Fever without apparent source on clinical examination

Area of Science:

• Pediatrics
• Infectious Diseases
• Epidemiology

Background:

• Childhood febrile illnesses, both acute and prolonged, require comprehensive understanding.
• Invasive pneumococcal disease (IPD) and serious bacterial infections (SBIs) in infants are significant concerns.
• Geographic variations in prolonged fever diagnoses necessitate localized clinical insights.

Purpose of the Study:

• To review recent literature on the epidemiology, evaluation, and treatment of acute and prolonged febrile illnesses in children.
• To synthesize findings on invasive pneumococcal disease, its epidemiology, and the impact of conjugate pneumococcal vaccination.
• To examine the occurrence of serious bacterial infections in febrile infants with respiratory syncytial virus (RSV) and the spectrum of diagnoses for prolonged fever.

Main Methods:

• Literature review of studies published during the review period.
• Analysis of epidemiological data on invasive pneumococcal disease (IPD) pre- and post-vaccination.
• Synthesis of clinical and laboratory findings for febrile infants with RSV and prolonged fever cases.

Main Results:

• Vaccination with conjugated pneumococcal vaccine has decreased invasive pneumococcal disease (IPD) in the US, though non-vaccine serotypes show a slight increase.
• Urinary tract infections are common in febrile infants with RSV, with bacteremia noted in neonates (<28 days).
• Diverse diagnoses and key clinical findings for prolonged fever are presented from international studies (Turkey, Thailand, Italy).

Conclusions:

• Conjugated pneumococcal vaccine significantly impacts invasive pneumococcal disease (IPD) epidemiology.
• RSV infection in febrile infants is associated with a high incidence of urinary tract infections.
• Understanding the broad spectrum of prolonged fever diagnoses is crucial for pediatric care globally.