Infections That Cause Chills
Chills are a common symptom associated with numerous bacterial, viral, and parasitic infections, with bacterial infections being particularly likely to cause pronounced chills, especially when accompanied by bacteremia.1
Common Infections Associated with Chills
Bacterial Infections:
- Plague (Yersinia pestis) - Presents with severe malaise, headache, vomiting, chills, cough, and abdominal pain. The septicemic form specifically includes fever and chills as prominent symptoms.1
- Q fever (Coxiella burnetii) - Causes mild to moderate flu-like symptoms including headache, fever, myalgia, arthralgia, anorexia, and sweats.1
- Melioidosis (Burkholderia pseudomallei) - Highly variable presentation that may include flu-like symptoms such as chills, headache, and joint pain.1
- Gram-negative bacteremia - Particularly associated with pronounced chills, with Klebsiella infections having an unusually high frequency of chills.2
Viral Infections:
Significance of Chills in Infection
Predictive value for bacteremia: Patients presenting with shaking chills have significantly higher odds of bacteremia (OR 5.9) compared to those without chills, making this an important clinical sign for serious bacterial infections.3
Diagnostic importance: The presence of shaking chills should prompt immediate consideration of blood cultures before starting antibiotics, as recommended by the Society of Critical Care Medicine.4, 5
Prognostic significance: Interestingly, in early sepsis from community-acquired pneumonia or pyelonephritis, patients with chills may have better long-term survival rates, possibly indicating a more efficient host immune response.6
Specific Clinical Scenarios Where Chills Are Prominent
Hemodialysis patients: Approximately 60% of hemodialysis patients presenting with chills during dialysis have an infection, with 33.5% having bacteremia, particularly those with vascular catheter access.7
Cholangitis and pyelonephritis: These conditions typically produce an abrupt temperature spike often accompanied by chills, with cholangitis having an unusually high frequency of chills.2
Chronic prostatitis: Bacterial prostatitis (Category I - acute) often presents with systemic symptoms including fever and chills, requiring prompt antimicrobial therapy.8
Diagnostic Approach to Patients with Chills
Blood cultures: Should be obtained before starting antibiotics in patients with chills, especially when accompanied by fever, as these symptoms are specific indications for blood cultures.4
Timing: Blood cultures should be taken as soon as possible after the onset of chills, without delaying antibiotic administration more than 45 minutes.5
Volume and technique: At least two sets of blood cultures (aerobic and anaerobic) should be obtained using proper aseptic technique.5
Treatment Considerations
Empiric antibiotics: Should be initiated promptly in patients with chills and suspected infection, particularly if accompanied by hemodynamic instability.1
Antibiotic selection: For respiratory infections, ciprofloxacin may be appropriate for certain pathogens, though it is not the first choice for pneumococcal pneumonia.9
Antiviral therapy: For influenza-related chills, oseltamivir should be started within 48 hours of symptom onset.10
Common Pitfalls to Avoid
Delaying antibiotics: Each hour of delay in administering antimicrobials in septic patients with chills is associated with increased mortality.5
Missing bacteremia: Patients with chills but no fever may still have bacteremia, so the absence of fever should not rule out serious infection.3
Overlooking non-infectious causes: While chills strongly suggest infection, they can occasionally be caused by non-infectious conditions such as medication reactions or malignancies.1
Remember that chills represent a physiological response to pyrogens and are an important clinical sign that should prompt thorough evaluation for underlying infection, particularly bacterial infections with potential for bacteremia.1, 3