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Patterns of illness in the highly febrile young child: epidemiologic, clinical, and laboratory correlates
Insights
High fevers in young children are often viral, with most cases showing respiratory symptoms. Systemic bacterial infections are rare, occurring in about one in 94 years of child care.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Microbiology
Background:
- Fever is a common symptom in infants and young children.
- Differentiating viral from bacterial causes of fever is crucial for appropriate treatment.
- Understanding the epidemiology of febrile illnesses in children is important for public health.
Purpose of the Study:
- To investigate the causes and clinical presentations of febrile illnesses in young children.
- To determine the incidence of viral and bacterial infections in children with high fevers.
- To assess the rate of systemic bacterial disease in otherwise healthy children presenting with fever.
Main Methods:
- Retrospective analysis of 301 episodes of fever (>= 103 F) in 375 children from October 1974 to October 1978.
- Collection of viral and bacterial cultures from respiratory tract, blood, and cerebrospinal fluid (CSF).
- Comparison of bacterial isolation rates in febrile children versus a control group of well children.
Main Results:
- 79% of high-fever episodes were associated with respiratory signs/symptoms.
- Viral cultures were positive in 38% of respiratory illness cases.
- Bacterial isolation rates (Haemophilus influenzae, Streptococcus pneumoniae, group A streptococci) from the upper respiratory tract did not differ between febrile and well children.
- Systemic bacterial disease was documented in 9 children (8 with bacteremia, 1 with positive CSF).
- The rate of bacteremic disease was one episode per 94 years of child care.
Conclusions:
- Most high-fevers in young children are likely viral and associated with respiratory symptoms.
- Routine bacterial cultures of the upper respiratory tract may not be highly informative in diagnosing the cause of fever.
- Clinically apparent systemic bacterial disease is uncommon in otherwise healthy febrile infants and young children.
Abstract:
Three hundred one episodes of fever greater than or equal to 103 F were documented in 375 infants and young children observed in a comprehensive care clinic during the period October 1974 to October 1978. Of such highly febrile illnesses 79% were accompanied by respiratory tract signs or symptoms, 7% by disease at a site other than the respiratory tract, and 22% of illnesses had no localizing signs or symptoms. Viral cultures were obtained from the respiratory tract in 178 cases and were positive in 68: 57/134 from respiratory illness; 2/4 from illness at sites other than the respiratory tract; and 9/40 in children without localizing disease. Bacterial cultures of the upper respiratory tract were obtained in 191 illnesses, but the overall rate of isolation of Haemophilus influenzae, Streptococcus pneumoniae and group A streptococci (46%) did not differ from that in a group of well children (39%). Bacterial cultures of the blood were obtained in 89 patients with fever greater than or equal to 103 F and in an additional 41 children with lower temperatures. Nine children had documented systemic bacterial disease (eight positive blood cultures and one positive CSF). The rate of clinically apparent systemic bacterial disease in these otherwise normal infants was one bacteremic episode per 94 years of child care.