Jonah Patel
Signs and symptoms are diagnostic indications of an illness, injury, or condition. Signs are objective and externally observable, while symptoms are a person's reported subjective experiences. Constitutional symptoms are common and nonspecific, affecting general well-being or the whole body. They include fever, chills, night sweats, malaise, fatigue, depression, weight loss, and anorexia. These symptoms are prevalent in many diseases and are often indicative of a serious systemic illness. They can be caused by various conditions, including infection, malignancy, hypothyroidism, diabetes, heart disease, and autoimmune disorders.
| Characteristics | Values |
|---|---|
| Commonality | Constitutional symptoms are common, especially during periods of active disease. |
| Affect | They affect general well-being or the whole body. |
| Examples | Fever, chills, night sweats, malaise, anorexia, weight loss, fatigue, headache, myalgia, arthralgia, depression, anxiety, sleep disturbances, etc. |
| Diagnostic Use | They are diagnostic indications of an illness, injury, or condition. |
| Objective/Subjective | Signs are objective and externally observable; symptoms are subjective experiences. |
| Observable | Signs may be visible, such as a rash or bruise, or otherwise detectable using tools like a stethoscope or blood pressure monitor. |
| Specificity | They are often non-specific, but some combinations can suggest certain diagnoses. |
| Seriousness | The presence of constitutional symptoms should alert the clinician to the potential of a serious systemic illness. |
| Persistence | They may persist in a relapsing-remitting fashion, accompanying new manifestations of the disease. |
| Differential Diagnosis | They are indicative of many diseases and by themselves are not specific. If they persist without a clear cause, further investigation is required. |
| Risk Factors | They are especially concerning if the patient is immunocompromised or has risk factors for infection. |
| Progression | Symptoms may be mild or severe, brief or longer-lasting, and they may become reduced (remission) or recur (relapse or flare-up). |
| Syndrome | A particular set of signs and symptoms associated with a disorder is known as a syndrome. |
| Asymptomatic | Some conditions, like subclinical infections, display no symptoms and are termed asymptomatic. |
| Chief Complaint | The term "chief complaint" is used to describe the initial concern of an individual when seeking medical help. |
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What You'll Learn
Fever, chills, and night sweats
Constitutional symptoms are a common manifestation of an active disease. They are typically non-specific and can include profound fatigue, anorexia, weight loss, low-grade fever, chills, night sweats, malaise, headache, myalgia, and unintended weight loss. These symptoms may suggest an infection or malignancy, especially in immunocompromised patients or those with risk factors for infection, such as recent bacterial infections or injection drug use.
Chills often accompany fever and are characterised by a sensation of chilliness. They are common in conditions with wide swings in temperature, such as hectic fevers, abscesses, pyogenic infections, tuberculosis, hypernephromas, lymphomas, and drug reactions. Continuous or sustained fevers, on the other hand, are usually not associated with true chills but are seen in conditions like typhoid fever, typhus, bacterial endocarditis, tuberculosis, fungal disease, and bacterial pneumonia.
Night sweats, or nocturnal sweating, can occur with any condition causing fever. They are often associated with tuberculosis, lymphoma, brucellosis, lung abscess, bacterial endocarditis, diabetic autonomic neuropathy, nocturnal hypoglycaemia, nocturnal angina, and diabetes insipidus. Night sweats are particularly common in influenza (flu) and can be unsettling, but they are typically a normal part of the body's response to the infection. The body's temperature regulation fluctuates during nighttime hours, and the inflammatory responses triggered by the flu virus lead to increased metabolism and a heightened heart rate, resulting in night sweats as the body works to control its temperature.
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Weight loss and anorexia
Constitutional symptoms are common manifestations of a disease, which may include profound fatigue, anorexia, weight loss, and low-grade fever. Anorexia and weight loss are two of the three manifestations of constitutional syndrome, with the third being asthenia.
Anorexia nervosa is a complex condition with no single cause. It is characterised by a restriction of calorie consumption, leading to weight loss or a failure to gain weight. This results in a significantly low body weight based on age, sex, height, and physical health. Anorexia is a side effect of starvation and malnutrition, and it can have many physical signs and symptoms, including:
- Dizziness and/or fainting
- Abnormal heart rhythm (arrhythmia)
- Low blood pressure (hypotension)
- Feeling cold all the time
- Absent or irregular periods (amenorrhea)
- Bloating and/or abdominal pain
- Muscle weakness and loss of muscle mass
- Dry skin, brittle nails and/or thinning hair
- Poor wound healing and frequent illness
People with anorexia may also exhibit changes in eating habits or routines, such as eating foods in a certain order or rearranging foods on a plate. They may also make frequent comments about feeling "fat" despite their weight loss, purge through intentional vomiting, misuse laxatives or diuretics, and compulsively or excessively exercise.
It is important to note that anorexia is a serious condition that requires medical attention. A healthcare provider will use various tests to rule out any medical conditions that could cause weight loss and evaluate the physical effects of anorexia.
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Fatigue and weakness
Constitutional symptoms are common, especially during periods of active disease. They are a manifestation of fever, anorexia, malaise, headache, and myalgia. They are also a common indicator of infection.
Fatigue is also associated with certain medications and treatments, such as over-the-counter drugs, bone marrow transplants, and chemotherapy. Additionally, weight issues and eating disorders can lead to fatigue. Obesity or being underweight can contribute to fatigue and other symptoms. Lifestyle factors, such as excessive alcohol use, can also play a role in causing fatigue.
Fatigue is a common symptom in patients with constitutional symptoms, with one study reporting easy fatigability in 30% of Japanese children with SS. Weakness is another early sign of constitutional symptoms, along with decreased cognitive functioning and irritability. Patients may also experience muscle cramps, twitching, and peripheral neuropathy.
If you are experiencing fatigue, it is important to consult a healthcare provider. They will ask about your lifestyle and medications and may conduct a physical examination and order lab tests to determine the underlying cause. Treatment options may include medication, exercise, or therapy.
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Malaise and depression
Malaise is a feeling of discomfort, illness, or uneasiness and is often accompanied by other symptoms like fever, chills, and night sweats. It can be a sign of infection or malignancy. Malaise can also be a symptom of hypothyroidism, hyperthyroidism, heart disease, lung disease, or cancer.
Depression, a complex condition with varying symptoms, can also be a constitutional symptom. It is often characterised by feelings of sadness, hopelessness, and a loss of interest in activities one used to enjoy. These feelings can interfere with work, social life, and family life. Depression can develop as a reaction to severe pain, stiffness, and malaise that limit physical activities. It is also associated with grief and bereavement, with some people experiencing symptoms of depression after a loss. In severe cases, depression may include symptoms of psychosis, suicidal thoughts, and feelings of guilt.
Both malaise and depression can be indicative of a more serious underlying condition. It is important to seek medical advice if you are experiencing these symptoms to ensure proper diagnosis and treatment.
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Serious systemic illness
Constitutional symptoms are a manifestation of a serious systemic illness that affects the entire body or general well-being. They are often interrelated and develop sequentially, reinforcing one another. For example, physical weakness due to illness may cause a depressed self-image, leading to withdrawal and, consequently, somnolence and disinterest in normal activities like eating. This can have a detrimental impact on a patient's physical and emotional well-being if left untreated.
Fever, a hallmark sign of infection, is a common constitutional symptom. It is induced by the release of interleukin-1 (IL-1), IL-6, and tumour necrosis factor-α (TNF-α), which act on the hypothalamus to alter the body's temperature set point. Fever is often accompanied by anorexia, and this combination can significantly impact the patient's nutritional status. Other constitutional symptoms that may accompany fever include chills, night sweats, malaise, headache, myalgia, and unintended weight loss. These symptoms can suggest infection or malignancy, especially in immunocompromised patients or those with risk factors for infection, such as recent bacterial infections or injection drug use.
Fatigue is another common constitutional symptom, especially in adolescents. It can lead to a decreased interest in normal activities and contribute to a patient's overall sense of malaise. Lymphadenopathy, or inflammation of the lymph nodes, is also reported in a significant number of cases, along with alopecia and arthralgias. These symptoms may occur at the onset of the disease or during flare-ups.
Vital signs, including temperature, heart rate, breathing rate, and blood pressure, can provide an immediate measurement of the body's overall functioning and health status. However, it is important to note that these ranges vary with age, weight, gender, and general health. While some symptoms are specific to certain diseases, many are non-specific, and a comprehensive evaluation is necessary to narrow down the potential diagnoses.
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Frequently asked questions
Signs and symptoms are diagnostic indications of an illness, injury, or condition. Signs are objective and externally observable, while symptoms are a person's reported subjective experiences. Constitutional symptoms are common and include profound fatigue, anorexia, weight loss, low-grade fever, and malaise.
Some examples of constitutional symptoms are chills, night sweats, unintended weight loss, and depression. These symptoms are prevalent in many diseases and by themselves are not specific to a particular condition.
The presence of constitutional symptoms should alert the clinician to the possibility of a serious systemic illness. For example, the association of constitutional symptoms with knee pain could suggest a primary tumor or metastatic disease. If the patient is immunocompromised, the constitutional symptoms are especially concerning.
