Signs of Infection — to Watch For During Chemotherapy
An infection during chemotherapy can become life-threatening within hours — and it may not come with the fever you expect. Knowing which signs to act on, and acting immediately, is what prevents a serious situation from becoming a critical one.
Medically reviewed by Dr. Naresh Gundu, Medical Oncologist, MBBS (Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar) · DNB Internal Medicine (Sir Gangaram Hospital, New Delhi) · DM Medical Oncology (AIIMS) · Last reviewed September 2026
- No fever does not mean no infection — Chemotherapy lowers the cells that fight infection and also the ones that produce a fever. Your body may give no clear warning at all.
- The days after each cycle carry the highest risk — White cell counts drop to their lowest days after chemotherapy. Your team will tell you your personal high-risk window.
- Act the same day — In a person with low white cells, infection can become dangerous within hours. Never wait overnight to see if it settles.
- Any symptom is worth a call — Shaking, confusion, a temperature you notice, or simply feeling wrong — call your team or go to the emergency department now.
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During chemotherapy, infection is a medical emergency even without a fever. Low white blood cell counts can stop your body producing its usual warning signals. Any temperature you notice, shaking, confusion, or a feeling that something is wrong means contacting your oncology team or going to the emergency department immediately — not tomorrow.
If a symptom below applies to you, do not wait for a callback. Call 1800-202-8726 or go to your nearest emergency department.
How does infection look different when your white cell count is low?
| Sign | In a person with normal immunity | In a neutropenic patient on chemotherapy |
|---|---|---|
| Fever | Usually present and obvious | May be absent or lower than expected — do not rely on this sign alone to decide whether to act |
| Chills and shaking | Often accompanies fever | Can be the only warning sign — sometimes present even when temperature appears normal |
| Redness or swelling at the site | Clear and noticeable | May be faint or absent — the immune reaction that causes it is reduced |
| Feeling confused or very unwell | Common with any infection | Can appear before any other sign — a sense that something is wrong is enough to act on |
| Typically starts | Any time — usually resolves with treatment | Most often in the days after each cycle when counts are at their lowest. Ask your team for your personal high-risk window. |
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Not sure whether this counts as an emergency?
Call the helpline. It is always better to check than to wait.
Report any of these today — even if they seem minor
- A temperature — any reading higher than your usual
- Shaking, shivering, or rigors at any time
- Burning or pain when you urinate
- A new cough or worsening shortness of breath
- Redness, warmth, swelling, or discharge at a line site, port, or wound
- Mouth sores that have become painful or are stopping you eating or drinking
- Confusion, unusual drowsiness, or a feeling that something is wrong
- New pain anywhere — including lower back, abdomen, or around a surgical site
Why can you be seriously ill without a high fever?
Fever is your immune system's response to infection. Chemotherapy lowers your white blood cell count — these cells both fight infection and produce the fever response. Without enough of them, your body may not produce a fever even when you have a serious infection.
NCCN and ASCO guidelines describe this combination — low white cells and any temperature — as a medical emergency needing same-day assessment, not a symptom to monitor at home. The absence of fever is not reassurance. It can mean your immune system is too suppressed to respond in its usual way.
The signals your body can still produce — shaking, a sense of being very unwell, confusion, rapid breathing — are the ones to act on immediately. Your instinct that something is wrong is worth a phone call.
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HUB — Low Blood Counts, Infection and Fever During Chemotherapy
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Frequently asked questions
What if I feel unwell but I do not have a fever?
Call your oncology team or go to the emergency department regardless. During chemotherapy, a serious infection can develop without the fever response you would normally expect, because the treatment has lowered the white blood cells that create it. Feeling unwell, shaking, confusion, or a sense that something is wrong are each enough reason to act the same day. Do not wait for a temperature to appear before calling.
How quickly can an infection become dangerous during chemotherapy?
In a person with low white blood cell counts, infection can become life-threatening within hours. This is different from how infection usually progresses in a healthy person, where the immune system slows the spread. During chemotherapy there is much less to contain it. This is why your team will always tell you to call the same day — never to wait overnight or until your next scheduled appointment.
Should I wait until my next appointment to mention a symptom?
No. Infection during chemotherapy does not wait for a scheduled appointment, and your oncology team expects these calls. If you have any of the signs on this page — a temperature, shaking, a change at a line site, confusion — call the same day or go to the emergency department. Calling early keeps your options open; calling late limits them.
Can a family member's cold or stomach bug infect me?
Yes, and the risk is real during chemotherapy, particularly when your white cell count is at its lowest. Ask anyone who is unwell at home — with a cold, stomach bug, or any other infection — to avoid close contact with you until they recover. This includes not sharing cups, towels, or sleeping in the same room while they are unwell. Let your oncology team know what is happening at home so they can advise you on your specific risk at that point in your cycle.
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