Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 16, 2021; 9(2): 296-307
Published online Jan 16, 2021. doi: 10.12998/wjcc.v9.i2.296
Effect of a fever in viral infections — the ‘Goldilocks’ phenomenon?
Lucas Belon, Peter Skidmore, Rohan Mehra, Edward Walter
Lucas Belon, Edward Walter, Department of Intensive Care Medicine, Royal Surrey County Hospital, Guildford GU2 7XX, Surrey, United Kingdom
Peter Skidmore, Rohan Mehra, Department of General Medicine, Royal Surrey County Hospital, Guildford GU2 7XX, Surrey, United Kingdom
Author contributions: All authors contributed to the background research and drafting of this work; all authors have read and approve the final manuscript.
Conflict-of-interest statement: None of the authors declares a conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Edward Walter, BM, BSc, FRCA, FFICM, MRCP, Attending Doctor, Department of Intensive Care Medicine, Royal Surrey County Hospital, Egerton Road, Guildford GU2 7XX, Surrey, United Kingdom. ewalter@nhs.net
Received: June 11, 2020
Peer-review started: June 11, 2020
First decision: November 14, 2020
Revised: November 23, 2020
Accepted: December 10, 2020
Article in press: December 10, 2020
Published online: January 16, 2021
Abstract

Acute infections, including those due to Coronaviridae and other viruses, often stimulate a febrile response. A mild fever appears to improve outcome; it appears to diminish viral replication by several mechanisms, including virion entry into host cells and genome transcription, and improving host defence mechanisms against the pathogen. However, a fever may also damage host cellular and tissue function and increase metabolic demands. At temperatures at the lower end of the febrile range, the benefit of the fever appears to outweigh the detrimental effects. However, at higher temperatures, the outcome worsens, suggesting that the disadvantages of fever on the host predominate. A non-infective fever is associated with a worse outcome at lower temperatures, suggesting that hyperthermia carries less benefit in the absence of infection. This review discusses the risks and benefits of a fever on the host response, focusing on the effects of a fever on viral replication and host response, and the detrimental effect on the host.

Keywords: Fever, Virus, Coronavirus, Infection, Body temperature regulation, Hyperthermia

Core Tip: Acute infections, including those due to coronavirus and other viruses, often stimulate a febrile response. A mild fever appears to improve outcome; it appears to diminish viral replication by several mechanisms, and improve host defence mechanisms against the pathogen. At higher temperatures, the outcome worsens, suggesting that the risks of fever on the host outweigh the benefit. A non-infective fever is associated with a worse outcome at lower temperatures. This paper discusses why a mild fever may be better than no, or very high fever.