Fever and Cough

Kelompok IV

Symptoms
Fever since two days, with cough and rhinnorhea Low Appetite Restlesness during sleep

Fever since two days, with cough and rhinnorhea

If rhinnorhea appears first, we must thinking these symptom appears because viral or bacterial infection. Fever is manifestation from those infection, the endotoxin or epitope from viral is becoming source of increase the set point in hipothalamus by pyrogens cytokine which release from macrophage, endothelial cell, etc. These pro-inflammatory substrate stimulate hypothalamic endothelium and increase level of PGE2. This substrate stimulate glial cells to release cAMP. This substrate is stimulating set point in thermoregulary in hypothalamus. The result is fever (Braunwald, 2008).

Low Appetite
Several inflammatory cytokines, including tumor necrosis factor-a, interleukin-6, interleukin-1b, and a proteolysis-inducing factor, have been shown to cause anorexia and cachexia. Most of these inflammatory cytokines appear to mediate anorexia by activation of the melanocortin system in the hypothalamus. The precise mechanisms by which cytokines or tumor products interact with the melanocortin pathway to decrease food intake are still unclear, but blockade of the hypothalamic melanocortin receptors appears to almost completely prevent their anorexic and cachectic effects in experimental animals.

Melanocortin System
There are two distinct types of neurons in the arcuate nuclei of the hypothalamus that are especially important as controllers of both appetite and energy expenditure : (1) POMC neurons that produce melanocyte- stimulating hormone together with cocaine- and amphetamine-related transcript (CART), and (2) neurons that produce the orexigenic substances NPY and (AGRP). Activation of the POMC neurons decreases food intake and increases energy expenditure, whereas activation of the NPY-AGRP neurons increases food intake and reduces energy expenditure. These neurons appear to be the major targets for the actions of several hormones that regulate appetite, including leptin, insulin, etc. In fact, the neurons of the arcuate nuclei appear to be a site of convergence of many of the nervous and peripheral signals that regulate energy stores. The POMC neurons release -MSH, which then acts on melanocortin receptors found especially in neurons of the paraventricular nuclei. Activation of these receptors reduces food intake while increasing energy expenditure. (Guyton, 2007).

Low Appetite
But, the doctor observed in patient with enlargement of tonsil (it depend on scenario or condition in patient), he/she difficult to swallow.

Lymphadenopathy