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Bacterial and viral pathogens causing fever in infants less than 3 months old
Insights
Fever in infants under 3 months is often caused by nonpolio enteroviruses, leading to aseptic meningitis. Urinary tract infections were the most common bacterial cause in this sick infant population.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Fever in infants under three months old is a common clinical presentation requiring prompt diagnosis.
- Identifying the causative pathogens is crucial for appropriate treatment and management of febrile infants.
- Previous studies have highlighted the diverse etiologies of fever in this vulnerable age group.
Purpose of the Study:
- To determine the relative causes of fever in infants less than three months of age presenting at Tripler Army Medical Center.
- To identify the most common bacterial and viral pathogens responsible for febrile illness in this demographic.
- To analyze the clinical presentations and diagnoses associated with identified pathogens.
Main Methods:
- Prospective study of 182 sick, febrile infants (<3 months old).
- Collection and culture of blood, cerebrospinal fluid, urine, nasopharyngeal secretions, and stool specimens.
- Serological confirmation of viral infections using paired acute and convalescent sera.
Main Results:
- A pathogen was isolated in 41% of infants (75 viral, 27 bacterial).
- Nonpolio enteroviruses were the most frequent pathogens (35%), commonly causing aseptic meningitis (62% of enterovirus cases).
- Urinary tract infection was the most common bacterial infection (11%), particularly in uncircumcised males. Salmonellosis occurred in 3% of infants.
Conclusions:
- Nonpolio enteroviruses are a leading cause of fever and aseptic meningitis in young infants.
- Urinary tract infections are the most frequent bacterial cause of fever in this age group.
- Early identification of pathogens is essential for managing febrile illnesses in infants.
Abstract:
We studied 182 sick, febrile (temperature greater than 38 degrees C) infants less than 3 months of age, who presented at our Tripler Army Medical Center, Honolulu, during a one-year period, to determine the relative causes of fever in this age group. Blood, cerebrospinal fluid, urine, nasopharyngeal secretions, and stool specimens were cultured for bacterial and viral pathogens. Paired acute and convalescent sera were collected to serologically confirm infection in infants from whom viral isolations were obtained only from the nasopharynx or stool. A viral pathogen was isolated in 75 infants (41%) and a bacterial pathogen was isolated in 27 infants (15%). Nonpolio enteroviruses were the most common pathogens demonstrated. They were isolated from 64 infants (35%), and 40 (62%) of these infants had aseptic meningitis, the most frequently made diagnosis. Urinary tract infection was the most common bacterial infection observed. It occurred in 20 infants (11%) and was most often seen without associated pyuria in uncircumcised male infants. Salmonellosis, the second most common bacterial infection, was observed in six infants (3%), and two of these did not have diarrhea or other gastrointestinal tract symptoms. No infant had septicemia and only one infant had bacterial (group B streptococcal) meningitis.