Fever without apparent source on clinical examination, infectious diseases, and lower respiratory infections in children

Fever without apparent source on clinical examination

PURPOSE OF REVIEW

Episodes of acute illness associated with fever are common in children. Less common but also diagnostically challenging are episodes of prolonged fever in children. This article reports recent literature that has focused on the epidemiology, pathophysiology, clinical and laboratory evaluation, and treatment of both types of episodes.

RECENT FINDINGS

A number of articles reviewed the epidemiology in several countries of bacteremia in children, including bacteremia caused by Streptococcus pneumoniae and Salmonella sp. Host susceptibility factors for bacterial illness, such as malnutrition, were reported. Diagnostic issues concerning bacteremia, including the technique of venipuncture and urine antigen testing, were of interest. A major study was published that reported a preventive approach through immunization to one type of bacteremia that caused by S. pneumoniae. Other studies addressed the issues of choice of therapy and duration of therapy in selected bacteremic disease, such as dental bacteremias and bacteremia, that were caused by Brucella melitensis. Lastly, several causes of prolonged fever (such as hemophagocytic syndrome and atypical cat scratch disease) were reported.

SUMMARY

During the review period, studies addressed diverse issues related to acute and prolonged episodes of fever in children. There was a particular emphasis on the epidemiology, diagnosis, prevention, and treatment of bacteremic illness in children.

Unexplained fever in the ED: analysis of 139 patients

This study examined consecutive patients with unexplained fever (UF) presenting to the ED to define their characteristics and to compare distinctive parameters between admitted and discharged patients. During a 3-month period, all adult patients presenting to the ED with UF were prospectively followed for 1 month. Of 139 patients with UF, 58 patients (42%) were admitted to the hospital, whereas 81 patients (58%) were discharged. Whereas most of the discharged patients had self-limited febrile disease and eventually recovered, the admitted patients had more unresolved fever, serious infections, or systemic diseases and a 5% mortality rate. The admitted patients were older, had more comorbidity, higher leukocyte count, and anemia, but not a higher degree of fever. Older age, comorbidity, leukocytosis, and anemia, but not higher degree of fever, should direct the decision toward admission of a patient with UF.

Fever without apparent source on clinical examination, lower respiratory infections in children, and enterovirus infections

This section focuses on issues in infectious disease that are commonly encountered in pediatric office practice. McCarthy discusses recent literature regarding the evaluation and management of acute fevers without apparent source on clinical examination in infants and children and the evaluation of children with prolonged fevers of unknown origin. Klig reviews recent literature about lower respiratory tract infection in children. Finally, Kennedy and Kahn discuss recent developments in infectious diseases pertinent to office practice.