Hyperpyrexia and high fever as a predictor for serious bacterial infection (SBI) in children—a systematic review

Rosenfeld-Yehoshua, Noa; Barkan, Shiri; Abu-Kishk, Ibrahim; Booch, Meirav; Suhami, Ruth; Kozer, Eran

doi:10.1007/s00431-018-3098-x

Cited by 23 publications

(24 citation statements)

References 43 publications

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“…It is well known that the incidence of pneumonia decreases with the introduction of the pneumococcal vaccine in the routine vaccination schedule [20] . The clinical and lab predictors of SBI identified in this study are similar to those previously reported [21][22][23][24] . In this study, pyuria as a simple point-of-care test had high specificity for predicting UTI, and 50% of UTIs were due to ESBL producing organisms.…”

Section: Discussionsupporting

confidence: 88%

Fever without Focus in Children Aged 1 to 36 Months- Aetiological Profile and Predictors of Specific Aetiology- A Prospective Observational Study

Ramanan

Arunprasath²

2022

IEM

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Backgrounds: This study aimed to describe the aetiological profile of fever without focus (FWF) in children aged one to thirty-six months and to identify clinical and laboratory predictors of specific aetiologies, especially serious bacterial infection (SBI). Materials & Methods: Children in the age range of one to thirty-six months, who were hospitalised due to FWF were included in this study. This prospective study was done over a period of 20 months in a medical college hospital in southern India. CBC (complete blood count) and CRP (c-reactive protein) tests, urine microscopic examination, blood and urine culture, Dengue antigen testing, and chest X-ray test were done for all feverish children. For those with fever beyond 5 days, additional tests including serological tests for Dengue, scrub typhus, and leptospirosis as well as Widal test were done. The final diagnosis was recorded, and clinical and laboratory parameters were analysed. Findings: Among 141 children with FWF, 41 (29%) had SBI, and 21(14.9%) had Dengue fever (DF). Leucocytosis, neutrophilia, and raised CRP levels were good predictors of SBI. Thrombocytopenia was an excellent predictor of DF. High fever was significantly associated with SBI and Dengue (p=.004), and fever beyond 3 days at presentation was significantly associated with SBI (p=<.001). Pyuria had a high specificity (94.5%) for identifying urinary tract infection (UTI). About 50% of UTIs were caused by extended spectrum beta lactamase (ESBL) producing organisms. Conclusion: SBI and DF were the most common causes of FWF. High fever, fever beyond 3 days at presentation, leucocytosis, neutrophilia, and a positive CRP test were predictors of SBI. Pyuria suggests UTI. Empirical antibiotic therapy should cover ESBL producing organisms. High fever and thrombocytopenia suggest Dengue fever.

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Section: Discussionsupporting

confidence: 88%

Fever without Focus in Children Aged 1 to 36 Months- Aetiological Profile and Predictors of Specific Aetiology- A Prospective Observational Study

Ramanan

Arunprasath²

2022

IEM

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“…This kind of fever does not require any long-term treatment and disappears on its own without any sequelae. Hyperpyrexia, indicative of bacterial infection, can also be diagnosed quickly by checking the patient’s medical history, physical examination and basic laboratory tests 3–5. However, some children suffer from long-term fevers with temperature higher than 38.3°C that last for months or even years without any clear diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Fever of unknown origin (FUO) in children: a single-centre experience from Beijing, China

Chen

Liu

et al. 2022

BMJ Open

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ObjectiveTo date, there is no standard diagnostic practice to identify the underlying disease-causing mechanism for paediatric patients suffering from chronic fever without any specific diagnosis, which is one of the leading causes of death in paediatric patients. Therefore, we aimed this retrospective study to analyse medical records of paediatric patients with fever of unknown origin (FUO) to provide a preliminary basis for improving the diagnostic categories and facilitate the treatment outcomes.DesignA retrospective study.SettingBeijing Children’s Hospital.ParticipantsClinical data were collected from 1288 children between 1 month and 18 years of age diagnosed with FUO at Beijing Children’s Hospital between January 2010 and December 2017.InterventionsAccording to the aetiological composition, age, duration of fever and laboratory examination results, the diagnostic strategies were analysed and formulated.Primary and secondary outcome measuresThe statistical analyses were carried out using SPSS V.24.0 platform along with the χ2 test and analysis of variance (p<0.05).ResultsThe duration of fever ranged from 2 weeks to 2 years, with an average of 6 weeks. There were 656 cases (50.9%) of infectious diseases, 63 cases (4.9%) of non-infectious inflammatory diseases (NIIDs), 86 cases (6.7%) of neoplastic diseases, 343 cases (26.6%) caused by miscellaneous diseases and 140 cases (10.9%) were undiagnosed. With increasing age, the proportion of FUO from infectious diseases gradually decreased from 73.53% to 44.21%. NIID was more common in children over 3 years old, and neoplastic diseases mainly occurred from 1 to 6 years of age. Among miscellaneous diseases, the age distribution was mainly in school-aged children over 6 years. Respiratory tract infection was the most common cause of FUO in children, followed by bloodstream infections. Bacterial infection was the most common cause in children with less than 1 year old, while the virus was the main pathogen in children over 1 year old.ConclusionsThe diagnosis of neoplastic diseases and miscellaneous diseases-related diseases still depends mainly on invasive examination. According to our clinical experience, the diagnostic process was formulated based on fever duration and the type of disease. This process can provide a guide for the diagnosis and treatment of paediatric FUO in the future.

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“…Although many studies have investigated predictors of SBI in young infants by implementing criteria or developing prediction models, few studies have focused on using the vital signs, such as body temperature, pulse rate, and oxygen saturation . One subgroup analysis of a systematic review showed that young infants with fever >40°C had a significantly high risk of SBI, but no study has defined the cut‐off point for each vital sign. The concept of systemic inflammatory response syndrome (SIRS) may be useful in this regard because SIRS is defined according to vital sign cut‐offs .…”

Section: Discussionmentioning

confidence: 99%

Predicting serious bacterial infection in febrile young infants utilizing body temperature

Nomura

Ihara

Sakakibara³

et al. 2019

Pediatrics International

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Background Febrile young infants have a high risk of serious infection. Although measuring vital sign parameters can serve as a rapid and effective assessment in these patients, their predictive value for serious bacterial infection (SBI) has not been fully investigated. Methods This retrospective observational study enrolled febrile (>38.0°C) infants aged <90 days at the time of presentation. Data from the emergency room triage database at Tokyo Metropolitan Children's Medical Center for the period 1 November 2011–30 November 2013, were reviewed. Variables included patient age, gender, and vital sign data, including body temperature, pulse rate, oxygen saturation, definitive diagnosis, and disposition. Results Two hundred and sixty‐nine patients were included, with a mean age of 55 days, and 158 (58.7%) were male. Of the total, 43 patients had an SBI. On logistic regression, body temperature ≥38.5°C (OR, 2.80; 95%CI: 1.37–5.74) was a significant predictor of SBI. Conclusion High‐grade fever was found to be a significant predictor of SBI in febrile young infants.

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Hyperpyrexia and high fever as a predictor for serious bacterial infection (SBI) in children—a systematic review

Cited by 23 publications

References 43 publications

Fever without Focus in Children Aged 1 to 36 Months- Aetiological Profile and Predictors of Specific Aetiology- A Prospective Observational Study

Fever without Focus in Children Aged 1 to 36 Months- Aetiological Profile and Predictors of Specific Aetiology- A Prospective Observational Study

Fever of unknown origin (FUO) in children: a single-centre experience from Beijing, China

Predicting serious bacterial infection in febrile young infants utilizing body temperature

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