Febre sem sinais localizatórios: avaliação de um protocolo de atendimento

Abstract

Objective: To evaluate the applicability of a standardized guideline for children up to 36 months of age with fever without source (FWS). Methods:Prospective cohort study involving children with FWS treated at the emergency department of Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil, from June 2006 to May 2007. The guideline classifies the risk of serious bacterial infection (SBI) according to the presence or absence of toxemia, age, and temperature. Laboratory screening was based on risk assessment: complete blood count, blood culture, urinalysis, urine culture, and, if necessary, chest radiography, cerebrospinal fluid, and coproculture. Results:We studied 251 children and, of these, 215 were followed up until the final diagnosis. Toxemia was found in 20 children, and 195 were well-appearing (30 up to 3 months old and 165 from 3 to 36 months old). Among those children from 3 to 36 months without toxemia, 95 had axillary temperature > 39 ºC. In 107 (49.8%) children, there was spontaneous resolution of fever; in 88 (40.9%), benign self-limited disease was identified; and in 20 (9.3%), there was SBI. Among the cases of SBI, we identified 16 urinary tract infections, three cases of pneumonia and one occult bacteremia. Of the 215 children, 129 (60%) received no antibiotics, and 86 received antibiotics at some point (45 empirically). Empirical antibiotic treatment was maintained for an average of 72 hours. Conclusion:The guideline was shown to be appropriate to follow up these children using simple laboratory tests that can be carried out at most health facilities. The most frequent SBI in this sample was urinary tract infection.J Pediatr (Rio J). 2009;85(5):426-432: Fever without source, children, serious bacterial infection.

A Importância Da Identificação Dos Principais Sinais Gerais De Perigo Como Base Da Estratégia Aidpi

“…Caso contrário, se não houver nenhum sinal de doença febril muito grave, apenas houver a febre em si, a criança é enquadrada no quadro verde, assim deve ser oferecido antitérmicos se a febre estiver acima de 38 graus e mandála para o conforto domiciliar, devendo ser acompanhada por dois dias. É válido ressaltar que a febre só acontece em resposta a uma doença ou perturbação orgânica e, segundo o Ministério da Saúde, considera-se febre temperaturas de 37,5ºC à 39,5ºC, febre alta de 39,5ºC à 41ºC, acima de 41ºC já é um quadro hipertérmico (MACHADO et al, 2009).…”

The Value of C-reactive Protein, Procalcitonin, Interleukin-6 Levels to Predict Urinary Tract Infection in Children with Fever without A Focus

“…Prevalence of UTI in febrile children under two was reported to be 2.1-7.4% (6)(7)(8)25). In a study done by Machado et al (26), UTI prevalence was reported to be 7.4%. In a study done by Lin et al (27), on the other hand, over 20% growth was found in the urine culture of febrile infants.…”