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Althammer A, Prückner S, Gehring GC, Lieftüchter V, Trentzsch H, Hoffmann F. Systemic review of age brackets in pediatric emergency medicine literature and the development of a universal age classification for pediatric emergency patients - the Munich Age Classification System (MACS). BMC Emerg Med 2023; 23:77. [PMID: 37491219 PMCID: PMC10369835 DOI: 10.1186/s12873-023-00851-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/14/2023] [Indexed: 07/27/2023] Open
Abstract
Currently arbitrary, inconsistent and non-evidence-based age cutoffs are used in the literature to classify pediatric emergencies. None of these classifications have valid medical rationale. This leads to confusion and poor comparability of the different study results. To clarify this problem, this paper presents a systematic review of the commonly used age limits from 115 relevant articles. In the literature search 6226 articles were screened. To be included, the articles had to address the following three topics: "health services research in emergency medicine", "pediatrics" and "age as a differentiator". Physiologic and anatomic principles with reference to emergency medicine were used to solve the problem to create a medically based age classification for the first time.The Munich Age Classification System (MACS) presented in this paper is thus consistent with previous literature and is based on medical evidence. In the future, MAC should lead to ensure that a uniform classification is used. This will allow a better comparability of study results and enable meta-analyses across studies.
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Affiliation(s)
- Alexander Althammer
- Institut für Notfallmedizin und Medizinmanagement (INM), Ludwig-Maximilians-University, Schillerstr. 53, 80336, Munich, Germany.
- Department of Anesthesiology, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
| | - Stephan Prückner
- Institut für Notfallmedizin und Medizinmanagement (INM), Ludwig-Maximilians-University, Schillerstr. 53, 80336, Munich, Germany
| | - Geogr Christian Gehring
- Institut für Notfallmedizin und Medizinmanagement (INM), Ludwig-Maximilians-University, Schillerstr. 53, 80336, Munich, Germany
| | - Victoria Lieftüchter
- Pediatric Intensive Care and Emergency Medicine, Dr. von Hauner Children's Hospital, Ludwig- Maximilians-University, Lindwurmstraße 4, 80337, Munich, Germany
| | - Heiko Trentzsch
- Institut für Notfallmedizin und Medizinmanagement (INM), Ludwig-Maximilians-University, Schillerstr. 53, 80336, Munich, Germany
| | - Florian Hoffmann
- Pediatric Intensive Care and Emergency Medicine, Dr. von Hauner Children's Hospital, Ludwig- Maximilians-University, Lindwurmstraße 4, 80337, Munich, Germany
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Lejarzegi A, Fernandez-Uria A, Gomez B, Velasco R, Benito J, Mintegi S. Febrile Urinary Tract Infection in Infants Less Than 3 Months of Age. Pediatr Infect Dis J 2023:00006454-990000000-00427. [PMID: 37171941 DOI: 10.1097/inf.0000000000003947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Urinary tract infection (UTI) is the leading cause of bacterial infection in infants younger than 3 months of age with fever without a source. OBJECTIVE The objective of the study was to analyze the characteristics of emergency department presentations of febrile infants younger than 3 months of age with a UTI and identify risk factors for invasive bacterial infection (IBI) secondary to UTI. METHODS This was a secondary analysis of a prospective observational registry that includes infants younger than 3 months with fever without a source managed at a pediatric emergency department between 2003 and 2019. RESULTS Of the 2850 patients included, 592 (20.8%) were diagnosed with a UTI (524, 88.5%, for Escherichia coli). Infants with UTIs showed significant clinical differences when compared with those not diagnosed with a bacterial infection: patients with a UTI were more likely to have a history of renal/urological problems (8.3% vs. 3.5%), temperature ≥39ºC (38.3% vs. 29%) and poor feeding (13% vs. 8.7%). Yet, nearly half (285 of the 592, 48.1%) of the infants with febrile UTIs had none of these 3 risk factors. Thirty-six infants (6.1%) had a secondary IBI. We identified the following independent risk factors for secondary IBI: infants younger than 1 month of age, parent-reported irritability, procalcitonin >0.5 ng/mL, and C-reactive protein >60 mg/L. CONCLUSIONS History and physical examination do not allow us to safely rule out a UTI among young febrile infants. Age, parent-reported irritability, and biomarkers are useful in identifying patients at increased risk of secondary IBI.
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Affiliation(s)
- Ainara Lejarzegi
- From the Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU. Bilbao, Basque Country, Spain
| | - Amaia Fernandez-Uria
- From the Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU. Bilbao, Basque Country, Spain
| | - Borja Gomez
- From the Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU. Bilbao, Basque Country, Spain
| | - Roberto Velasco
- Pediatric Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Javier Benito
- From the Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU. Bilbao, Basque Country, Spain
| | - Santiago Mintegi
- From the Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU. Bilbao, Basque Country, Spain
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Pfiffner M, Gotta V, Pfister M, Vonbach P, Berger-Olah E. Pharmacokinetics and tolerability of intranasal or intravenous administration of nalbuphine in infants. Arch Dis Child 2023; 108:56-61. [PMID: 36100355 PMCID: PMC9763164 DOI: 10.1136/archdischild-2022-323807] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 08/11/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Intranasal nalbuphine could be a safe, efficacious and non-invasive alternative to parenteral pain medication in infants. We aimed to assess pharmacokinetics (PK) and tolerability of intranasal and intravenous nalbuphine administration in infants. METHODS Prospective open-label study including infants 1-3 months of age admitted to the emergency department, receiving nalbuphine for procedural pain management. Patients were alternately allocated to a single nalbuphine dose of 0.05 mg/kg intravenously or 0.1 mg/kg intranasally. Nalbuphine PK samples were collected 15, 30 and 120-180 min after dosing. Area under the concentration time curve (AUC0-Tlast) was calculated by non-compartmental analysis (NCA) and compared by Wilcoxon test. Neonatal Infant Pain Score was assessed during nalbuphine administration and the following interventions: venous access, urinary catheterisation, lumbar puncture. RESULTS Out of 52 study subjects receiving nalbuphine, 31 were eligible for NCA (11 intravenous, 20 intranasal). Median AUC0-Tlast after 0.05 mg/kg intravenously was 8.7 (IQR: 8.0-18.6) µg×L/hour vs 7.6 (5.4-10.4) µg×L/hour after intranasal administration of 0.1 mg/kg (p=0.091). Maximum serum concentration (Cmax) was observed 30 min after intranasal administration (3.5-5.6 µg/L). During intravenous and intranasal nalbuphine administration, mild to no pain was recorded in 71% and 67% of study subjects, respectively. CONCLUSION This is the first study investigating intranasal administration of nalbuphine in infants suggesting an intranasal bioavailability close to 50%. Non-invasive intranasal application was well tolerated. Additional studies are warranted to optimise dosing and timing of interventions as Cmax is delayed by half an hour after intranasal administration. TRIAL REGISTRATION NUMBER NCT03059511.
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Affiliation(s)
- Miriam Pfiffner
- Hospital Pharmacy, University Children's Hospital Zurich, Zurich, Switzerland
| | - Verena Gotta
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children’s Hospital, Basel, Switzerland
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children’s Hospital, Basel, Switzerland
| | - Priska Vonbach
- PEDeus, a subsidiary of the University Children’s Hospital Zurich, Zurich, Switzerland
| | - Eva Berger-Olah
- Emergency Unit, University Children’s Hospital Zurich, Zurich, Switzerland
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Chen A, Zhu J, Lin Q, Liu W. A Comparative Study of Forehead Temperature and Core Body Temperature under Varying Ambient Temperature Conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15883. [PMID: 36497956 PMCID: PMC9740153 DOI: 10.3390/ijerph192315883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/20/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
UNLABELLED When the ambient temperature, in which a person is situated, fluctuates, the body's surface temperature will alter proportionally. However, the body's core temperature will remain relatively steady. Consequently, using body surface temperature to characterize the core body temperature of the human body in varied situations is still highly inaccurate. This research aims to investigate and establish the link between human body surface temperature and core body temperature in a variety of ambient conditions, as well as the associated conversion curves. METHODS Plan an experiment to measure temperature over a thousand times in order to get the corresponding data for human forehead, axillary, and oral temperatures at varying ambient temperatures (14-32 °C). Utilize the axillary and oral temperatures as the core body temperature standards or the control group to investigate the new approach's accuracy, sensitivity, and specificity for detecting fever/non-fever conditions and the forehead temperature as the experimental group. Analyze the statistical connection, data correlation, and agreement between the forehead temperature and the core body temperature. RESULTS A total of 1080 tests measuring body temperature were conducted on healthy adults. The average axillary temperature was (36.7 ± 0.41) °C, the average oral temperature was (36.7 ± 0.33) °C, and the average forehead temperature was (36.2 ± 0.30) °C as a result of the shift in ambient temperature. The forehead temperature was 0.5 °C lower than the average of the axillary and oral temperatures. The Pearson correlation coefficient between axillary and oral temperatures was 0.41 (95% CI, 0.28-0.52), between axillary and forehead temperatures was 0.07 (95% CI, -0.07-0.22), and between oral and forehead temperatures was 0.26 (95% CI, 0.11-0.39). The mean differences between the axillary temperature and the oral temperature, the oral temperature and the forehead temperature, and the axillary temperature and the forehead temperature were -0.08 °C, 0.49 °C, and 0.42 °C, respectively, according to a Bland-Altman analysis. Finally, the regression analysis revealed that there was a linear association between the axillary temperature and the forehead temperature, as well as the oral temperature and the forehead temperature due to the change in ambient temperature. CONCLUSION The changes in ambient temperature have a substantial impact on the temperature of the forehead. There are significant differences between the forehead and axillary temperatures, as well as the forehead and oral temperatures, when the ambient temperature is low. As the ambient temperature rises, the forehead temperature tends to progressively converge with the axillary and oral temperatures. In clinical or daily applications, it is not advised to utilize the forehead temperature derived from an uncorrected infrared thermometer as the foundation for a body temperature screening in public venues such as hospital outpatient clinics, shopping malls, airports, and train stations.
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Affiliation(s)
- Anming Chen
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, China
| | - Jia Zhu
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, China
- Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China
| | - Qunxiong Lin
- Guangdong Public Security Science and Technology Collaborative Innovation Center, Guangdong Provincial Public Security Department, Guangzhou 510050, China
| | - Weiqiang Liu
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, China
- Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China
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Simon H, Pedreira MC, Barbosa SMDM, Fernandes TF, Escobar AMDU. Clinical management of fever in children in Brazil: practical recommendations from an expert panel. EINSTEIN-SAO PAULO 2022; 20:eRW6045. [PMID: 35946741 PMCID: PMC9345508 DOI: 10.31744/einstein_journal/2022rw6045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 03/15/2021] [Indexed: 11/05/2022] Open
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Fever Without an Apparent Source in Young Infants: A Multicenter Retrospective Evaluation of Adherence to the Dutch Guidelines. Pediatr Infect Dis J 2020; 39:1075-1080. [PMID: 32858646 DOI: 10.1097/inf.0000000000002878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Dutch fever without an apparent source (FWS) guidelines were published to timely recognize and treat serious infections. We determined the adherence to the Dutch FWS guidelines and the percentage of serious infections in infants younger than 3 months of age. Second, we identified which clinical criteria, diagnostic tests, and management were associated with nonadherence to the guidelines. METHODS A retrospective cohort study was performed in 2 Dutch teaching hospitals. We assessed the charts of all infants with FWS who presented at the emergency departments from September 30, 2017, to October 1, 2019. Diagnostic and therapeutic decisions were compared with the recommendations, as published in the Dutch guidelines. Infants were categorized into the nonadherence group in case 1 or more recommendations were not adhered to. RESULTS Data on 231 infants were studied; 51.5% of the cases adhered to the Dutch guidelines and 16.0% suffered from a serious infection. The percentage of infants with a serious infection was higher in the adherence compared with the nonadherence group. We observed no relevant differences in clinical outcomes. Univariate regression analysis showed that an abnormal white blood cell count was associated with nonadherence (OR 0.4, P = 0.049). Not obtaining a urine and blood culture and not starting intravenous antibiotic treatment were the most frequent reasons for nonadherence to the guidelines. CONCLUSIONS Our study indicates that there was nonadherence in a large proportion of FWS cases. The guidelines may need to be adjusted to increase adherence.
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Mintegi S, Gomez B, Carro A, Diaz H, Benito J. Invasive bacterial infections in young afebrile infants with a history of fever. Arch Dis Child 2018; 103:665-669. [PMID: 29449214 DOI: 10.1136/archdischild-2017-313578] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the prevalence of invasive bacterial infections (IBI, pathogenic bacteria in blood or cerebrospinal fluid) in infants less than 90 days old with fever without a source related to the presence or absence of fever on arrival to the emergency department (ED). DESIGN Prospective registry-based cohort study. SETTING Paediatric ED of a tertiary teaching hospital. PATIENTS We included infants less than 90 days old with a history of fever evaluated in the ED from 2003 to 2016. MAIN OUTCOMES AND MEASURES The prevalence of IBI in patients with a history of fever who were febrile and afebrile on arrival to the ED. RESULTS We included 2470 infants: 678 afebrile and 1792 febrile when evaluated in the ED. Fifty-nine (2.4%) were diagnosed with an IBI (bacteraemia 46, meningitis 7 and sepsis 6): 16 in the group of afebrile infants with a history of fever (2.4%, 95% CI 1.4 to 3.8 vs 43 in the febrile group, 2.4%, 95% CI 1.8 to 3.2). Of the 16 afebrile infants with a history of fever diagnosed with an IBI, 14 were well appearing. The rate of non-IBI (pathogenic bacteria in urine or stools) was similar in both groups (15.5% and 16.7%). CONCLUSIONS The prevalence of IBI in infants ≤90 days with a history of fever is similar regardless of the presence of fever on the arrival at the ED. The approach to infants with a history of fever who are afebrile in the ED should not differ from that recommended for infants who are febrile in the ED.
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Affiliation(s)
- Santiago Mintegi
- Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain.,Department of Pediatrics, University of the Basque Country, Bilbao, Spain
| | - Borja Gomez
- Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain.,Department of Pediatrics, University of the Basque Country, Bilbao, Spain
| | - Alba Carro
- Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain.,Department of Pediatrics, University of the Basque Country, Bilbao, Spain
| | - Haydee Diaz
- Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain.,Department of Pediatrics, University of the Basque Country, Bilbao, Spain
| | - Javier Benito
- Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain.,Department of Pediatrics, University of the Basque Country, Bilbao, Spain
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Consensus Guidelines on Evaluation and Management of the Febrile Child Presenting to the Emergency Department in India. Indian Pediatr 2017; 54:652-660. [PMID: 28607213 DOI: 10.1007/s13312-017-1129-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
JUSTIFICATION India, home to almost 1.5 billion people, is in need of a country-specific, evidence-based, consensus approach for the emergency department (ED) evaluation and management of the febrile child. PROCESS We held two consensus meetings, performed an exhaustive literature review, and held ongoing web-based discussions to arrive at a formal consensus on the proposed evaluation and management algorithm. The first meeting was held in Delhi in October 2015, under the auspices of Pediatric Emergency Medicine (PEM) Section of Academic College of Emergency Experts in India (ACEE-INDIA); and the second meeting was conducted at Pune during Emergency Medical Pediatrics and Recent Trends (EMPART 2016) in March 2016. The second meeting was followed with futher e-mail-based discussions to arrive at a formal consensus on the proposed algorithm. OBJECTIVE To develop an algorithmic approach for the evaluation and management of the febrile child that can be easily applied in the context of emergency care and modified based on local epidemiology and practice standards. RECOMMENDATIONS We created an algorithm that can assist the clinician in the evaluation and management of the febrile child presenting to the ED, contextualized to health care in India. This guideline includes the following key components: triage and the timely assessment; evaluation; and patient disposition from the ED. We urge the development and creation of a robust data repository of minimal standard data elements. This would provide a systematic measurement of the care processes and patient outcomes, and a better understanding of various etiologies of febrile illnesses in India; both of which can be used to further modify the proposed approach and algorithm.
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de la Torre M, de Lucas N, Velasco R, Gómez B, Mintegi S. Etiología y evolución de las infecciones potencialmente graves en lactantes menores de 3 meses febriles. An Pediatr (Barc) 2017; 87:42-49. [DOI: 10.1016/j.anpedi.2016.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/30/2016] [Accepted: 07/15/2016] [Indexed: 10/21/2022] Open
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Aetiology and outcomes of potentially serious infections in febrile infants less than 3 months old. An Pediatr (Barc) 2017. [DOI: 10.1016/j.anpede.2016.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Mintegi S, Gomez B, Martinez-Virumbrales L, Morientes O, Benito J. Outpatient management of selected young febrile infants without antibiotics. Arch Dis Child 2017; 102:244-249. [PMID: 27470162 DOI: 10.1136/archdischild-2016-310600] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 07/05/2016] [Accepted: 07/08/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To analyse the outpatient management of selected febrile infants younger than 90 days without systematic lumbar puncture and antibiotics. METHODS A prospective registry-based cohort study including all the infants ≤90 days with fever without a source (FWS) who were evaluated in a paediatric emergency department (ED) over a 7-year period (September 2007-August 2014). We analysed the outcome of those infants with low-risk criteria for serious bacterial infection (SBI) managed as outpatients without antibiotics and without undergoing a lumbar puncture. Low-risk criteria: Well appearing, older than 21 days of age, no leucocyturia, absolute neutrophil count ≤10 000, serum C reactive protein ≤20 mg/L, procalcitonin <0.5 ng/mL and no clinical deterioration during the stay in the ED (always <24 hours). RESULTS 1472 infants with FWS attended the ED. Of these, 676 were classified to be at low risk for SBI without performing a lumbar puncture. After staying <24 hours in the short-stay unit of the ED, 586 (86.6%) were managed as outpatients without antibiotics. Two patients were diagnosed with SBI: one occult bacteraemia and one bacterial gastroenteritis. Both were afebrile when evaluated again and did well. No patient returned to the ED due to clinical deterioration. Fifty-one infants (8.7%) returned to the ED mainly due to persistence of fever or irritability. None was diagnosed with definite SBI or non-bacterial meningitis. CONCLUSIONS Outpatient management without antibiotics and systematic lumbar puncture is appropriate for selected febrile infants younger than 3 months of age with close follow-up.
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Affiliation(s)
- Santiago Mintegi
- Paediatric Emergency Department, Cruces University Hospital. University of the Basque Country, Bilbao, Spain
| | - Borja Gomez
- Paediatric Emergency Department, Cruces University Hospital. University of the Basque Country, Bilbao, Spain
| | - Lidia Martinez-Virumbrales
- Paediatric Emergency Department, Cruces University Hospital. University of the Basque Country, Bilbao, Spain
| | - Oihane Morientes
- Paediatric Emergency Department, Cruces University Hospital. University of the Basque Country, Bilbao, Spain
| | - Javier Benito
- Paediatric Emergency Department, Cruces University Hospital. University of the Basque Country, Bilbao, Spain
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Calvo C, Gallardo P, Torija P, Bellón S, Méndez-Echeverría A, Del Rosal T, Baquero-Artigao F, Sainz T, Romero M, Cabrerizo M. Enterovirus neurological disease and bacterial coinfection in very young infants with fever. J Clin Virol 2016; 85:37-39. [PMID: 27833059 DOI: 10.1016/j.jcv.2016.10.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/27/2016] [Accepted: 10/30/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Very little information exists on simultaneous infections by viruses and bacteria in infants with fever without source (FWS). OBJECTIVES To investigate the incidence of bacterial coinfection in infants up to 3 months of age with neurological viral infection. STUDY DESIGN Prospective study performed in infants below 90 days of age attending the emergency room of two public hospitals in Spain for FWS. Those who had viral screening performed in CSF, together with blood, CSF and urine cultures were included. Herpes virus, EV and HPeV detection in CSF was performed by PCR. Coinfections between viruses in CSF and serious bacterial infections were described. RESULTS 119 Infants less than 90 days of age were recruited. Forty-five (38%) had viral infection of the central nervous system, and in 8 of them (17.7%) we found a concurrent bacterial infection: 7 urinary tract infections (UTI) and 1 sepsis. In all cases, the virus identified in CSF was EV. CONCLUSIONS Bacterial infections were frequent in young infants with viral neurological infections associated to EV. Urinary tract infection was the most common bacterial disease.
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Affiliation(s)
- Cristina Calvo
- Pediatrics Department, Hospital Severo Ochoa, Leganés, Madrid, Spain; Pediatric and Infectious Diseases, Hospital La Paz, La Paz Research Insititute (IdiPAZ), Madrid, Spain.
| | - Paula Gallardo
- Pediatrics Department, Hospital Severo Ochoa, Leganés, Madrid, Spain.
| | - Patricia Torija
- Pediatrics Department, Hospital Severo Ochoa, Leganés, Madrid, Spain
| | - Sara Bellón
- Pediatrics Department, Hospital Severo Ochoa, Leganés, Madrid, Spain.
| | - Ana Méndez-Echeverría
- Pediatric and Infectious Diseases, Hospital La Paz, La Paz Research Insititute (IdiPAZ), Madrid, Spain.
| | - Teresa Del Rosal
- Pediatric and Infectious Diseases, Hospital La Paz, La Paz Research Insititute (IdiPAZ), Madrid, Spain.
| | - Fernando Baquero-Artigao
- Pediatric and Infectious Diseases, Hospital La Paz, La Paz Research Insititute (IdiPAZ), Madrid, Spain.
| | - Talía Sainz
- Pediatric and Infectious Diseases, Hospital La Paz, La Paz Research Insititute (IdiPAZ), Madrid, Spain.
| | - María Romero
- Laboratory of Microbiology, Hospital La Paz, Madrid, Spain.
| | - María Cabrerizo
- Enterovirus Unit, National Centre for Microbiology, Health Institute "Carlos III", Madrid, Spain.
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Westra SJ, Karmazyn BK, Alazraki AL, Dempsey ME, Dillman JR, Garber M, Moore SG, Raske ME, Rice HE, Rigsby CK, Safdar N, Simoneaux SF, Strouse PJ, Trout AT, Wootton-Gorges SL, Coley BD. ACR Appropriateness Criteria Fever Without Source or Unknown Origin—Child. J Am Coll Radiol 2016; 13:922-30. [DOI: 10.1016/j.jacr.2016.04.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 04/27/2016] [Indexed: 11/16/2022]
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Nascimento-Carvalho AC, Ruuskanen O, Nascimento-Carvalho CM. Comparison of the frequency of bacterial and viral infections among children with community-acquired pneumonia hospitalized across distinct severity categories: a prospective cross-sectional study. BMC Pediatr 2016; 16:105. [PMID: 27449898 PMCID: PMC4957893 DOI: 10.1186/s12887-016-0645-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 07/15/2016] [Indexed: 01/17/2023] Open
Abstract
Background The comparison of the frequencies of bacterial and viral infections among children with community-acquired pneumonia (CAP) admitted in distinct severity categories, in an original study, is lacking in literature to-date. We aimed to achieve this goal. Methods Children aged 2-59-months-old hospitalized with CAP were included in this prospective study in Salvador, Brazil. Clinical data and biological samples were collected to investigate 11 viruses and 8 bacteria. Severity was assessed by using the World Health Organization criteria. Results One hundred eighty-one patients were classified as “non-severe” (n = 53; 29.3 %), “severe” (n = 111; 61.3 %), or “very severe” (n = 17; 9.4 %) CAP. Overall, aetiology was detected among 156 (86.2 %) cases; viral (n = 84; 46.4 %), bacterial (n = 26; 14.4 %) and viral-bacterial (n = 46; 25.4 %) infections were identified. Viral infection frequency was similar in severe/very severe and non-severe cases (46.1 % vs. 47.2 %; p = 0.9). Pneumococcal infection increased across “non-severe” (13.2 %), “severe” (23.4 %), and “very severe” (35.3 %) cases (qui-squared test for trend p = 0.04). Among patients with detected aetiology, after excluding cases with co-infection, the frequency of sole bacterial infection was different (p = 0.04) among the categories; non-severe (12.5 %), severe (29.3 %) or very severe (55.6 %). Among these patients, sole bacterial infection was independently associated with severity (OR = 4.4 [95 % CI:1.1–17.6]; p = 0.04) in a model controlled for age (OR = 0.7 [95 % CI:0.5–1.1]; p = 0.1). Conclusions A substantial proportion of cases in distinct severity subgroups had respiratory viral infections, which did not differ between severity categories. Bacterial infection, particularly pneumococcal infection, was more likely among severe/very severe cases. Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0645-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Olli Ruuskanen
- Department of Paediatrics, Turku University and University Hospital, Turku, Finland
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15
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Pasternak Y, Yarden-Bilavsky H, Kodman Y, Zoldan M, Tamary H, Ashkenazi S. Inhaled corticosteroids increase blood neutrophil count by decreasing the expression of neutrophil adhesion molecules Mac-1 and L-selectin. Am J Emerg Med 2016; 34:1977-1981. [PMID: 27498916 DOI: 10.1016/j.ajem.2016.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 07/02/2016] [Accepted: 07/05/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The objective was to investigate the effect of commonly used inhaled corticosteroids on white blood cell count (WBC) and to examine the mechanisms involved. METHODS This randomized comparative study comprised 60 healthy adults. We measured the effects of budesonide (by face mask inhalation or aerosol inhaler), fluticasone (by inhaler), and saline inhalation (control) on WBC and the differential leukocyte count, especially the absolute neutrophil count (ANC). To elucidate the mechanisms involved, we measured the expression of the adhesion neutrophil ligands Mac-1 (CD11b) and L-selectin (CD62L), and granulocyte colony-stimulating factor serum levels. RESULTS Six hours after a single-dose inhalation of budesonide, mean increases of 23.4% in WBC (95% confidence interval [CI], 11.3-35.4) and 30.1% in ANC (95% CI, 7.2-53.0) were noted. The percentage of neutrophils increased from 54.6% to 58.1% (P< .001). Inhaled fluticasone increased WBC and ANC by 12.6% (95% CI, 1.5-23.7) and 22.7% (95% CI, 6.2-39.2), respectively (P< .01 for both). The absolute lymphocyte and eosinophil counts did not change significantly from baseline. The expression of Mac-1 and L-selectin decreased by 51.0% (P< .01) and 30.9% (P= .02), respectively, following face mask inhalation of budesonide and by 39.8% (P= .01) and 17.4% (P= .17), respectively, following inhalation of fluticasone. No significant changes in granulocyte colony-stimulating factor levels were noted. CONCLUSIONS Glucocorticoid inhalation increases WBC by increasing ANC. Reduced neutrophil adhesion to the endothelial surface, mediated by decreased adhesion molecule expression on neutrophils, is a plausible mechanism. Physicians should be aware of the effect of inhaled corticosteroids on WBC, as it may influence clinical decisions, especially in the emergency department.
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Affiliation(s)
| | - Havatzelet Yarden-Bilavsky
- Department of Pediatrics A, Schneider Children Medical Center, Israel; Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yona Kodman
- Division of Hematology Oncology, Schneider Children Medical Center, Israel
| | - Meira Zoldan
- Division of Hematology Oncology, Schneider Children Medical Center, Israel
| | - Hannah Tamary
- Division of Hematology Oncology, Schneider Children Medical Center, Israel; Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Shai Ashkenazi
- Department of Pediatrics A, Schneider Children Medical Center, Israel; Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
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Jimenez X, Shukla SK, Ortega I, Illana FJ, Castro-González C, Marti-Fuster B, Butterworth I, Arroyo M, Anthony B, Elvira L. Quantification of Very Low Concentrations of Leukocyte Suspensions In Vitro by High-Frequency Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1568-1573. [PMID: 27067281 DOI: 10.1016/j.ultrasmedbio.2016.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/28/2016] [Accepted: 01/30/2016] [Indexed: 06/05/2023]
Abstract
Accurate measurement of very low cerebrospinal fluid (CSF) white blood cell (WBC) concentration is key to the diagnosis of bacterial meningitis, lethal if not promptly treated. Here we show that high frequency ultrasound (HFUS) can detect CSF WBC in vitro in concentrations relevant to meningitis diagnosis with a much finer precision than gold standard manual counting in a Fuchs-Rosenthal chamber. WBC concentrations in a mock CSF model, in the range 0-50 WBC/μL, have been tested and compared to gold standard ground truth. In this range, excellent agreement (Cohen's kappa [κ] = 0.78-90) (Cohen 1960) was observed between HFUS and the gold standard method. The presented experimental set-up allowed us to detect WBC concentrations as low as 2 cells/μL. HFUS shows promise as a low-cost, reliable and automated technology to measure very low CSF WBC concentrations for the diagnosis of early meningitis.
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Affiliation(s)
- Xavier Jimenez
- Madrid-MIT M+Vision Consortium, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Shiva K Shukla
- Instituto de Tecnologías Físicas y de la Información, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Isabel Ortega
- Proteomic and Metabolomic Unit, Clinical Laboratory Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Francisco J Illana
- Proteomic and Metabolomic Unit, Clinical Laboratory Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos Castro-González
- Madrid-MIT M+Vision Consortium, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Berta Marti-Fuster
- Madrid-MIT M+Vision Consortium, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, 02129 Charlestown, MA, USA
| | - Ian Butterworth
- Madrid-MIT M+Vision Consortium, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Manuel Arroyo
- Proteomic and Metabolomic Unit, Clinical Laboratory Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Brian Anthony
- Department of Mechanical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, 02139 Cambridge, MA, USA
| | - Luis Elvira
- Instituto de Tecnologías Físicas y de la Información, Consejo Superior de Investigaciones Científicas, Madrid, Spain
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Abstract
BACKGROUND Classical criteria differ when performing cerebrospinal fluid (CSF) analysis in infants younger than 90 days with fever without a source (FWS). Our objectives were to analyze the prevalence and microbiology of bacterial meningitis in this group and its prevalence in relation to clinical and laboratory risk factors. METHODS This is a substudy of a prospective registry including all infants of this age with FWS seen between September 2003 and August 2013 in a Pediatric Emergency Department of a Tertiary Teaching Hospital. RESULTS Lumbar puncture was performed in 639 (27.0%) of the 2362 infants with FWS seen, the rate being higher in not well-appearing infants [60.9% vs. 25.7%; odds ratio (OR), 4.49] and in those ≤21 days old (70.1% vs. 20.4%; OR, 9.14). Eleven infants were diagnosed with bacterial meningitis: 9 were ≤21 days old (prevalence 2.8% vs. 0.1%; OR, 30.42) and 5 were not well-appearing infants (5.7% vs. 0.2%; OR, 23.06). Bacteria isolated were Streptococcus agalactiae (3), Escherichia coli (3), Listeria monocytogenes (3), Streptococcus pneumoniae (1) and Neisseria meningitidis (1). None of the 1975 well-appearing infants >21 days old were diagnosed with bacterial meningitis, regardless of whether biomarkers were altered. CONCLUSIONS In infants younger than 90 days with FWS, performing CSF analysis for ruling out bacterial meningitis must be strongly considered in not well-appearing infants and in those ≤21 days old. The recommendation of systematically performing CSF analysis in well-appearing infants 22-90 days of age on the basis of analytical criteria alone must be reevaluated.
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Alanazi A, Al Enezi F, Alqahtani MM, Alshammari TF, Ansari MA, Al-Oraibi S, Qureshi S. Effects of passive smoking on students at College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh. J Nat Sci Biol Med 2015; 6:100-5. [PMID: 25810644 PMCID: PMC4367017 DOI: 10.4103/0976-9668.149100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Despite the recent campaigns to eliminate smoking, the rates are still increasing world-wide. Exposure to passive smoking (PS) is associated with morbidity and mortality from awful diseases. Although many college students smoke, little is known about their exposure to PS, common places and sources of exposures in Saudi Arabia. Aim: The aim of the following study is to identify prevalence and magnitude of PS among college students, exposure time, locations, sources of exposure, investigate the effects and make recommendations. Materials and Methods: A cross-sectional study was performed to identify factors associated with PS exposure among students of College of Applied Medical Sciences, Riyadh. Results: Out of 61 students included in the study, 91.8% were found exposed to PS. Exposure in Hospitality venues (Estirah) was the most common followed by other areas. Among the sources of exposure, the highest was among friends and the least were parents and guests. The frequency of highest exposure per month was >15 times and the lowest was 10-15 times. Levels of annoyance varied between 18% and 37.7%, respectively. Since the values obtained for different markers in the pulmonary function test are more than the predicted values, the observed spirometry is normal. The percent oxygen saturation in hemoglobin and blood pressure of PS were in normal range. Conclusion: Since the properties of mainstream smoke and environmental tobacco smoke are quite different, risk extrapolation from active to PS is uncertain, especially during a short period. Nevertheless, it can be deteriorating during a longer duration, hence; the administrators, policy makers and tobacco control advocates may endorse policies to restrict smoking in shared areas, particularly working environment.
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Affiliation(s)
- Abdullah Alanazi
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Farhan Al Enezi
- , , Respiratory Therapy Department, College of Applied Medical Sciences, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammd Mesfer Alqahtani
- , , Respiratory Therapy Department, College of Applied Medical Sciences, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Turki Faleh Alshammari
- , , Respiratory Therapy Department, College of Applied Medical Sciences, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Saleh Al-Oraibi
- Occupational Therapy Department, College of Applied Medical Sciences, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Shoeb Qureshi
- Academic and Research Department, College of Applied Medical Sciences, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
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Kanegaye JT, Jacob JM, Malicki D. Automated urinalysis and urine dipstick in the emergency evaluation of young febrile children. Pediatrics 2014; 134:523-9. [PMID: 25136043 DOI: 10.1542/peds.2013-4222] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The performance of automated flow cytometric urinalysis is not well described in pediatric urinary tract infection. We sought to determine the diagnostic performance of automated cell counts and emergency department point-of-care (POC) dipstick urinalyses in the evaluation of young febrile children. METHODS We prospectively identified a convenience sample of febrile pediatric emergency department patients <48 months of age who underwent urethral catheterization to obtain POC and automated urinalyses and urine culture. Receiver operating characteristic analyses were performed and diagnostic indices were calculated for POC dipstick and automated cell counts at different cutpoints. RESULTS Of 342 eligible children, 42 (12%) had urinary bacterial growth ≥ 50000/mL. The areas under the receiver operating characteristic curves were: automated white blood cell count, 0.97; automated bacterial count, 0.998; POC leukocyte esterase, 0.94; and POC nitrite, 0.76. Sensitivities and specificities were 86% and 98% for automated leukocyte counts ≥ 100/μL and 98% and 98% for bacterial counts ≥ 250/μL. POC urine dipstick with ≥ 1+ leukocyte esterase or positive nitrite had a sensitivity of 95% and a specificity of 98%. Combinations of white blood cell and bacterial counts did not outperform bacterial counts alone. CONCLUSIONS Automated leukocyte and bacterial counts performed well in the diagnosis of urinary tract infection in these febrile pediatric patients, but POC dipstick may be an acceptable alternative in clinical settings that require rapid decision-making.
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Affiliation(s)
- John T Kanegaye
- Departments of Pediatrics and Rady Children's Hospital San Diego, San Diego, California
| | - Jennifer M Jacob
- Departments of Pediatrics and Rady Children's Hospital San Diego, San Diego, California
| | - Denise Malicki
- Departments of Pediatrics and Rady Children's Hospital San Diego, San Diego, California Pathology, University of California San Diego School of Medicine, La Jolla, California; and
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Esposito S, Principi N. Pharmacotherapy for pneumococcal infections: an update. Expert Opin Pharmacother 2012; 14:65-77. [PMID: 23256539 DOI: 10.1517/14656566.2013.756867] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The management of pneumococcal diseases still places a significant burden on medical and economic resources. The subjects at greatest risk of pneumococcal infections are children. AREAS COVERED The aim of this review is to analyse the best current therapeutic approach to pneumococcal resistance, taking into account the level of susceptibility of Streptococcus pneumoniae, and the pharmacokinetics and pharmacodynamics of different antibiotics in the various pneumococcal diseases. EXPERT OPINION Antibiotic treatment of a number of pneumococcal diseases remains difficult or impossible due to the presence of strains resistant to commonly used antibiotics. In children the problem is significantly more important than in adults due to the reduced number of licenced drugs for subjects in the first years of life. The new conjugate pneumococcal vaccines containing 10 (PCV10) and 13 serotypes (PCV13), which include most of the recently emerging strains, might reduce the incidence of pneumococcal infections and the circulation of resistant pathogens. However, it is likely that optimal results will only be reached after the development of effective vaccines based on conserved proteins that are capable of preventing all pneumococcal infections, regardless of the serotype of the causative organism.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milano, Italy.
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Increased prevalence of anellovirus in pediatric patients with fever. PLoS One 2012; 7:e50937. [PMID: 23226428 PMCID: PMC3511395 DOI: 10.1371/journal.pone.0050937] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 10/25/2012] [Indexed: 01/03/2023] Open
Abstract
The Anelloviridae family consists of non-enveloped, circular, single-stranded DNA viruses. Three genera of anellovirus are known to infect humans, named TTV, TTMDV, and TTMV. Although anelloviruses were initially thought to cause non-A-G viral hepatitis, continued research has shown no definitive associations between anellovirus and human disease to date. Using high-throughput sequencing, we investigated the association between anelloviruses and fever in pediatric patients 2–36 months of age. We determined that although anelloviruses were present in a large number of specimens from both febrile and afebrile patients, they were more prevalent in the plasma and nasopharyngeal (NP) specimens of febrile patients compared to afebrile controls. Using PCR to detect each of the three species of anellovirus that infect humans, we found that anellovirus species TTV and TTMDV were more prevalent in the plasma and NP specimens of febrile patients compared to afebrile controls. This was not the case for species TTMV which was found in similar percentages of febrile and afebrile patient specimens. Analysis of patient age showed that the percentage of plasma and NP specimens containing anellovirus increased with age until patients were 19–24 months of age, after which the percentage of anellovirus positive patient specimens dropped. This trend was striking for TTV and TTMDV and very modest for TTMV in both plasma and NP specimens. Finally, as the temperature of febrile patients increased, so too did the frequency of TTV and TTMDV detection. Again, TTMV was equally present in both febrile and afebrile patient specimens. Taken together these data indicate that the human anellovirus species TTV and TTMDV are associated with fever in children, while the highly related human anellovirus TTMV has no association with fever.
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Andrade AL, Toscano CM, Minamisava R, Costa PS, Andrade JG. Pneumococcal disease manifestation in children before and after vaccination: what's new? Vaccine 2012; 29 Suppl 3:C2-14. [PMID: 21896349 DOI: 10.1016/j.vaccine.2011.06.096] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 06/24/2011] [Indexed: 12/25/2022]
Abstract
Pneumococcal infections remain a relevant cause of morbidity and mortality in children, especially in countries where vaccination has not been introduced. In contrast to the common belief by many pediatricians, the most important pneumococcal infections are of the respiratory tract and not invasive diseases. The recent pandemic of the H1N1 virus prompted studies to better understand the interaction between the influenza virus, Streptococcus pneumoniae, and pneumonia outcomes. Radiological findings of bacteremic pneumonia have been well investigated and besides the typical alveolar consolidation, a broad spectrum of atypical patterns has been reported. Molecular techniques, such as real-time polymerase chain reaction (PCR), can improve the detection of S. pneumoniae in sterile fluids, mainly in regions where previous antibiotic therapy is a common practice. In the post vaccination era, new manifestations of pneumococcal invasive disease, such as hemolytic uremic syndrome, have increased in association with parapneumonic empyema. Moreover, serotypes not included in PCV7, particularly serotypes 1, 3, 5, 7F, and 19A, have been among the most common isolates in pneumococcal disease. In Latin America, pneumococcal primary peritonitis has been described as an important clinical syndrome in a growing proportion of patients, mainly in girls. The development of newer and more specific diagnostic markers to distinguish bacterial and viral pneumonia are urgently sought, and will be especially pertinent after the introduction of pneumococcal conjugate vaccines with expanded serotypes. Such markers would minimize inappropriate diagnosis of false positive cases and treatment with antibacterial agents, while increasing positive predictive values for diagnosis of bacterial pneumonia. The extension of serotype coverage with the new conjugate vaccines is promising for pneumococcal infections and coverage against antibiotic-resistant strains.
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Affiliation(s)
- Ana Lucia Andrade
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goias, Rua 235, esq 1a. Avenida, Setor Leste Universitário, 74605-050 Goiania, Goias, Brazil.
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Abstract
We performed a 7-year registry-based retrospective study. We included 1365 infants younger than 3 months of age with fever without a source; 81 (5.9%) had <5000 leukocytes/mm(3). Among the 1021 well-appearing 29- to 90-day-old infants, prevalence of serious bacterial infection (SBI) was 13.8% for those with a normal white blood cell count, 6.8% for those with leukopenia (odds ratio, 0.45), and 36.6% for those with leukocytosis (odds ratio, 3.59). None of the 9 well-appearing febrile neonates with leukopenia developed an SBI. Leukopenia, in well-appearing young febrile infants, should not be considered as an SBI risk factor.
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Abstract
OBJECTIVES AND METHODS The aim of the present retrospective, cross-sectional, descriptive study was to determine the characteristics of febrile 3- to 36-month-old children who were admitted to the emergency department (ED) with the chief complaint of fever and returned with the same complaint within 72 hours (returning group), compared with age-matched children who did not return to the ED (nonreturning group). Demographics and predischarge evaluation extent were focused on. RESULTS Compared with the nonreturning group (n = 305), the returning group (n = 92) demonstrated higher mean temperature at home (P = 0.008), longer fever duration (P < 0.0001), and greater pain frequency (P = 0.03). Demographics and predischarge evaluation extent were similar in both groups. Within the returning group, fever duration was longer at the time of the second visit (P = 0.004). CONCLUSIONS Higher fever causes higher rate of return visits. Among the investigated groups, pain was the sole differentiating symptom. Further studies should identify patterns that diminish children's ED readmission.
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Blumental S, Huisman E, Cornet MC, Ferreiro C, De Schutter I, Reynders M, Wybo I, Kabamba-Mukadi B, Armano R, Hermans D, Nassogne MC, Mahadeb B, Fonteyne C, Van Berlaer G, Levy J, Moulin D, Vergison A, Malfroot A, Lepage P. Pandemic A/H1N1v influenza 2009 in hospitalized children: a multicenter Belgian survey. BMC Infect Dis 2011; 11:313. [PMID: 22060843 PMCID: PMC3224785 DOI: 10.1186/1471-2334-11-313] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 11/07/2011] [Indexed: 11/29/2022] Open
Abstract
Background During the 2009 influenza A/H1N1v pandemic, children were identified as a specific "at risk" group. We conducted a multicentric study to describe pattern of influenza A/H1N1v infection among hospitalized children in Brussels, Belgium. Methods From July 1, 2009, to January 31, 2010, we collected epidemiological and clinical data of all proven (positive H1N1v PCR) and probable (positive influenza A antigen or culture) pediatric cases of influenza A/H1N1v infections, hospitalized in four tertiary centers. Results During the epidemic period, an excess of 18% of pediatric outpatients and emergency department visits was registered. 215 children were hospitalized with proven/probable influenza A/H1N1v infection. Median age was 31 months. 47% had ≥ 1 comorbid conditions. Febrile respiratory illness was the most common presentation. 36% presented with initial gastrointestinal symptoms and 10% with neurological manifestations. 34% had pneumonia. Only 24% of the patients received oseltamivir but 57% received antibiotics. 10% of children were admitted to PICU, seven of whom with ARDS. Case fatality-rate was 5/215 (2%), concerning only children suffering from chronic neurological disorders. Children over 2 years of age showed a higher propensity to be admitted to PICU (16% vs 1%, p = 0.002) and a higher mortality rate (4% vs 0%, p = 0.06). Infants less than 3 months old showed a milder course of infection, with few respiratory and neurological complications. Conclusion Although influenza A/H1N1v infections were generally self-limited, pediatric burden of disease was significant. Compared to other countries experiencing different health care systems, our Belgian cohort was younger and received less frequently antiviral therapy; disease course and mortality were however similar.
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Affiliation(s)
- Sophie Blumental
- Pediatric Infectious Diseases Unit, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Brussels, Belgium.
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Management of the non-toxic-appearing acutely febrile child: a 21st century approach. J Pediatr 2011; 159:181-5. [PMID: 21592518 PMCID: PMC4876866 DOI: 10.1016/j.jpeds.2011.03.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 02/17/2011] [Accepted: 03/22/2011] [Indexed: 11/22/2022]
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Galetto-Lacour A, Gervaix A. Identifying severe bacterial infection in children with fever without source. Expert Rev Anti Infect Ther 2011; 8:1231-7. [PMID: 21073288 DOI: 10.1586/eri.10.118] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
For decades, many investigators have attempted to identify clinical or laboratory markers that can accurately differentiate severe bacterial from self-limiting viral infections in young children with fever without source. Unfortunately, no perfect marker has been discovered so far. Many guidelines recommend white blood cell count as a screening marker in fever without source, whereas compelling evidence in the literature emphasizes the superior characteristics of C-reactive protein and procalcitonin. One way to improve predictive value is the combination of prediction rules of different tests for clinical and laboratory markers. Several clinical decision rules, reviewed in this article, have been suggested but seem to be difficult to implement in practice due to their complexity. Recently, procalcitonin, C-reactive protein and urinary dipstick were combined in a simple risk index score that displayed promising predictive value in severe bacterial infections in children. Ultimately, impact analyses still have to be performed to show improved quality of care in this setting.
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Affiliation(s)
- Annick Galetto-Lacour
- Division of Pediatric Emergency Medicine, Geneva University Hospitals and University of Geneva, 1211 Geneva 14, Switzerland.
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Well appearing young infants with fever without known source in the emergency department: are lumbar punctures always necessary? Eur J Emerg Med 2011; 17:167-9. [PMID: 19820403 DOI: 10.1097/mej.0b013e3283307af9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We included 685 consecutive previously healthy well appearing infants younger than 3 months with fever without known source admitted to an Emergency Department without routinely performing lumbar punctures (LP). LP was performed in 198 infants. Of these, 36 (18.1%) showed pleocytosis. Two infants less than 15 days were diagnosed with bacterial meningitis and 47 with aseptic meningitis (6.8%). LP was not performed in 487 infants. Of these, 69 were admitted to ward (46 had urinary tract infection) and 418 were discharged. In this group, we registered 38 unscheduled revisits to the Emergency Department (four aseptic meningitis). All infants did well. It is unnecessary to perform a LP routinely on infants over 1 month of age. The decision to perform the LP in previously healthy and well appearing infants with fever without known source attended by an experienced paediatric emergency physician can be individualized with no subsequent adverse outcomes. This approach may lead to under-diagnosing nonbacterial meningitis.
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Abstract
BACKGROUND Infantile herpes simplex virus encephalitis (HSVE) infection remains a significant cause of morbidity and mortality. Diagnosis is often difficult in this population, where a specific pattern of clinical and laboratory signs are lacking. This often results in unnecessary treatment of infants with empiric acyclovir. This study evaluates the use of empiric acyclovir at the Kentucky Children's Hospital and attempts to correlate any laboratory or clinical findings that may be highly suggestive of HSVE. METHODS Medical records of infants younger than 1 year admitted and treated with acyclovir were evaluated for any consistent pattern of clinical findings suggestive of HSVE. Specifically, serum and cerebrospinal fluid (CSF) white blood cell counts, red blood cell counts, cerebrospinal glucose and protein, and clinical neurological findings upon admission were evaluated. RESULTS Two hundred eighteen infants were identified and included in the study. Three infants were identified with polymerase chain reaction-positive HSVE. Only CSF leukocytosis was consistent among HSVE-positive infants. All infants with HSVE exhibited generalized neurological findings. Neither hemorrhagic CSF nor focal neurological findings were indicative of HSVE infection. DISCUSSION Herpes simplex virus encephalitis has a very low prevalence within this population. Clinically significant neurological findings as well as specific risk factors must be present to consider treatment with empiric acyclovir. Apnea and focal seizures are not specific risk factors for herpetic meningitis in infants. Lack of a CSF leukocytosis is a strong negative predictor for HSVE, and hemorrhagic fluid is not specific for HSVE.
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Fouzas S, Mantagou L, Skylogianni E, Varvarigou A. Reactive thrombocytosis in febrile young infants with serious bacterial infection. Indian Pediatr 2010; 47:937-43. [DOI: 10.1007/s13312-010-0158-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 11/26/2009] [Indexed: 11/28/2022]
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Gómez B, Mintegi S, Benito J, Egireun A, Garcia D, Astobiza E. Blood culture and bacteremia predictors in infants less than three months of age with fever without source. Pediatr Infect Dis J 2010; 29:43-7. [PMID: 19934784 DOI: 10.1097/inf.0b013e3181c6dd14] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES (1) To assess the rate of bacteremia in febrile infants less than 3 months of age admitted to a pediatric emergency department at a tertiary hospital; (2) to describe the bacteria isolated; and (3) to analyze factors related to increased probability of having a positive blood culture. METHODS A retrospective, cross-sectional, 5-year descriptive study that includes all infants less than 3 months of age who presented with fever without source (FWS) and had a blood culture performed. RESULTS A blood culture was performed in 1018 (91.5%) of 1125 infants admitted, and a bacterial pathogen was grown in 23 (2.2%) of these; 8 were associated with a positive urine culture. The most frequently isolated pathogen was Escherichia coli (9), followed by Streptococcus pneumoniae (4). The risk factors detected by multivariate analysis were: (a) being classified as "not well-appearing" (12.5% vs. 1.8%; odds ratio: 8.37) and (b) leukocyturia and/or nitrituria in a urine dipstick test (5.6% vs. 1.6%; odds ratio: 3.73). C-reactive protein value was higher than white blood cell count and absolute neutrophil count in detecting bacteremia; a 70 g/L cut-off had a specificity of 93.8%, but sensitivity of only 69.6%. CONCLUSIONS A positive blood culture rate of 2.2% was found in infants less than 3 months of age with FWS. C-reactive protein, white blood cell count, and absolute neutrophil count were not good bacteremia predictors. We recommend obtaining a blood culture in infants less than 3 months of age with FWS, particularly those patients considered "not well-appearing" and those with leukocyturia and/or nitrituria.
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Affiliation(s)
- Borja Gómez
- From the Paediatric Emergency Department, Cruces Hospital, Plaza de Cruces s/n, Barakaldo, Spain.
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Reardon JM, Carstairs KL, Rudinsky SL, Simon LV, Riffenburgh RH, Tanen DA. Urinalysis is not reliable to detect a urinary tract infection in febrile infants presenting to the ED. Am J Emerg Med 2009; 27:930-2. [PMID: 19857409 DOI: 10.1016/j.ajem.2008.07.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Revised: 07/12/2008] [Accepted: 07/13/2008] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Urinary tract infections are a common source of serious bacterial infections in febrile infants younger than 2 years. Our objective was to compare urinalysis with urine culture in the emergency department evaluation of febrile infants. METHODS A febrile infant registry was instituted at a tertiary care hospital treating an average of 55000 patients annually (27% children), from December 2002 to December 2003. Patients were eligible if they were younger than 3 months and had a temperature of at least 38 degrees C or if they were between 3 and 24 months of age and had a temperature of at least 39 degrees C. Data abstracted included age, sex, and temperature. Urinalysis (UA) and urine culture (UCx) results were obtained from electronic hospital archives. RESULTS Nine hundred eighty-five patients were entered into the febrile infant registry. Male patients comprised 55%. The mean age of patients was 12.6 months; median was 12 months. Four hundred thirty-five (78% of eligible patients) had both a UA and UCx from the same specimen, and there were 45 (10.3%) positive UCx result. Females accounted for 33 (73%) of 45 positive results. The sensitivity of UA for predicting a positive UCx result was 64% (95% confidence interval [CI], 49%-78%), whereas the specificity was 91% (95% CI, 88%-94%). The positive predictive value was 46% (95% CI, 31%-53%), with a negative predictive value of 96% (95% CI, 93%-97%). CONCLUSION Urinalysis is not reliable for the detection of urinary tract infections in febrile infants when compared with urine cultures.
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Fortuna EL, Carney MM, Macy M, Stanley RM, Younger JG, Bradin SA. Accuracy of non-contact infrared thermometry versus rectal thermometry in young children evaluated in the emergency department for fever. J Emerg Nurs 2009; 36:101-4. [PMID: 20211398 DOI: 10.1016/j.jen.2009.07.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2009] [Revised: 07/22/2009] [Accepted: 07/23/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We evaluated the accuracy of a non-contact infrared thermometer compared with a rectal thermometer. METHODS Two hundred patients, ages 1 month to 4 years, were included in the study. Each child underwent contemporaneous standard rectal thermometry and mid forehead non-contact infrared thermometry. Clinical features, including chief complaint, recently administered antipyretic agents, and ambient temperature at the time of measurement, were included. ANALYSIS Linear models were used to compare agreement between the 2 techniques, as well as to determine bias of infrared thermometry at different rectal temperatures. Multivariate linear models were used to evaluate the impact of clinical variables and ambient temperature. RESULTS A linear relationship between rectal and infrared temperature measurements was observed; however, the coefficient of determination (r(2)) value between was only 0.48 (P < 0.01). Infrared thermometry tended to overestimate the temperature of afebrile children and underestimate the temperature of febrile patients (P < .01). Ambient temperature and child age did not affect the accuracy of the device. CONCLUSION In this study, non-contact infrared thermometry did not sufficiently agree with rectal thermometer to indicate its routine use.
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Affiliation(s)
- Ezio L Fortuna
- Children's Emergency Services, and Level E Nurse, Department of Emergency Medicine, Ann Arbor, MI, USA.
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Chiappini E, Galli L, Bonsignori F, Venturini E, Principi N, de Martino M. Self-reported pediatricians' management of the well-appearing young child with fever without a source: first survey in an European country in the anti-pneumococcal vaccine era. BMC Public Health 2009; 9:300. [PMID: 19689826 PMCID: PMC2736943 DOI: 10.1186/1471-2458-9-300] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Accepted: 08/19/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent studies suggest a substantially reduced risk of invasive bacterial infection in children vaccinated with heptavalent pneumococcal conjugate vaccine (PCV). To investigate whether the introduction of PCV might affect clinical decision making, we conducted a cross-sectional survey aimed at Italian Pediatric physicians. RESULTS The study included 348 (46.5%) primary care pediatricians; 251 (36.4%) hospital pediatricians, and 139 (20.1%) pediatric residents. In an hypothetical scenario, a well-appearing 12-month-old child with fever without source would be sent home with no therapy by 60.7% (419/690) of physicians if the child was not vaccinated with PCV. The proportion increased to 74.2% (512/690) if the child had received PCV (P < 0.0001). Also, physicians would obtain blood tests less frequently in the vaccinated than in unvaccinated children (139/690 [20.1%] vs. 205/690 [29.7%]; P < 0.0001), and started empiric antibiotic therapy less frequently (3.0% vs. 7.5%; P < 0.0001). In the hypothetical event that white blood cell count was 17,500/microL, a significantly lower proportion of physicians would ask for erythrocyte sedimentation rate (P < 0.017), C reactive protein (P < 0.0001), blood culture (P = 0.022), and urine analysis or dipstick (P = 0.028), if the child had received PCV. Only one third of participants routinely recommended PCV. CONCLUSION Our data suggest that implementation of educational programs regarding the proper management of the febrile child is needed.
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Affiliation(s)
- Elena Chiappini
- Department of Pediatrics, University of Florence, Florence, Italy.
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Rudinsky SL, Carstairs KL, Reardon JM, Simon LV, Riffenburgh RH, Tanen DA. Serious bacterial infections in febrile infants in the post-pneumococcal conjugate vaccine era. Acad Emerg Med 2009; 16:585-90. [PMID: 19538500 DOI: 10.1111/j.1553-2712.2009.00444.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective was to identify the epidemiology of serious bacterial infections (SBI) and the current utility of obtaining routine complete blood counts (CBC) and blood cultures to stratify infants at risk of SBI, in the study population of febrile infants in the post-heptavalent pneumococcal conjugate vaccine (PCV7) era. METHODS A cohort study with nested case-controls was undertaken at a tertiary care military hospital emergency department (ED) from December 2002 through December 2003. Irrespective of clinical findings at the initial encounter, patients were included if they were under 3 months of age and had a home or ED temperature of >or=100.4 degrees F or if they were between 3 and 24 months of age with a temperature of >or=102.3 degrees F. Data abstracted included age, temperature, peripheral white blood cell (WBC) count, and discharge diagnosis. Culture (blood, urine, and cerebrospinal fluid [CSF]) and chest radiograph (CXR) results were obtained through review of the electronic hospital archives. SBI was defined as pneumonia, urinary tract infection (UTI), meningitis, or bacteremia. RESULTS A total of 985 children aged 0 to 24 months were enrolled. Fifty-five percent were male, the median age was 12 months (interquartile range = 8-17 months), and 79% had received at least one PCV7. A total of 132 cases of SBI were identified in 129 infants (13.1%): 82 pneumonias, 45 UTI, five bacteremias, and no cases of bacterial meningitis. The frequency of bacteremia was 0.7%. No statistical difference was detected in the WBC count between the SBI and non-SBI groups (13.8 +/- 5.8 and 11.7 +/- 5.6, respectively; p = 0.055). No readily available WBC cutoff on the receiver operating characteristic (ROC) curve proved to be an accurate predictor of SBI. No statistical difference was detected in mean temperature between the SBI and non-SBI groups (103.3 +/- 1.2 and 103.2 +/- 1.2 degrees F, respectively; p = 0.26), nor was there a difference noted when groups were broken down by age or height of fever. CONCLUSIONS The WBC count and height of fever were not found to be accurate predictors of SBI in infants age 3 to 24 months. UTI and pneumonias made up the vast majority of SBI in this population of infants. The overall bacteremia frequency was well below 1%. This calls into question the continued utility of obtaining routine complete cell counts and blood cultures in the febrile infant in the post-PCV7 era.
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Affiliation(s)
- Sherri L Rudinsky
- Department of Emergency Medicine, Naval Medical Center, San Diego, CA, USA.
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Affiliation(s)
- Sherman J Alter
- Associate Professor of Pediatrics, Boonshoft School of Medicine, Wright State University, Division of Infectious Disease, The Children's Medical Center of Dayton, Dayton, Ohio, USA
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Houseni M, Chamroonrat W, Servaes S, Alavi A, Zhuang H. Applications of PET/CT in Pediatric Patients with Fever of Unknown Origin. PET Clin 2008; 3:605-19. [DOI: 10.1016/j.cpet.2009.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Moreno-Carvalho OA, Cardoso MRA, Nascimento-Carvalho CM. Neutrophils and red blood cells in the cerebrospinal fluid of newborns. Acta Paediatr 2008; 97:816-8. [PMID: 18397355 DOI: 10.1111/j.1651-2227.2008.00769.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ishimine P. The evolving approach to the young child who has fever and no obvious source. Emerg Med Clin North Am 2007; 25:1087-115, vii. [PMID: 17950137 DOI: 10.1016/j.emc.2007.07.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Fever is a common complaint of young children who seek care in the emergency department. Recent advances, such as universal vaccination with the pneumococcal conjugate vaccine, require the review of traditional approaches to these patients. This article discusses newer strategies in the evaluation and management of the young child with fever, incorporating changes based on the shifting epidemiology of bacterial infection.
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Affiliation(s)
- Paul Ishimine
- Departments of Medicine and Pediatrics, School of Medicine, University of California-San Diego, 200 West Arbor Drive, San Diego, CA 92103, USA.
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Myers C, Gervaix A. Streptococcus pneumoniae bacteraemia in children. Int J Antimicrob Agents 2007; 30 Suppl 1:S24-8. [PMID: 17707612 DOI: 10.1016/j.ijantimicag.2007.06.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2007] [Accepted: 06/18/2007] [Indexed: 11/30/2022]
Abstract
Occult bacteraemia is the most frequent invasive disease caused by Streptococcus pneumoniae in children less than 3 years of age. Despite the relative frequency of this infection, its management is still a challenging task for paediatricians because fever is often the only symptom and a considerable overlap exists in the clinical presentation of children with fever without a focus due to viral illness and children with occult bacteraemia. Management protocols take into account the age of the patient, the clinical score for severity and the results of laboratory tests such as the white blood cell count, the C-reactive protein and the blood procalcitonin level in order to define accurately who will benefit from an antibiotic treatment. Despite appropriate healthcare facilities and access to care the case fatality rate in developed countries is around 9% in children aged less than 1 year. Prevention with the 7-valent conjugate vaccine against S. pneumoniae will decrease morbidity and mortality associated with invasive disease due to these bacteria. However, replacement by non-vaccine serotypes has been noted in countries where the vaccine is widely used and this concern needs to be monitored carefully over the next few years.
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Affiliation(s)
- C Myers
- Department of Pediatrics, University Hospitals of Geneva, Switzerland
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