Bacteremia may present with a lot of signs and symptoms depending on the site of the primary infection, comorbid events and stage of the disease.

The following system-wise presentation are eminent in the majority of bacteremia cases:

General Appearance: Patients in severe bacteremia may present with pallor and lethargy due to blood coagulation and destruction. Oxygen desaturation during fulminant disease may present with cyanosis.

Systemic response: Fever is the most common heralding sign of infection and bacteremia in both children and adults due to a set point resetting which may lead to diaphoresis (excessive sweating). Older people may present with hypothermia due to incompetent immune response.

Head and Neck: Micro-hemorrhages of the conjunctiva may occur with DIC.

Chest and Heart: Patients will appear frequent and shallow breathing with severe bacteremia due to metabolic acidosis that decreases the blood pH. Heart murmurs are accentuated with bacterial endocarditis.

Abdomen: Enlargement and hardening of the abdomen may be observable if bacteremia complicates to peritonitis. Bleeding via the anus may be observed with blood coagulation complications

Extremities: Extremities may appear cold and clammy due to vasodilation with cytokine proliferation. Pulses may be less palpable due to late signs of septic shock.

• Fever

  Children younger than 3 years commonly develop fevers. Most of the time, they have other symptoms, such as a cough and runny nose, which help doctors diagnose the cause of the fever. Sometimes, however, children have fever and no other symptoms. [merckmanuals.com]

  Management of fever without source in infants and children. Ann Emerg Med. 2000;36:602-614. [ Links ] 2 Simon AE, Lukacs SL, Mendola P. [scielo.br]

  Fever on the day of FUBC was associated with higher rates of positive FUBC for gram-positive cocci (GPC) but not GNB. Mortality and care in the intensive care unit were not associated with positive FUBC. [ncbi.nlm.nih.gov]

  In the same way, bacteremia may stand as a complication of a primary diseases like typhoid fever, staphylococcal skin infections, and streptococcal pneumonia. [symptoma.com]

• Chills

  Among patients with normal food consumption, without shaking chills, the incidence of true bacteremia was 2.4% (13/552). Among patients with poor food consumption and shaking chills, the incidence of true bacteremia was 47.7% (51/107). [journalofhospitalmedicine.com]

  The severity of chills graded on an ordinal scale (shaking chills, LR, 4.7; 95% CI, 3.0-7.2) may be more useful. [ncbi.nlm.nih.gov]

  In febrile patients, the presence or absence of chills is more informative, and the presence of shaking chills may be the most useful finding (Table 89-1). [jamaevidence.mhmedical.com]

  Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. [icd9data.com]

• Hypothermia

  Older people may present with hypothermia due to incompetent immune response. Head and Neck: Micro-hemorrhages of the conjunctiva may occur with DIC. [symptoma.com]

  Fever > 38.0C measured at least twice in the 48 h prior to recruitment; or > 38.5C once during the 48 h; or hypothermia Previous enrollment in this trial Concurrent participation in another clinical trial Information from the National Library of Medicine [clinicaltrials.gov]

  Some of the symptoms of bacteremia are: High fever Hypothermia Hypoxemia A rapid heart beat Rapid breathing Nausea Paleness Weakness The above mentioned symptoms are normally felt when bacteremia is progressing and becoming septic however when mild bacteremia [howshealth.com]

  Anaerobic bloodstream infection episodes were also more likely to be associated with hypothermia and hypotension at the time the blood culture was obtained. [doi.org]

  Elderly patients also are more likely to have atypical presentations, such as hypothermia rather than a fever, or nonspecific presentations when septic. [atsu.edu]

• Rigor

  An extensive variety of clinical manifestations, such as fever, rigors, shock, altered circulatory dynamics, cutaneous manifestations changes in the coagulation, complement, and other mediator systems, and effects on the lungs, heart, kidney, liver, and [ncbi.nlm.nih.gov]

  Few hours later, the patient started to improve; the pyrexia and the rigors subsided and the BP started to stabilize. Thereafter the patient maintained her hemodynamic stability. [casesjournal.biomedcentral.com]

  In both guidelines CD 12,14,15 it is plain to see that we need more clinical studies with high levels of scientific evidence for a more adequate and rigorous implementation of their recommendations. [medintensiva.org]

• Malaise

  Symptoms Symptoms of bacteremia may include: fever over 101°F (38.3°C) chills malaise abdominal pain nausea vomiting diarrhea anxiety shortness of breath confusion Not all of these symptoms are usually present. [encyclopedia.com]

  Symptoms Symptoms of bacteremia may include: fever over 101 °F (38.3 °C) chills malaise abdominal pain nausea vomiting diarrhea anxiety shortness of breath confusion Not all of these symptoms are usually present. [medical-dictionary.thefreedictionary.com]

  At this stage, some minimal malaise and low-grade fever may become manifest. Stage III If homeostasis is not restored and if the inflammatory stimuli continue to seed into the systemic circulation, a significant systemic reaction occurs. [emedicine.medscape.com]

• Pneumonia

  […] as a contaminant because none of these organisms cause pneumonia. [atsjournals.org]

  Results: Non-ESBL-producing Klebsiella pneumoniae and ESBL-producing Klebsiella pneumoniae cases are found frequently in the Mexico hospital. [scielo.sa.cr]

  Conclusions: Gram-negative infections could cause bacteremia in pediatric patients with pneumonia and K. pneumoniae resistant to third generation cephalosporin and pseudomonas infection should be considered. [erj.ersjournals.com]

  […] usually related with S. pneumoniae such as pneumonia, meningitis, or sinusitis, and the bacteremia occurred 30 days after hospitalization. [ncbi.nlm.nih.gov]

  […] and treatment characteristics 93 12.16 % 672 87.84 % Pneumonia characteristics Pre-pneumonia LOS, days Mean [SD] 11.3 [15.0] 8.6 [13.7] Median (IQR) 4.7 (1.1, 15.8) 4.6 (0.9, 11) 0.333 ICU prior to pneumonia 15 16.13 % 94 13.99 % 0.634 Pneumonia type [ccforum.com]

• Hypotension

  […] between institutions; however, patients at Stanford were more likely to have had a diagnosis of bone marrow transplantation, liver failure, or poor nutritional status, while more patients at UCSF had solid organ transplant, diabetes, pulmonary disease, or hypotension [ncbi.nlm.nih.gov]

  Hypotension was defined as a mean arterial pressure less than 65 mm Hg, the only available cutoff. [doi.org]

  Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock Crit Care Med 2006;34:1589-1596 Ulldemolins M, Nuvials X, Palomar M, Masclans JR, Rello J. [uwhealth.org]

  Tachycardia and hypotension have been studied at different thresholds, but generally have LRs < 2.0 and, as isolated findings, have low diagnostic accuracy. [jamaevidence.mhmedical.com]

• Hypertension

  The patient, a woman aged 41 years, had hypertension and chronic renal disease, and died following an exploratory laparotomy for abdominal pain. [journals.lww.com]

  A 65-year-old man with a prior diagnosis of alcoholic cirrhosis, type 2 diabetes mellitus, and hypertension presented with hematemesis to the community hospital He was referred to our hospital for further examination and treatment because sources of bleeding [ginmu.naramed-u.ac.jp]

  The second case is a 88-year-old diabetic and hypertensive woman with significant vasculopathy, diagnosed with ACKD secondary to diabetic nephropathy, on haemodialysis through a femoral CVC, who was admitted due to septic shock of uncertain origin. [revistanefrologia.com]

  The patient is known with type 2 diabetes, hypertension, mixed dementia, spastic paraplegia, urinary bladder tumour that was excised endoscopically and permanent urinary catheter. [alliedacademies.org]

  Case An 82-year-old man with non-Hodgkin’s lymphoma in remission and a history of congestive heart failure and hypertension presents with one week of generalized malaise and intermittent fevers. [the-hospitalist.org]

• Tachycardia

  Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. [icd9data.com]

  Tachycardia and hypotension have been studied at different thresholds, but generally have LRs < 2.0 and, as isolated findings, have low diagnostic accuracy. [jamaevidence.mhmedical.com]

  […] with at least one blood culture positive for S. aureus within 48 hours before randomization At least one of the following signs or symptoms of bacteremia: Temperature ≥ 38.0°C WBC count > 10,000 or < 4,000 cells/µL or > 10% immature neutrophils (bands) Tachycardia [clinicaltrials.gov]

  No significant differences between groups were observed as regards T° >37 °C, p = 0.25; T° >39 °C, p = 0.39; tachycardia, p = 0.47; consciousness disorder, p = 0.79; myalgia, p =0.54; tachypnea, p = 0.47; mean blood pressure (MBP) <65, p = 0.08, or central [revistasam.com.ar]

• Neck Pain

  He also mentioned an acute upper back and neck pain 5 days before, for which he had visited the on-call emergency department and for which he was prescribed analgesics. The patient reported a history of hypertension, dyslipidemia and hyperuricemia. [nature.com]

• Confusion

  Sepsis is a clinical condition involving bacteria in the blood as well, which is why it is commonly confused with bacteremia. [apollomd.com]

  However, C. kerstersii maybe be confused with Comamonas testosteroni using the automatic bacterial identification systems currently available. [ncbi.nlm.nih.gov]

  Sepsis can lead to signs such as: Fever Chills, which may include shaking A rapid heart rate A rapid and shallow rate of breathing Mental changes, like confusion In the worst cases, sepsis can turn into septic shock. [study.com]

  Upon admission, the clinical examination revealed the following: pale, dry skin, basal crackles, SaO 2 91%, hypotension (a systolic blood pressure of 88 mmHg), heart rate of 98/min, spastic paraplegia, and confusion. [alliedacademies.org]

• Renal Insufficiency

  […] calculi Renal insufficiency Urinary tract obstruction Complications Meningitis Endocarditis Osteomyelitis Sepsis Cellulitis Peritonitis Consultations Infectious disease consultation is usually indicated. [ncbi.nlm.nih.gov]

• Oliguria

  El GA presentó más: escalofríos 22 (44%) frente a 54 (26,60%), p = 0,016; sudoración, 21 (42,00%) frente a 50 (24,63%); p = 0,014; oliguria, 8 (16%) frente a 14 (6,9%); p = 0,04; signos de hipoperfusión periférica, 12 (24%) frente a 19 (9,36%); p <0,01 [revistasam.com.ar]

  Some clues to a septic event include fever, hypotension, oliguria (diminished excretion of urine), or anuria (no urine excreted); tachypnea and hypothermia without obvious cause; and bleeding. [atsu.edu]

  The CDC-approved diagnosis of clinical sepsis requires the presence of at least 1 of the following clinical signs or symptoms with no other recognized cause—temperature >38°C, hypotension, or oliguria—and the presence of all of the following conditions [doi.org]

The following laboratory workups are used in occult and persistent bacteremia:

• Blood Culture and Sensitivity testing: This diagnostic test isolates the bacteria and determines the ideal antibiotic to be used in the disease.
• Urinalysis: Assess the possibility of urinary tract infection in patients.
• White blood cell (WBC) count: This is the most common test used in Bacteremia. A WBC count of more than 15 per high power field demonstrates occult and persistent bacteremia.
• Absolute neutrophil count (ANC): This test is 76-82% sensitive for occult bacteremia illustrated in a figure of 7,000-10,000 ANC [8].
• Cerebrospinal fluid (CSF) analysis: Harvested through a lumbar tap, CSF analysis is a valuable tool in determining meningitis.

• Staphylococcus Aureus

  Staphylococcus aureus bacteriuria as a prognosticator for outcome of Staphylococcus aureus bacteremia: a case control study. BMC Inf Dis. 2010;10:225. Lodise TP, McKinnon PS, Swiderski L, Rybak MJ. [the-hospitalist.org]

  I provided the questions and he composed the following… Most recent studies on Staphylococcus aureus have focused on the methicillin-resistant S. aureus (MRSA), but infections due to methicillin-susceptible S. aureus (MSSA) continue to represent a significant [idstewardship.com]

  Emergence of vancomycin resistance in Staphylococcus aureus. Glycopeptide-intermediate Staphylococcus aureus Working Group. N Eng J Med. 1999;340:493-501. 48. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. [revistabiomedica.org]

  BACKGROUND: Staphylococcus aureus bacteremia (SAB) causes a significant burden on the population. [ncbi.nlm.nih.gov]

• Gram-Positive Bacteria

  Variations in PCT serum concentrations are not determined solely by Gram-negative or Gram-positive bacteria but are also affected by distinct groups of pathogens and different foci of infection. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01187134. [ncbi.nlm.nih.gov]

  Convert to ICD-10-CM : 790.7 converts approximately to: 2015/16 ICD-10-CM R78.81 Bacteremia Approximate Synonyms Bacteremia (bacteria in blood) Bacteremia due to gram negative bacteria Bacteremia due to gram positive bacteria Bacteremia due to Salmonella [icd9data.com]

  These are largely anaerobic Gram-negative bacteria under the gum-line and facultative gram-positive bacteria above the gum-line. Oral microbial communities ultimately overwhelm the local immune response and facilitate local infection. [augusta.pure.elsevier.com]

  The treatment regimen is decided based on the type of bacteria involved in the infection. In gram-positive bacteria, there are methicillin-resistant Staphylococcus epidermis and Staphylococcus aureus strains. [medindia.net]

• Gram-Positive Coccus

  Parvimonas micra is an anaerobic, Gram-positive coccus belonging to oral, gastrointestinal and genital flora, rarely causing infections in humans. [ncbi.nlm.nih.gov]

  122 14.3 True positive 75 8.8 Gram‐positive coccus 26 3.1 Gram‐negative baccili 46 5.4 Gram‐negative coccus 1 0.1 Fungus 1 0.1 Anaerobic 1 0.1 Contamination 47 5.6 Blood culture negative 729 85.7 Food consumption Low food consumption group 344 4.4 Moderate [journalofhospitalmedicine.com]

• Leukocytosis

  […] for adult patients with isolated fever or leukocytosis without considering the pretest probability. [doi.org]

  Elevated temperatures alone do not accurately predict bacteremia (for ≥38°C [>100.3°F], LR, 1.9 [95% CI, 1.4-2.4]; for ≥38.5°C [>101.2°F], LR, 1.4 [95% CI, 1.1-2.0]), nor does isolated leukocytosis (LR, <1.7). [ncbi.nlm.nih.gov]

  Population in Whom Bacteremia Should Be Considered Bacteremia is considered when patients have fever, chills, leukocytosis, focal infections, or signs of shock without an obvious cause, or when the physician suspects endocarditis. [jamaevidence.mhmedical.com]

  The blood test showed leukocytosis (10,850/>L, normal formula), hemoglobin 12.1 g/dL, C-reactive protein 10 mg/L. The rest of analyzed parameters were normal range. [revistanefrologia.com]

In non-complicated bacteremia, the symptom of fever may be treated with acetaminophen. In general, bacteremia may clinically be treated with empiric doses of antibiotics and antifungal to shorten its clinical course and reduce complication.

Empiric treatments should always be reassessed with periodic blood cultures to rule out bacterial resistance to the treatment [9].

In meningitis, parenteral antibiotics were found to be more effective than oral antibiotics for treatment and in reducing its sequelae [10].

Complication of metabolic acidosis with sepsis should be controlled by altering it with parenteral sodium bicarbonate. Uncontrolled systemic inflammation may be allayed by the introduction of hydrocortisone in the blood stream.

Those in shock may be stabilized by the use of plasma expanders and intravenous fluids.

Occult bacteremia is arbitrarily self-limiting to all patient. In severe bacteremia cases however, risk were significantly higher in the age group below 3 months and beyond 55 years old. The absence of prior immunizations worsens the prognosis.

Morbidity state of children and adults will also be an indispensable predictor of bacteremia prognosis. The nature of the invading bacteria may influence the outcome of bacteremia. The World Health Organization (WHO) has conveyed that more than 6 million children die from pneumococcal infections presenting in either bacteremia, meningitis or pneumonia in developing countries worldwide [7].

Complications

Patients may present with the following complications with persistent and severe bacteremia:

• Sepsis: Uncontrolled bacteremia may proliferate and induce this systemic state and response. Sepsis may further complicate to septic shock or disseminated intravascular coagulation (DIC) and eventually death.
• Abscesses: Local bacteremia may spread to the skin and give rise to abscess.
• Meningitis: This represents the bacterial infection of the brain’s meninges.
• Peritonitis: Bacteremia that emanates from the intestine or stomach may complicate to involve the peritoneum.
• Endocarditis: Inflammation of the heart that are usually seeded from prosthetic heart valves or dental procedures.
• Organ failure: An endstage organ damage may be eminent in overwhelming infections.

Bacteremia may be occult or persistent (overwhelming) in nature. It may arise from any infections of the body like the lungs, abdomen, skin or urinary system.

Bacteremia may also incite infections of susceptible organs and may coexist with these primary infections of the bones (osteomyelitis), brain (meningitis) and the heart (endocarditis).

In the same way, bacteremia may stand as a complication of a primary diseases like typhoid fever, staphylococcal skin infections, and streptococcal pneumonia.

The incidence of isolated bacteremia may be challenging because of the existence of comorbid illnesses that disrupts the clinical presentation. With this regard, cohort studies tag bacteremia with common signs of significant temperature elevation, clinical appearance, associated risk factors and laboratory criteria.

In a United States study, incidence of bacteremia in children less than 3 months old without prior Haemophilus influenza type B (HiB) immunization were noted to be 1-2.2% for non-toxic infants, and 10-11% in infants that are toxic [1]. However, in age group 3-36 months old, the risk of serious bacteremia climbs to 10-90% [2]. The most common causative agent in infants less than 3 months old is Eschericha coli at 42% of cases while group B Streptococcus at 23% of cases [3]. Infants and children with concurrent immunization lowers the risk of bacteremia to 0.5% incidence [4].

Bacterial or viral invasion may triggers an immune response by releasing cytokines in the plasma. The assimilation of the cytokines causes a resetting of the thermoregulatory centers of the hypothalamus manifesting as fever (or increased of body temperature) [5]. The fidelity of the immune system dictates whether bacteremia is spontaneously resolved or whether it overwhelms the host.

Young children with immature immune system are unable to mount efficient immunoglobulin G (IgG) to combat encapsulated bacterial pathogens. Their opsonin and macrophage surface defense may also be underdeveloped to prevent bloodstream invasion [6]. Adult and child patients with immune-compromised states like those in antineoplastic drugs and those with inherent antibody defects may be a predictive sign for severe bacteremia. Prior immunizations with specific antigens may influence the type of invading organism in bacteremia among children.

Routine multiple immunization at an early age may significantly reduce the risk of persistent bacteremia and may directly influence patient morbidity and mortality. High risk patients for endocarditis like those with cardiac implants and those undergoing dental procedures should be given prophylactic antibiotics to prevent fulminant bacteremia.

Dirty wounds and surgical wounds should be dressed with antiseptics liberally to prevent pathogens from invading the bloodstream. Inserted bladder catheters and nasogastric tubes should be done aseptically to reduce the risk of bacteria translocation leading to iatrogenic bacteremia.

Bacteremia is a clinical condition where there is transient proliferation of bacteria in the bloodstream. Majority of cases of bacteremia may result from tooth brushing, dental procedures, and simple medical procedures which may spontaneously resolve.

However, persistent bacteremia may develop from serious infections like pneumonia and osteomyelitis to cause life-threatening scenarios. Persistent bacteremia especially in an immune-compromised host may lead to a system-wide response referred to as sepsis.

Innocent fever in both children and adults should always be taken as a sign of impending disease and should be brought to medical attention to avoid untoward complications.

Self-medication with antibiotics should never be an option for other medicines may damage the kidneys or the liver if taken for the incorrect indication. Compliance to medications in bacteremia is of paramount importance to ensure recovery and prevent the immergence of resistant strains of bacteria.