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Occult pneumococcal bacteremia and the febrile infant and young child
Insights
Occult pneumonoccemia (OP) is unexpected Streptococcus pneumoniae bacteremia in young children. High-risk factors include age, fever, and elevated white blood cell counts, potentially leading to serious complications.
Area of Science:
- Pediatrics
- Infectious Diseases
- Bacteriology
Background:
- Occult pneumonoccemia (OP) is defined as unsuspected Streptococcus pneumoniae bacteremia in previously healthy children presenting with fever and either no discernible infection focus or an upper respiratory infection.
- This condition is particularly relevant in urban emergency room and clinic settings.
Observation:
- Four cases of OP are presented, alongside a review of existing literature.
- Key risk factors for OP include children aged 6 to 24 months presenting with rectal temperatures ≥38.9°C (102°F) and white blood cell counts ≥15,000/mm³.
- Associated symptoms may include irritability, rhinorrhea, and febrile seizures.
Findings:
- Among untreated patients with OP, outcomes varied upon follow-up of positive blood cultures.
- 40% experienced spontaneous resolution.
- 29% had persistent symptoms with sterile blood cultures, 22% had persistent symptoms with positive blood cultures, and 10% developed pneumococcal meningitis.
Implications:
- Early identification of OP risk factors in febrile young children is crucial.
- Prompt diagnosis and appropriate management can prevent severe complications like meningitis.
- Understanding the natural course of untreated OP informs clinical decision-making and resource allocation.
Abstract:
Occult pneumonoccemia (OP) is unsuspected Streptococcus pneumoniae bacteremia occurring in a previously well child who presents with fever associated with either no focus or an upper respiratory focus infection. In this report, four cases of OP are presented and the literature is reviewed. The risk of OP appears highest for children, seen in urban emergency rooms and clinics, who are 6 to 24 months of age with rectal temperatures greater than or equal to 38.9 C (102 F) and who have white blood cell counts greater than or equal to 15,000/mm3. Other symptoms associated with OP include irritability, rhinorrhea, and febrile seizures. When recalled because of positive blood cultures, 40 per cent of untreated patients with OP had had spontaneous resolution of their illness, 29 per cent had persistent fever or symptoms and sterile blood cultures, 22 per cent had persistent fever or symptoms and positive blood cultures, while 10 per cent had a febrile course complicated by pneumococcal meningitis.