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Fever Without Source in Unvaccinated Children Aged 3 to 24 Months: What Workup Is Recommended?
Leah Finkel1, Camila Ospina-Jimenez2, Michael Byers3
1From the Departments of Emergency Medicine and Pediatrics.
Insights
Fever without source (FWS) in young children is common, but diagnostic approaches have evolved with vaccination. This review focuses on unvaccinated children and proposes a new treatment algorithm.
Area of Science:
- Pediatrics
- Infectious Diseases
- Emergency Medicine
Background:
- Fever is a frequent emergency department complaint in children.
- Fever without source (FWS) is diagnosed when no infection source is apparent after initial evaluation.
- Vaccination has significantly altered the landscape of FWS management in children.
Purpose of the Study:
- To review current knowledge on FWS in children aged 3-24 months in the modern era.
- To address the specific challenges of FWS in unvaccinated children.
- To propose a diagnostic and treatment algorithm for unvaccinated young children with FWS.
Main Methods:
- Literature review of FWS in children aged 3-24 months.
- Analysis of the impact of vaccination on FWS epidemiology.
- Development of a proposed treatment algorithm for unvaccinated children.
Main Results:
- Widespread vaccination has decreased the incidence of certain bacterial infections causing FWS.
- The percentage of unvaccinated children is increasing, necessitating updated management strategies.
- Current diagnostic and treatment guidelines may not be optimal for unvaccinated populations.
Conclusions:
- Management of FWS in young children requires adaptation due to changing vaccination rates.
- A specific algorithm is needed for the evaluation and treatment of unvaccinated children with FWS.
- Further research is warranted to validate proposed management strategies for this growing population.
Abstract:
Fever is the most common complaint for infants and children brought to the emergency department. Most febrile children younger than 3 years will have a clinically apparent source of infection. However, in approximately 20% of these children, a source cannot be identified by history and physical examination alone. The recommended diagnostic approach to children younger than 3 years presenting with fever without source (FWS) has changed dramatically over the past 30 years because of the widespread use of the Haemophilus influenza type b and polyvalent pneumococcal vaccines. The percentage of children in the United States unvaccinated at 24 months is now over 1% and seems to be increasing. This article will review what is currently known about FWS in children aged 3 to 24 months in the modern era and how it pertains to unvaccinated children treated in the emergency department. An algorithm for the treatment of unvaccinated young children presenting with FWS is proposed.
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