Evaluation of post-infectious inflammatory reactions in a retrospective study of 3 common invasive bacterial infections in pediatrics

Abstract

Infectious diseases can result in unanticipated post-infectious inflammatory reactions (PIIR). Our aim was to explore PIIR in 3 frequent pediatric bacterial invasive infections in France by a retrospective monocentric study. We included children hospitalized between 2003 and 2012 for Streptococcus pneumoniae (SP), Neisseria meningitidis (NM), or Streptococcus pyogenes invasive infections. The PIIR had to have occurred between 3 and 15 days without fever despite an individually tailored antibiotic therapy. A descriptive analysis was carried out to determine PIIR risk factors. We included 189 patients, of whom 72, 79, and 38 exhibited invasive infections caused by S pyogenes, SP, and NM, respectively. The mean age was 44 months. PIIR were observed in 39 cases, occurring after a median of 8 days (5-12), with a median duration of 3 days (2-6). Fever, arthritis, and pleural effusion were observed in 87%, 28.2%, and 25.6%, respectively. In multivariate analysis, PIIR were associated with pleuropneumonia, hospitalization in an intensive care unit (ICU), and elevated C-reactive protein (CRP). PIIR were observed in 20% of children after SP, NM, or S pyogenes invasives infections. Their occurrence was associated with the initial severity but not the etiological microorganism. Further studies are warranted to confirm these findings.

Inflammatory rebound and postinfectious inflammatory response in children with pleural infection: A single‐center retrospective study

“…PIIR has been observed in different types of pediatric bacterial invasive infections. A French retrospective monocentric study identified 39 cases of PIIR in 189 children (20%) with various invasive infections due to S. pneumoniae , N. meningitis , or S. pyogenes 27 . Fever was the most frequent symptom of PIIR (87%), occurring on average 3.8 days after the end of the infectious episode.…”

“…27 pyogenes. 27 Fever was the most frequent symptom of PIIR (87%), occurring on average 3.8 days after the end of the infectious episode.…”

“…26 Rather than a persisting infection, there are several arguments in favor of a postinfectious inflammatory reaction (PIIR) defined as the presence of clinical inflammatory manifestations after the end of an infectious episode. 27 pyogenes. 27 Fever was the most frequent symptom of PIIR (87%), occurring on average 3.8 days after the end of the infectious episode.…”

“…Rather than a persisting infection, there are several arguments in favor of a postinfectious inflammatory reaction (PIIR) defined as the presence of clinical inflammatory manifestations after the end of an infectious episode 27 . PIIR has been observed in different types of pediatric bacterial invasive infections.…”