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Occult pneumonia in infants with high fever without source: a prospective multicenter study
Santiago Mintegi1, Javier Benito, Jose Ignacio Pijoan
1Pediatric Emergency Department, Cruces Hospital, Bilbao, Spain. santiago.mintegi@osakidetza.net
Pediatric Emergency Care
|June 26, 2010
Summary
Occult pneumonia in infants with fever and high white blood cell counts is less common post-vaccine. Age, absolute neutrophil count, and CRP levels predict pneumonia risk in these children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Radiology
Background:
- Occult pneumonia (pneumonia without a clear source) in febrile infants with high white blood cell (WBC) counts was previously reported in 20% of cases before the 7-valent pneumococcal conjugated vaccine (PCV7).
- Chest X-rays (CXRs) were commonly used to diagnose occult pneumonia in these infants.
- The introduction of PCV7 may have impacted the prevalence of occult pneumonia.
Purpose of the Study:
- To determine the prevalence of occult pneumonia in infants with fever and elevated WBC counts in the PCV7 era.
- To evaluate the predictive value of WBC count, absolute neutrophil count (ANC), and C-reactive protein (CRP) levels for occult pneumonia.
Main Methods:
- A multicenter prospective study involving 188 infants (aged 1-36 months) with fever and WBC count > 20 x 10(9)/L.
- Infants underwent CXR in the absence of respiratory symptoms.
- Multivariable binary logistic regression analyzed the influence of age, ANC, and CRP on pneumonia prevalence.
Main Results:
- The incidence of radiological pneumonia was 13.3% (25 out of 188 infants).
- Pneumonia risk was associated with older age (infants >12 months), elevated CRP (>100 mg/L), and elevated ANC (>20 x 10(9)/L).
- WBC count was not a significant predictor when ANC was considered.
Conclusions:
- The incidence of occult pneumonia in this high-risk infant group appears lower post-PCV7 introduction.
- Infants older than 12 months with higher ANC and CRP levels have an increased risk of pneumonia.
- These findings suggest a need for continued vigilance and risk stratification in diagnosing pneumonia in febrile infants.
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