Chills refer to feeling cold after an exposure to a cold environment. The word can also refer to an episode of shivering along with paleness and feeling cold. Chills (shivering) may occur at the beginning of an infection and are usually associated with a fever. Chills are caused by rapid muscle contraction and relaxation. Chills are an important symptom with certain diseases such as malaria. The underlying cause of a chill can be exposure to a cold environment, viral and bacterial infections, colds, influenza, meningitis, pneumonia, strep throat, or urinary tract infections. Symptoms that may occur with chills include: aches and pains, cough, diarrhea, earache, fever, nausea, and rash. Certain combinations of symptoms that might indicate a serious or life-threatening condition, the patient should immediately seek medical advice if these symptoms are perceived: change in level of consciousness or alertness, such as passing out or unresponsiveness, pale or bluish coloration of the skin , lips or nails (cyanosis), respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking, seizure, stiff neck and vomiting.