Ebola Virus Disease and the Variable Febrile and Subjective Response

I am going to West Africa soon with full knowledge of the risks to ourselves but the purpose of screening is to contain further transmission of the disease. There is no screening checkbox for “not feeling right”. Subjective fever.
Always a good topic as to what constitutes fever. We all remember the days when “normal” was 98.6 degrees F. Now, with digital read outs, Harrison’s textbook of internal medicine defines a fever as’ “a morning oral temperature of >37.2 °C (>98.9 °F) or an afternoon oral temperature of >37.7 °C (>99.9 °F) while the normal daily temperature variation is typically 0.5 °C (0.9 °F).”

Additionally, so we are all on the same page, we would really like to have it as close to the “core body temperature” as possible but, in reality, most of us don’t want an esophageal probe every time we feel uneasy, so we do need another way that best approximates our own, individual core body temperature. Only you know what that is.

Also the manner in which it is measured and observed by another is critical in its accuracy. A rectal thermometer is the best, then oral (mouth closed!), temporal artery (not across the forehead, not a strip), then tympanic in that order. A lot of variability. Because of that, and my soap-box statement is I am weary of “check-box” medical history taking, a blanket check box that specifies a single number to fit every single individual is simply thoughtless.

Let’s take a scenario of infection.

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Image 1. Clinical course of single patient found to have been infected by the Tai Forest Ebolavirus (TAFV). His temperature varies during the viremia stage.

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