Elsevier

Journal of Infection

Volume 33, Issue 3, November 1996, Pages 185-191
Journal of Infection

Original article
Relative bradycardia in infectious diseases

https://doi.org/10.1016/S0163-4453(96)92225-2Get rights and content

Relative bradycardia in infectious diseases is a poorly defined term. No exact and useful definition exists and the underlying mechanisms are unknown. Despite this, the term is often used in the literature and in clinical practice both as a clinical sign for an individual patient and as a characteristic feature of certain specific diseases. In this study a definition of relative bradycardia as a clinical sign in an individual patient and a definition of relative bradycardia as a characteristic feature of a specific disease were established based on a reference population comprising 673 patients with various infectious diseases. Relative bradycardia as a clinical sign in an individual patient held no predictive value regarding the likely type of infection. Relative bradycardia as a characteristic feature of specific disease was found for typhoid fever (P = 0.003), Legionnaire's disease (P = 0.005), and pneumonia caused by Chlamydia sp. (P = 0.0005), but not for mycoplasma pneumonia. It was not found for other pulmonary infections, infections caused by other Salmonella sp., other extracellular Gram-negative infections, or viral infections. Thus, relative bradycardia as a clinical sign has no predictive value for obtaining a tentative diagnosis, but relative bradycardia as a feature of specific disease is seen in typhoid fever, Legionnaire's disease, and pneumonia caused by Chlamydia sp. It seems that relative bradycardia as a feature of specific disease only occurs in diseases caused by organisms that are both Gram-negative and intracellular.

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    Despite the fact that this is a well-known term, relative bradycardia in infectious diseases has been poorly defined and the underlying mechanisms are unknown. In their study, Ostergaard et al.11 concluded that relative bradycardia did not predict the likely type of infection in individual patients but that the slope of the line relating temperature and pulse was less steep in infections due to typhoid fever, Legionnaire’s disease and Chlamydia pneumonia. Relative bradycardia should not apply to patients on medications that affect the pulse (eg, beta-blockers, diltiazem, verapamil) or who have pacemaker-induced rhythm or arrhythmias 12.

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