Drink lots of fluid.
  • Do not wear too many clothes (do not overdress or underdress) or use too many blankets.
  • Keep the room at a comfortable temperature, but make sure that fresh air is circulating (use a fan if available).
  • A damp vest and a fan can be effective in lowering temperature.
  • Don't wipe the sweat off immediately as this helps to cool the body.
  • Cool baths and tepid sponging are not recommended.

Antipyretic drugs

  • There is evidence that host defence mechanisms are enhanced by a raised temperature.
  • Antipyretics, eg paracetamol and ibuprofen, should therefore not be used routinely but can be of value, especially for patients with systemic disease (particularly heart failure or respiratory failure), and when fever causes acute confusion.
  • Consider either paracetamol or ibuprofen as an option if a child appears distressed or is unwell.
  • Do not administer paracetamol and ibuprofen at the same time, but consider using the alternative agent if there is insufficient response to the first drug.[3] 
  • Antipyretic agents do not prevent febrile convulsions in young children and should not be used specifically for this purpose.[3] 

Further reading & references

  1. Mourad O, Palda V, Detsky AS; A comprehensive evidence-based approach to fever of unknown origin. Arch Intern Med. 2003 Mar 10;163(5):545-51.
  2. Viera AJ, Bond MM, Yates SW; Diagnosing night sweats. Am Fam Physician. 2003 Mar 1;67(5):1019-24.
  3. Feverish illness in children - Assessment and initial management in children younger than 5 years; NICE Guideline (May 2013)

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Dr Colin Tidy
Current Version:
Peer Reviewer:
Prof Cathy Jackson
Document ID:
2147 (v23)
Last Checked:
11/06/2013
Next Review:
10/06/2018