Fever without source in infants and young children: dilemma in diagnosis and management

Abstract

BackgroundThere is controversy surrounding the management of young children who have a fever without a source (FWS). Several strategies have been designed with the purpose of managing children with FWS.AimsTo assess the applicability of a standardized guideline for children up to 36 months of age with FWS.SettingPediatric emergency unit, Al-Adan Hospital, Kuwait City, Kuwait, from May 2011 to October 2011.DesignProspective, cross-sectional study.Methods and materialsThe study involved children with FWS up to 36 months of age. The guideline classifies the risk of serious bacterial infection (SBI) according to the age of the child, the presence or absence of toxemia, clinical presentation, and laboratory screening tests.ResultsA total of 481 children were included in the present study, but only 385 cases completed the study; 3.9% of patients had toxemia at the initial evaluation. We found 26 children with SBI (6.8%); 12 patients with SBI did not present with toxemia. In all, 40.4% of studied newborns were diagnosed as having a urinary tract infection, and 42.7% of patients as self-limited probable viral etiology. Of the 109 young infants without toxemia, 53.2% were classified as being at high risk of SBI. Of the 163 toddlers without toxemia, 72.4% were treated with antibiotics; 48.4% of patients received therapeutic treatment and 25.8% received empirical treatment.ConclusionThe guideline followed in our pediatric emergency unit seemed to be appropriate in following up with these children using simple laboratory tests. The most frequent SBI in this sample was urinary tract infection.

Clinical and epidemiological characteristics of children admitted with fever in emergency department with or without sepsis

“…It is important to note that the majority of the sepsis studies were conducted at intensive care units, where patients with severe sepsis and septic shock, and late stages of sepsis continuum, were included. Our finding highlights an important difference between these two populations, because in EDs, the vast majority of children present with benign and self-limited viral infections [25]. In addition, in our study, most of the patients were younger than 1 year of age.…”

The Diagnostic Significance of Hemogram Indicators and Serum Markers of Inflammation in Serious Bacterial Infections in Children Under 5 Years of Age

“…Вероятно, это связано с широким индиви-дуальным разнообразием симптомов, и прежде всего с субъективностью их оценки [17,18]. Важное место в диагностике ТБИ у детей с лихорадкой занимают лабо-раторные исследования [19]. Наиболее информативными и надежными считают показатели гемограммы (общее число лейкоцитов, нейтрофилов), а также некоторые сывороточные параметры, в частности прокальцитонин (ПКТ) и С-реактивный белок (СРБ) [20].…”

Effectiveness of Laboratory Markers in Determining Serious Bacterial Infection in Children with Fever without Source

“…Multivariate logistic regression analysis of independent markers to be used in determining SBI Lacour et al7 reported a prevalence of SBI of 27% in well-appearing FWS patients aged under 3 months and Elhassanien et al10 reported a prevalence of 6.8% in children under the age of 3 years. Well-appearing children with FWS aged between 3 months and 17 years were enrolled in our study, and the prevalence of SBI was 11.9%.While some studies have reported an association between body temperature elevation and development of SBI,…”