Having chills but no fever: what it can mean

Shivering can warm the body after cold exposure, exertion, anxiety or a sudden change in temperature. A thermometer reading can be normal while an infection is developing or while the body is reacting to pain. Influenza, dengue fever, malaria, pneumonia, kidney infection and urinary tract infection may present with chills among other symptoms; the condition itself should not be inferred from chills alone. Sepsis is a medical emergency that can include chills with confusion, fast breathing or profound weakness.

Move to a warm, dry place, change damp clothing and take small drinks if you feel well enough. Recheck your temperature with a reliable thermometer if chills return, and record timing, medicines, travel, insect exposure, urinary symptoms, cough and pain. Do not bundle up heavily if you later develop a fever. Contact a clinician if episodes recur or another symptom appears.

Call emergency services for confusion, difficulty breathing, blue or mottled skin, fainting, severe weakness, inability to stay awake, or a rapidly worsening illness. Seek prompt medical advice for chills after travel to a malaria or dengue area, pain in the side or back, burning urine, persistent cough, or a rising temperature. Infants, older adults and people with reduced immunity may need assessment despite a normal reading.

Could cold exposure, a medicine or an infection explain the episodes? How should I measure and record my temperature? Do my travel, urinary, chest or stomach symptoms change the urgency? Which warning signs should prompt emergency care?