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A Behavioral Screen for Heat-Induced Seizures in Mouse Models of Epilepsy
Published on: July 12, 2021
Febrile seizures with leukocytosis as a predictor for occult bacteremia
Eiki Ogawa1, Kensuke Shoji1, Satoshi Kamidani1,2
1Division of Infectious Diseases, Department of Medical Specialties, National Center for Child Health and Development, Tokyo, Japan.
Insights
High white blood cell count and fever can predict occult pneumococcal bacteremia in children with febrile seizures, even after pneumococcal conjugate vaccine use. These criteria remain valuable for identifying at-risk pediatric patients in the post-PCV era.
Area of Science:
- Pediatrics
- Infectious Diseases
- Vaccinology
Background:
- Occult pneumococcal bacteremia (OPB) risk criteria (fever >39°C, WBC >15,000/mm³) were established pre-pneumococcal conjugate vaccine (PCV).
- PCV introduction significantly reduced the predictive value of these traditional OPB criteria.
- Febrile seizures are common in children with OPB, suggesting this population warrants further investigation for OPB prediction.
Purpose of the Study:
- To evaluate factors predicting occult pneumococcal bacteremia (OPB) in children presenting with febrile seizures.
- To assess the utility of traditional OPB risk criteria in the post-PCV era for children with febrile seizures.
Main Methods:
- Retrospective analysis of pediatric patients (3-36 months) presenting to the ED with febrile seizures and blood cultures drawn.
- Exclusion of patients with underlying medical conditions.
- Statistical comparison of demographics and risk criteria between patients with and without OPB.
Main Results:
- Of 1082 patients with febrile seizures, 397 had blood cultures; 87% had received ≥3 PCV doses.
- Eight of nine patients (89%) with OPB met the traditional risk criteria.
- Only 12% of patients without OPB met the criteria, with a significantly lower likelihood of OPB (0.3% vs 14.3%).
Conclusions:
- Elevated white blood cell count and fever remain effective predictors of OPB in pediatric patients with febrile seizures.
- These findings support the continued use of these criteria for risk stratification in the post-PCV era.
- Screening for OPB in febrile seizure patients using these criteria may still be practical and informative.
Background:
Febrile children 3-36 months old, who had a body temperature >39°C and white blood cell (WBC) count >15 000/mm3 were known to be at risk for occult pneumococcal bacteremia (OPB) in the pre-pneumococcal conjugate vaccine (PCV) era. The positive predictive value of these criteria, however, decreased dramatically after the introduction of PCV, indicating a need for alternative criteria. A high rate of febrile seizures has been noted in children with OPB, suggesting that screening may still be practical in this population. We performed a retrospective analysis to evaluate factors that predict OPB in patients visiting the emergency department (ED) with febrile seizures.
Methods:
Children 3-36 months old who visited the ED for febrile seizures and had blood cultures taken were included. Patients with underlying diseases were excluded from analysis. We performed statistical analyses comparing patient demographics according to the presence or absence of OPB.
Results:
One thousand and eighty-two patients visited the ED with febrile seizure, and blood cultures were taken in 397, of whom 87% had received more than three doses of PCV. Of the nine patients with OPB, eight (89%) met the risk criteria. In contrast, only 12% (48/388) of those without OPB met the criteria. In this population, those who fulfilled the risk criteria were more likely to have OPB than those who did not (14.3% vs 0.3%; likelihood ratio, 7.17).
Conclusions:
High WBC count and fever may effectively predict OPB in pediatric patients with febrile seizure in the post-PCV era.
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