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Occult pneumococcal bacteraemia and febrile convulsions
Insights
Occult pneumococcal bacteraemia in children, often presenting as febrile convulsions, was identified in the UK. Early detection and prospective studies are crucial for understanding this condition and its complications.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Streptococcus pneumoniae bacteraemia occurs in children.
- Occult pneumococcal bacteraemia, where the infection source is unknown, is a recognized entity in the USA.
- This condition has not been widely reported in the United Kingdom.
Purpose of the Study:
- To report the occurrence of occult pneumococcal bacteraemia in children in the UK.
- To investigate the association between occult pneumococcal bacteraemia and febrile convulsions.
- To highlight the need for further research into this condition.
Main Methods:
- Retrospective review of hospital records over two years.
- Identification of children with bacteraemia due to Streptococcus pneumoniae.
- Analysis of clinical presentation, laboratory findings, and outcomes.
Main Results:
- Twenty-nine children had Streptococcus pneumoniae bacteraemia.
- Fifteen previously healthy children had occult bacteraemia, often unsuspected clinically.
- In young children, occult pneumococcal bacteraemia was frequently associated with febrile convulsions.
Conclusions:
- Occult pneumococcal bacteraemia may be an under-recognized cause of febrile convulsions in children.
- Further prospective studies are needed to clarify the incidence, complications, and optimal management.
- This condition warrants increased clinical suspicion, especially in young children presenting with febrile seizures.
Abstract:
Over two years 29 children had bacteraemia due to Streptococcus pneumoniae at this hospital. In 15 previously healthy children the site of infection could not be identified, and in most of them, bacteraemia was not suspected clinically. All 15 had high total white cell (greater than or equal to 17 x 10(9)/1) and neutrophil (greater than or equal to 11 x 10(9)/1) counts. Twelve children were under 4 years of age, and of these, 10 had been admitted because of a simple febrile convulsion and one had a prolonged febrile convulsion. Occult pneumococcal bacteraemia has been reported in the USA for more than 10 years, but no series has been reported from the United Kingdom. Occult pneumococcal bacteraemia may be an important cause of febrile convulsions. Persisting bacteraemia and the development of focal infections, including pneumococcal meningitis, have been reported. Meningitis did not occur after occult bacteraemia in our patients. Studies to date have been retrospective, and thus the true incidence of the complications and the best treatment are not clear. A prospective study of children with febrile convulsions could provide answers.