NO fever, NO bacteriaemia?

Clinical Scenario

A 80 yo nursing home resident woman  is brought to the ED by ambulance. 

“Hypothension, cough and a hystory of heart failure ”, refers the nurse. 

She looks pale and confused, her respiratory rate is 22, oxygen saturation on room air is 90%. Ear temperature is 36,5°C, BP  is 90/60 mmHg, HR is 95.

There’re pulmonary rales. Lactate are 4 mmol/dl.

Is it a low flow heart failure or is there and underline pneumonia? Does the absence of fever rule out bacteriaemia? 

Conclusion 

Although fever has been incorporated into prediction rules for blood infections, proven infection may be present in the absence of fever. 

Temperature as a single parameter is a poor indicator of bacteremia. 

Bibliography 

TA Seigel 

Inadequacy of temperature and white blod cell count in prediting bacteremia in patients with suspected infection.

J Emerg Med 2012 vol 42 n3 pp 254-259. 

Ciro Paolillo