Blood Fever begins with a prologue during which a young girl named Amy Goodenough is aboard her father's yacht in the middle of the Mediterranean when she becomes witness to a band of pirates under the command of Zoltan the Magyar who board the yacht. Zoltan's men ransack the vessel and in the process murder Amy's father who was unwilling to part with his priceless possessions. When Amy fails to get revenge by throwing a knife at Zoltan and hitting him in the shoulder, she is taken prisoner, but swears she will one day succeed in achieving vengeance.
Following the adventure SilverFin, James Bond is back at Eton where he is now a member of a secret risk-taking club known as the Danger Society. As summer vacation looms, James is given the opportunity to go to Sardinia on a field trip with one of his professors, Peter Haight and a colleague, Cooper-ffrench. While there Bond would also be able to visit his cousin, Victor Delacroix (a relation of Monique Delacroix, James deceased mother).
Prior to leaving, Bond learns of the tragedy that took place on the Goodenough's yacht from his friend, Mark Goodenough, Amy's brother who attends Eton. Bond is also witness to a mysterious group whose followers are marked on both of their hands with an ‘M’ (double M), which James eventually learns is the mark of the Millenaria, a defunct secret Italian society that has had plans throughout history to restore the Roman Empire.
Once arriving in Sardinia, James and his classmates begin a tour of the country to learn its history, during which Bond is poisoned (though the reader is not aware of it at the time) and almost killed. To get away and relax, Bond departs from his classmates to spend time with his Cousin Victor, his artist friend Poliponi, and his teenage servant Mauro. While there Victor is host to the Count Ugo Carnifex, a man who is later identified as the leader of the reorganized Millenaria that plans once again to restore the glory of the Roman Empire. Carnifex achieves the funding for such a task, as well as for his palace located high in the mountains of Sardinia, and his lavish lifestyle, by hiring pirates such as Zoltan the Magyar to plunder valuable items; however, Carnifex is a fraud who cannot actually afford to compensate his “employees”. Additionally, when Zoltan arrives at Carnifex's palace, Carnifex declares ownership over Amy Goodenough, much to the great annoyance of Zoltan, whom during his travels to Sardinia had formed a unique and strange bond with Amy.
Later Bond is once again reunited with his classmates who are now in a town near Carnifex's palace. During one night, Bond sneaks into the palace and finds Amy's cell, but is unable to rescue her and instead informs Peter Haight. Things go bad, however, when Haight reveals himself to be a loyal servant of Carnifex and had earlier attempted to poison and kill James for asking too many questions about the Millenaria. Carnifex subsequently tortures James by allowing the mosquitoes to have a field day (Carnifex betting that at some point one of them will be a carrier of malaria) while James is stripped of his shirt and strapped down, thus preventing him from escaping, killing any mosquitoes feeding and scratching itches, bringing the pain to a maximum. Bond is later rescued by Mauro's sister, Vendetta, who kisses him consistently.
Having put up with Carnifex for as long as he could bear, Zoltan turns against Carnifex by flooding his palace leaving it in ruins. Carnifex's sea plane is swept away by the water and flies straight into the count, killing him. Just prior, Bond sneaks into the palace with the help of Vendetta, much to her dismay, to rescue Amy. Vendetta is reluctant to let Bond go and attacks him. Bond convinces her not to follow and, for good measure, he gives her a tongue kiss of his own. After the destruction of the palace, Bond and Amy return to Victor Delacroix's villa, but are ambushed on the way by Peter Haight. Bond and Amy are saved, however, by Zoltan the Magyar who gives his life for their protection in the process. The grief-stricken Amy hugs Bond for comfort.
Amy and Bond arrive at Victor's villa. After skinny dipping and lying on the beach, they go up together. However, Jana Carnifex, Ugo's sister, is waiting for them. Bond tricks her, however, by jumping off the rock, while Victor distracts her. She slips and falls into a bed of sea urchins, where she finally dies from the pain and poison. As Bond and Amy wade to the surface, Amy suddenly steps on a sea urchin. Bond knows exactly how to remove it.
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