Septicemia1 is a silent killer. The absence of fever in the elderly (aged 65 years and older) in whom 42% of cases of septicemia and 6296 of the related deaths occur,2 makes septicemia particularly difficult to diagnose (see p 1478 in this issue of The Journal). Without careful antibiotic therapy, recovery is rare in this life-threatening disease. After myocardial infarction, septicemia is the most frequent cause of death in the elderly, aged 70 years and older,3 provided that all types of cancer are listed separately. In Europe, the term bacteremia indicates the temporary asymptomatic presence of bacteria in the blood and septicemia is the disease caused by established bacteremia. In the United States, the word bacteremia is used for both. I prefer the European nonmenclature, as it parallels bacteriuria and cystitis or pyelonephritis.
The disease is often iatrogenic and hospital- or nursinghome—acquired; thus, physicians should be aware
Smith IM. Afebrile Septicemia. JAMA. 1982;248(12):1502. doi:10.1001/jama.1982.03330120060034
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