Occult Pneumonia in Infants With High Fever Without Source

Abstract

In the era of PCV7, the incidence of pneumonia in infants younger than 36 months with high FWS and WBC count greater than 20 x 10(9)/L seems to be lower than that previously reported. However, this is not a uniform group because the incidence of pneumonia increases in infants older than 12 months and with higher ANC and serum CRP level.

Diagnostic properties of C-reactive protein for detecting pneumonia in children

“…A recent study in children with fever, conducted by Mintegi et al, 19 investigated the value of CRP in diagnosing pneumonia in 188 children younger than 36 months presenting in pediatric emergency departments. These children had no symptoms of LRTI, but presented with high fever without source.…”

Occult bacteraemia is uncommon in febrile infants who appear well, and close clinical follow-up is more appropriate than blood tests

“…Guidelines recommend that patients with a urinary tract infection who are older than 3 months of age should be managed as outpatients without performing specific blood analysis. Although leucocytosis may be useful in diagnosing pneumonia in patients with fever without source , in our opinion its prevalence in this group of patients does not justify performing a blood test on all of them. Close follow‐up will allow the radiologic diagnosis of pneumonia in those patients with persisting fever or onset of respiratory symptoms.…”

Occult pneumonia in a child

“…Several studies have demonstrated that leucocytosis greater than 20 × 10 9 /l and/or a C reactive protein higher than 100 mg/l are associated with the occurrence of occult pneumonia in children with fever without an apparent source 7 8. However, a recent prospective study could not confirm the predictive value of these parameters 9. We recommend clinicians to include occult pneumonia in the differential diagnosis in children with fever without a source when leucocytosis, elevated C reactive protein and abdominal pain and/or meningeal irritation are present.…”