Clinical Profiles and Complete Blood Count Could Not Identify Children Aged 3 to 36 Months Who Had Fever Without Source at High Risk for Bacteremia

Objectives: To evaluate the incidence and causes of occult bacteremia and whether clinical profiles and complete blood count could reliably identify high-risk-for-bacteremia children aged 3 to 36 months who had fever without source (FWS).Material and Methods: The medical data of children aged 3 to 36 months who presented with FWS for 1 to 7 days but with no clinical signs of sepsis and were subsequently hospitalized between January 2007 and December 2017 with one or more of the following high risk features, body temperature >39 degrees Celsius, inactive behavior, white blood cell (WBC) count >15,000 cells per cubic millimeter (cells/mm3 ), absolute neutrophil count >10,000 cells/mm3 , or absolute band count >1,500 cells/mm3 , were recorded.Results: Bacteremia was found in 12 of 160 (7.5%) children with one or more of the high-risk features. The pathogens were non-typhoidal Salmonella (5 patients), Streptococcus pneumoniae (4 patients), and Salmonella Typhi (3 patients). None of the high-risk features could differentiate between children with and without bacteremia. Five of the 8 patients with Salmonella septicemia had normal WBC counts leading to delays in prescribing empirical antibiotics and none of them had complications. None of the 117 patients in the non-bacteremia group who did not receive antibiotics or discontinued them after negative hemoculture had complications during hospitalization.Conclusion: High-risk features could not help to identify occult bacteremia in children aged 3-36 months who had FWS.

Familial Mediterranean Fever with Neonatal Onset: Case Report

Familial Mediterranean fever (FMF) is an autosomal recessively inherited disorder characterized by recurrent fever and attacks of abdominal pain, chest pain, and joint pain. Attacks of recurrent fever and serositis are encountered clinically. Attacks may present either with only one symptom or many simultaneous symptoms. Although most of the patients are diagnosed clinically above the age of 2, those cases who are diagnosed before 2 years of age and with clinical course of isolated fever are believed to have a more serious course and tend to develop amyloidosis. In this article, a case who was admitted first on the 22nd day of life and later diagnosed to have FMF with recurrent attacks of isolated fever and no other focus is presented. We emphasize that FMF may present as early as in the first month of life, and it should be considered in cases presenting with fever of unknown origin and misdiagnosed to have late neonatal sepsis or occult bacteremia at this age group.

Etiology, Treatment, and Outcome of Children Aged 3 to 36 Months With Fever Without a Source at a Community Hospital in Southern Thailand

Background: Fever without a source (FWS) in young children can result from occult bacteremia, urinary tract infection (UTI), meningitis, or certain viral infections. In rural areas of Thailand, where bacterial cultures are not available in some community hospitals, the appropriate examination and management of FWS remain controversial. Methods: We retrospectively searched electronic medical records for medical diagnoses associated with FWS and evaluated the characteristics and clinical courses of children aged 3 to 36 months with FWS who were admitted to a community hospital in southern Thailand between January 2015 and December 2016. Results: Sixty-seven children aged 3 to 36 months with an initial diagnosis of FWS were enrolled. The median age was 11 months (interquartile range [IQR] 8-21 months). Complete blood counts, blood cultures, urine analysis results and urinary cultures were obtained from 67 (100.0%), 31 (46.3%), 47 (70.1%), and 7 (10.5%) patients, respectively. The most common empirical antibiotic administered to these patients was ceftriaxone (71.6%); however, 4 patients recovered without antibiotic administration. The median duration of intravenous antibiotic administration was 4 days (IQR 2-4 days). Intravenous antibiotics were replaced by oral antibiotics in 38 patients (62.3%). The median time to fever subsidence was 30 hours (IQR 12-60 hours). Regarding final diagnoses, 5 patients (7.5%) were diagnosed with culture-confirmed UTI, and 2 (3.0%) had bacteremia (due to contamination). The majority of the children (60, 89.6%) retained the diagnosis of FWS. Presentation at the hospital was significantly earlier in children with culture-confirmed UTI (median 1 day) than in those with culture-negative FWS (median 3 days) ( P = .019). Discussion: We evaluated the characteristics and clinical courses of young children with FWS presenting at a community hospital and the treatment approaches utilized by physicians. Although all patients had good prognoses during the study period, we identified several areas for improvement in conducting proper examinations (especially assessments for UTI in children presenting within the first day of fever onset).

Pneumococcal serotypes in children and relationship with clinical presentation and antimicrobial susceptibility in the PCV13 era

Background: The aim of this study was to analyse the serotypes causing invasive pneumococcal disease (IPD) according to the clinical presentation, and antimicrobial susceptibility in children aged ≤17 years before the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in the official paediatric schedule. Methods: We conducted a prospective study in children ≤17 years with IPD attended in three Catalan hospitals between January 2012 and June 2016. IPD cases were diagnosed by culture or RT-PCR. Demographic, microbiological, and clinical data were analysed. Associations were assessed using the odds ratio (OR) and 95% confidence intervals (CI). Results: Of the 253 cases included, 34.4% were aged < 2 years, 38.7% 2-4 years and 26.9% 5-17 years. Over 64% of cases were PCV13 serotypes. Cases with PCV13 serotypes were associated with overall pneumonia (OR:7.47[4.0-13.96]) and complicated pneumonia (OR:7.2[4.04-12.75]), overall and in each age group (p<0.05). Serotypes 3 and 1 were associated with complicated pneumonia (p<0.05). Non-PCV13 serotypes were associated with meningitis (OR:7.32[2.33-22. 99]) and occult bacteremia (OR:3.6[1.56-8.76]). Serotype 19A was more frequent in children aged <2 years and serotype 3 and 1 in those aged 2-4 years and >4 years, respectively. Forty-four cases (36.1%) were non-susceptible to penicillin and 16.4% were also non-susceptible to cefotaxime. There were no significant differences between PCV13 and non-PCV13 cases with non-susceptible penicillin strains (36.1% and 36.0%, respectively), while PCV13 cases showed more frequently non-susceptible cefotaxime strains (23.6%; p=0.010). Serotypes 19A and 14 were associated with non-susceptibility to both penicillin and cefotaxime strains (p=0.003 and p<0.001, respectively) and serotype 19A with resistant to penicillin (p=0.002) Conclusions: PCV13 serotypes were the most frequent serotypes in children aged ≤17years, mainly serotype 3, 1 and 19A. Non-PCV13 serotypes were associated with meningitis and occult bacteraemia while PCV13 serotypes with pneumonia. PCV13 and non-PCV13 cases presented high frequency of non-susceptibility to penicillin. Serotypes 19A, and 14 were associated with non-susceptibility to both penicillin and cefotaxime, and serotype19A with penicillin resistance.