Can a wound infection happen without fever?

Written by WISH Clinic

Clinically reviewed by Dr. Traci A. Kimball, MD, MBA

Last medical review

Yes. Fever is a sign of infection but never a required one — it’s one item among several, and any of them is a reason to call. In people with diabetes or pressure ulcers, infection may cause less obvious signs.

Yes. Fever is on every list of infection signs, but never as a requirement — always as one item among several.

For a venous or ischemic ulcer, the signs of infection are redness, increased warmth, or swelling around the wound; more drainage than before or drainage that is yellowish or cloudy; bleeding; odor; fever or chills; increased pain. Any one of those is a reason to contact a provider.

For a pressure sore: a foul odor from the sore, pus coming out of the sore, redness and tenderness around the sore, skin close to the sore that is warm or swollen, or fever. For a diabetic foot ulcer: redness, increased warmth, or swelling around the wound; extra drainage; pus; odor; fever or chills; increased pain; increased firmness around the wound.

Fever is on all three lists and required by none of them.

The usual signs can also be muted in some people. In people with diabetes or pressure ulcers, infection may cause less obvious redness but more pain, swelling, or general illness.

That matters, because those are exactly the two groups many of these wounds affect.

The same point applies to feeling. For diabetic feet, redness, warmth, or tenderness are often absent because of nerve damage, and diabetic ulcers are often painless.

The practical conclusion: waiting for a temperature before reporting a wound that has changed is waiting for something that may not come. The lists above do not ask for fever; they ask for any one of several changes.

What to watch for

For leg ulcers, the signs of infection are redness, increased warmth, or swelling around the wound; more drainage than before or drainage that is yellowish or cloudy; bleeding; odor; fever or chills; increased pain. Any one is a reason to contact a provider.

In people with diabetes or pressure ulcers, infection may cause less obvious redness but more pain, swelling, or general illness.

For diabetic feet, redness, warmth, or tenderness are often absent because of nerve damage.

A person who seems generally unwell, with a wound that looks much as it did, is worth reporting on that basis alone.

Wound Wizard is general education and can’t tell you whether a wound is infected. Your own clinician is the right person to ask.

What we look at

  • Examining the wound and the skin around it
  • Deciding whether the wound is infected
  • Taking account of conditions that mute the usual signs
  • Choosing treatment if it is infected

Related questions

Sources

  1. Venous ulcers - self-care — MedlinePlus, U.S. National Library of Medicine https://medlineplus.gov/ency/patientinstructions/000744.htm
  2. How to care for pressure sores — MedlinePlus, U.S. National Library of Medicine https://www.medlineplus.gov/ency/patientinstructions/000740.htm
  3. Diabetes - foot ulcers — MedlinePlus, U.S. National Library of Medicine https://medlineplus.gov/ency/patientinstructions/000077.htm
  4. Wound Q&A for patients and relatives — European Wound Management Association
Non-healing wound care at The WISH Clinic

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