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Updated: Jun 9, 2025
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Factors contributing to the non-identification of bacterial meningitis in febrile infants: A case series study
Krishnan Chakkiyar1, P R Sabeel Abdulla1, M D Fiji1
1Department of Pediatrics, Government Medical College Kozhikode, Kozhikode, Kerala, India.
Abstract:
Non-identification of serious bacterial infection (SBI) in febrile infants is a common occurrence in clinical practice, culminating in catastrophic presentations. Six infants who initially presented to the clinician with fever without a focus, and were lately diagnosed with bacterial meningitis were analyzed for clinician-related factors contributing to the non-identification of meningitis. In a febrile neonate and a febrile young infant, lack of comprehensive evaluation was contributing to the non-identification of SBI; in four infants above the age of 3 months, meningitis was missed in spite of clinicians practicing treatment guidelines. Inadequate symptom characterization in two febrile infants and inappropriate interpretation of hemogram in three febrile infants also contributed to the non-identification of meningitis. Except for one, all infants developed complications. We conclude that the characterization of clinical features of SBI-like meningitis, interpretation of lab data, and adherence to the treatment guidelines are crucial in the management of an infant presenting as fever without a focus.
Insights
Missing serious bacterial infections (SBI) in febrile infants can lead to severe outcomes. This study highlights clinician-related factors like inadequate evaluation and misinterpretation of lab results contributing to missed meningitis diagnoses in infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Medicine
Background:
- Serious bacterial infections (SBI) in febrile infants are often difficult to identify, potentially leading to severe complications.
- Delayed or missed diagnoses of meningitis in infants can result in catastrophic outcomes.
- Fever without a focus is a common presentation in infants, posing diagnostic challenges.
Purpose of the Study:
- To analyze clinician-related factors contributing to the missed diagnosis of meningitis in febrile infants.
- To identify specific reasons for the non-identification of serious bacterial infections in young children.
- To improve the diagnostic accuracy for meningitis in infants presenting with fever.
Main Methods:
- Retrospective analysis of six infants diagnosed with bacterial meningitis after initially presenting with fever without a focus.
- Evaluation of clinician-related factors, including clinical assessment, symptom characterization, and laboratory data interpretation.
- Review of adherence to established treatment guidelines.
Main Results:
- Lack of comprehensive evaluation contributed to missed SBI in a neonate and a young infant.
- Meningitis was missed in four infants over 3 months old despite guideline adherence.
- Inadequate symptom characterization and inappropriate hemogram interpretation were identified in multiple cases.
- All but one infant developed complications.
Conclusions:
- Accurate characterization of clinical features suggestive of SBI-like meningitis is critical.
- Proper interpretation of laboratory data, such as hemograms, is essential for timely diagnosis.
- Adherence to treatment guidelines, coupled with vigilant clinical assessment, is crucial for managing infants with fever without a focus.
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