Fever without apparent source on clinical examination

Screening for dental focal infections in febrile patients with hematologic malignancies who received chemotherapy: a retrospective cohort study

Source of fever in chemotherapy patients is often unknown. Fever can also be fatal. No observational studies have determined the incidence of dental focal infection (DFI)-associated fever, despite oral cavity being a potential source of infection. We report the incidence of fever after chemotherapy in patients with hematological malignancies and their association with DFIs in 441 patients visiting our institution during a 6-year period. Dental treatments, including tooth extraction, were performed, and their oral and hematological profiles were monitored after chemotherapy. Fever was evident in 87 (38.5%) of 226 patients (≥ 38˚C) after the first cycle of chemotherapy. Sepsis due to DFIs (n = 4; 4.6%) was evaluated. Chemotherapy was delayed due to DFI in one case. Fever after chemotherapy should be differentiated from oral infections. Our study emphasizes the significance of DFI in patients with fever after chemotherapy and can help in improving the prognosis of patients.

Performance of risk stratification criteria in the management of febrile young infants younger than three months of age

AIM

We evaluated the diagnosis, risk stratification and management of febrile infants under three months of age who presented to an Israeli paediatric emergency room (ER).

METHODS

This retrospective study enrolled all febrile infants examined in the paediatric ER of Soroka Medical Center during 2010-2013. The patients were classified into low-risk and high-risk subgroups and compared by age and ethnicity.

RESULTS

Overall, 2251 febrile infants (60.5% of Bedouin and 34.4% of Jewish ethnicity) were enrolled. Hospitalisation rates were higher among Bedouin vs. Jewish infants (55 vs. 39.8%, p < 0.001). Fever without localising signs was diagnosed in 1028 (45.6%) infants and 499 (48.5%) were hospitalised; 26% were stratified as high-risk and 74% as low-risk. Bedouin infants rates were more likely to be at high-risk (p = 0.001) and hospitalised (p < 0.001) than Jewish infants. With regard to low-risk infants, the incidence rates were higher before two months than two to three months of age (73.3 vs. 59%, p < 0.001), as were the hospitalisation rates (46.3 vs. 20.1%, p < 0.001). No differences were recorded for the hospitalisation rates of Bedouin and Jewish infants between the three daily shifts.

CONCLUSION

Major differences were recorded in hospitalisation rates, risk stratification and management of Bedouin and Jewish infants with fever without localising signs.