Sepsis is a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs. A key sign of sepsis is an elevated or abnormally low body temperature. However, some people wonder if it’s possible to have sepsis without a fever. This article will examine the relationship between temperature changes and sepsis and discuss whether sepsis can develop without spikes or drops in temperature.
What is sepsis?
Sepsis occurs when an infection triggers a chain reaction throughout the body, setting off widespread inflammation that can lead to tissue damage, organ failure, and death. It is a medical emergency that requires rapid treatment to prevent serious complications and death.
Sepsis begins when an infection – often bacterial, but sometimes fungal or viral – enters the bloodstream and overwhelms the body’s immune defenses. The infection triggers the release of inflammatory chemicals, causing changes that can damage multiple organ systems.
Some key facts about sepsis include:
- It can start from an infection anywhere in the body, but common sites include the lungs, urinary tract, skin, and abdominal organs.
- Common culprits include bacteria such as Staphylococcus aureus and Escherichia coli.
- People with weakened immune systems are at higher risk.
- It can lead to septic shock, a dangerous drop in blood pressure that impairs blood flow and oxygen delivery.
- Sepsis requires emergency medical treatment and can progress quickly to multi-organ failure.
- Even with treatment, sepsis carries a risk of death typically ranging from 20-50%.
The speed at which sepsis worsens emphasizes the need for rapid recognition and treatment. Doctors watch for several signs and symptoms that can indicate sepsis is developing.
What are the symptoms of sepsis?
The symptoms of sepsis result from the widespread inflammation and its effects on organs and tissues. No single sign or symptom definitively indicates sepsis, but several suggestive findings together raise suspicion. Typical signs and symptoms include:
Fever
A temperature over 101°F (38.3°C) or under 96.8°F (36°C) is one of the most common signs of sepsis. Fever indicates that the immune system has shifted into high gear to combat an infection. The temperature change is triggered by pyrogenic cytokines – inflammatory chemicals that act on the hypothalamus, the body’s temperature control center.
In some cases, sepsis causes hypothermia rather than fever. This can result from poor circulation or the effects of inflammation on the hypothalamus. A low temperature indicates sepsis may be advanced.
Rapid heart rate
Tachycardia, or heart rate over 90 beats per minute, often accompanies infection and can signify sepsis. As infection and inflammation progress, the heart works harder to pump blood and oxygenate tissues.
Rapid breathing
Faster than normal breathing, called tachypnea, arises as the body tries to increase oxygenation to stressed organs. Adults with sepsis often breathe over 20 times per minute.
Confusion or disorientation
Mental status changes occur as inflammation impairs brain cell function. Confusion and sleepiness are common in sepsis.
Extreme pain or discomfort
Widespread inflammation can cause muscle aches, joint pain, and general discomfort. Altered mental status may lead to lack of reaction to pain.
Clammy or sweaty skin
Sepsis commonly causes changes in skin appearance and sweating. Pale skin, patchy rashes, blue tinge to the lips or nails, and clamminess signal poor circulation and oxygenation.
Other possible signs
Additional indicators of sepsis can include:
- Low blood pressure from vascular effects of inflammation
- Elevated white blood cell count as the immune system reacts
- Kidney dysfunction from impaired circulation and cell damage
- Abnormal coagulation with increased clotting risk
- Decreased urine output as the kidneys falter
- High lactate levels indicating impaired tissue oxygenation
- Shortness of breath from fluid buildup and poor oxygen exchange
Not everyone with sepsis exhibits all of these manifestations. However, the presence of several suggestive clinical and lab findings warrants investigation for sepsis as the root cause.
How is sepsis diagnosed?
Doctors diagnose sepsis based on symptoms, examination findings, and test results indicating widespread inflammation, organ dysfunction, and confirmed or suspected infection. There is no single definitive test for sepsis. Key components of diagnosis include:
History and clinical evaluation
The doctor elicits a thorough history to identify any recent illness, infection exposures, medical conditions, medications, and details about current symptoms. Vital signs showing fever, rapid breathing and heartbeat, and blood pressure changes provide initial clues. The physical exam helps identify signs of infection and organ impairment.
Lab tests
Common lab tests in sepsis evaluation include:
- Complete blood count to check for elevated white blood cell count
- Blood cultures to identify pathogens
- Urinalysis and culture to detect urinary tract infection
- Coagulation studies to assess blood clotting function
- Comprehensive metabolic panel to evaluate organ function
- Lactate level to determine degree of tissue oxygen deprivation
- C-reactive protein and procalcitonin to confirm inflammatory response
Imaging and other tests
Depending on the suspected infection source, imaging like chest x-ray, CT scan, or ultrasound may help locate infection. Tests like lumbar puncture may be needed to diagnose meningitis.
Sepsis screening tools
Systems like the Sequential Organ Failure Assessment (SOFA) score and quick SOFA (qSOFA) criteria rapidly identify sepsis likelihood based on clinical criteria. Specific sepsis biomarkers are also in development.
How is sepsis treated?
Sepsis requires urgent, aggressive treatment for the best chance of recovery and survival. Goals of treatment include:
- Rapid antibiotic therapy to fight the underlying infection
- Intravenous fluids and medications to maintain blood pressure
- Oxygen and respiratory support if needed
- Treating organ dysfunction, which may require ICU care
- Identifying and draining infected fluid collections
- Medications to improve heart and circulatory function
In many cases, sepsis treatment begins before the infecting organism is identified, using broad-spectrum antibiotics that act against multiple types of bacteria. Once lab tests pinpoint the pathogen, doctors can select more targeted antibiotics.
Sepsis requires monitoring in the hospital intensive care unit. Even after the infection improves, recovery can be prolonged due to lasting organ damage. Rehabilitation services are often needed before discharge home.
With rapid diagnosis and proper treatment, many patients with sepsis can recover fully. But delays in treatment can be fatal – in severe sepsis, mortality increases roughly 8% per hour that appropriate antibiotics are delayed. Quick recognition and medical care are imperative.
Can you have sepsis without a fever?
Fever is a very common sign of developing sepsis, but it is not an absolute requirement for the diagnosis. Sepsis can sometimes progress without early fever or with a low or normal temperature throughout illness. Factors like age, medications, and immune dysfunction influence fever patterns in sepsis.
Elderly and very young
In newborns and the elderly, the immune response to infection may differ, resulting in sepsis without a spiking fever. The very young and very old are also more prone to sepsis from atypical organisms that incite less fever. Weakened immune function in advanced age also blunts fever.
Medications
Some drugs like steroids, nonsteroidal anti-inflammatory medications, and certain cancer therapies can affect temperature regulation and fever patterns during infection. People taking these medications may have sepsis without a high fever.
Immune dysfunction
Individuals with weakened immunity from conditions like HIV/AIDS, cancer chemotherapy, and organ transplant immunosuppression may not mount a fever in response to infections that trigger sepsis. Their muted immune reaction can mask early sepsis clues.
Hypothermia
As described earlier, low body temperature can occur in sepsis, resulting from impaired thermoregulation, poor tissue perfusion, or some bacterial toxins. Sepsis with hypothermia portends worse prognosis.
Atypical presentation
While uncommon, sepsis can occasionally develop without fever or hypothermia. This tends to occur in severe sepsis reaching late stages more quickly. Lack of fever doesn’t preclude sepsis.
Key takeaways
In summary, while fever is a cardinal sign of sepsis, sepsis can develop without significant fever in some cases:
- The elderly, very young, and immunocompromised may not mount fever due to immune dysfunction
- Medications can blunt fever response even during serious infection
- Hypothermia rather than fever may manifest in some sepsis cases
- Rapidly progressive sepsis may not always cause early fever
- Regardless of temperature, urgent evaluation is needed for anyone with potential sepsis signs like confusion, extreme pain, difficulty breathing, or poor organ function
The possibility of sepsis can’t be excluded solely based on lack of high fever. Diagnosis requires a full assessment for organ dysfunction plus signs of infection. Sepsis without fever can certainly occur, and rapid treatment is still vital to prevent severe illness or death. The key is recognizing sepsis symptoms early, whether or not fever is present.
The bottom line
Fever is a frequent but not universal hallmark of sepsis. Sepsis can develop without significant fever, especially in those with impaired immune function. Regardless of temperature pattern, timely evaluation and treatment are critical in sepsis. Any sign of infection plus organ dysfunction warrants urgent medical care to halt sepsis progression, whether or not fever is present on initial assessment. The outcome depends on fast action.
