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FAQ > Can you have a central line infection without a fever?

Q: Can you have a central line infection without a fever?

Central line-associated infections can present in a variety of ways. One of the most common symptoms is a fever. For that reason, central line users with a fever above 100.4° (38° C) are instructed to go immediately to a fever.

The definition of a central line-associated bloodstream infection is often simplified to two symptoms: fever and redness or soreness around the central line. Unfortunately, these symptoms are just two possible symptoms and are very poor predictors on their own.

Not every infection is accompanied by a fever. 1 This can cause confusion for patients and families who are deciding whether or not to seek treatment. It also leads to misdiagnosis at the hospital, where patients are sometimes discharged to home without testing or treatment based on body temperature measured there, regardless of other symptoms.

Many factors affect whether or not a person develops a fever. 2 For example, age, immunocompromised conditions, other medical conditions such as liver cirrhosis or asthma 3 4, and certain medications may affect whether or not a person runs a fever. Some studies also suggest that certain bacterial infections are more likely to cause atypical or afebrile symptoms. 1,2

It is also significant that sepsis can cause hypothermia, an abnormally low body temperature, instead of fever, an unusually high one.5

Bloodstream infection cannot be safely ruled out based on body temperature alone. Other symptoms such as lethargy, confusion, fast heart rate, shortness of breath, pain, nausea, and abnormal blood pressure should also be considered. 6,7

The only accurate way to rule out a central line-associated bloodstream infection is to draw blood cultures. The sooner this is done, the better the prognosis for recovery.

References

  1. Transient bacteremia may not cause any symptoms.
    Jayaweera JAAS, Sivakumar D. Asymptomatic central line-associated bloodstream infections in children implanted with long term indwelling central venous catheters in a teaching hospital, Sri Lanka. BMC Infect Dis. 2020 Jun 29;20(1):457. doi: 10.1186/s12879-020-05190-5. PMID: 32600427; PMCID: PMC7325288. https://pubmed.ncbi.nlm.nih.gov/32600427/
  2. Chia-Hung Yo, Meng-tse Gabriel Lee, Yenh-Chen Hsein, Chien-Chang Lee, Risk factors and outcomes of afebrile bacteremia patients in an emergency department, Diagnostic Microbiology and Infectious Disease, Volume 86, Issue 4, 2016, Pages 455-459, ISSN 0732-8893, https://doi.org/10.1016/j.diagmicrobio.2016.08.020.{https://www.sciencedirect.com/science/article/pii/S0732889316302607)
  3. Chen HY, Hsu YC. Afebrile Bacteremia in Adult Emergency Department Patients with Liver Cirrhosis: Clinical Characteristics and Outcomes. Sci Rep. 2020 May 6;10(1):7617. doi: 10.1038/s41598-020-64644-7. PMID: 32376846; PMCID: PMC7203181.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203181/
  4. El-Radhi AS. Fever in Common Infectious Diseases. Clinical Manual of Fever in Children. 2019 Jan 2:85–140. doi: 10.1007/978-3-319-92336-9_5. PMCID: PMC7122655. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7122655/
  5. Sepsis Alliance. (2023, January 5). Symptoms | Sepsis Alliance. https://www.sepsis.org/sepsis-basics/symptoms/
  6. Martins FS, Guedes GG, Santos TM, de Carvalho-Filho MA. Suspected infection in afebrile patients: Are they septic? Medicine (Baltimore). 2017 Mar;96(10):e6299. doi: 10.1097/MD.0000000000006299. PMID: 28272257; PMCID: PMC5348205.https://pubmed.ncbi.nlm.nih.gov/28272257/
  7. "Mild symptoms include malaise and nausea, and severe symptoms include high fever with rigors, hypotension, vomiting, and changes in mental status in the setting of a normal catheter exit site or tunnel, on physical examination. Exit-site infection is indicated by the presence of erythema, swelling, tenderness, and purulent drainage around the catheter exit and the part of the tunnel external to the cuff."
    Gahlot R, Nigam C, Kumar V, Yadav G, Anupurba S. Catheter-related bloodstream infections. Int J Crit Illn Inj Sci. 2014 Apr;4(2):162-7. doi: 10.4103/2229-5151.134184. PMID: 25024944; PMCID: PMC4093967. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4093967/




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