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Occult bacteremia in the 3-month-old to 3-year-old age group
1Division of Infectious Diseases, Children's Hospital, Boston, Massachusetts 02115.
Insights
Identifying occult bacteremia in febrile children is crucial. A high white blood cell count can help detect two-thirds of these serious infections, guiding timely treatment to prevent complications.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Occult bacteremia, or bloodstream infection without an obvious source, often precedes severe pediatric infections.
- Febrile children aged 3-36 months are at high risk for bacteremia caused by Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis.
- Clinical examination alone is often insufficient to differentiate bacteremic from non-bacteremic children.
Purpose of the Study:
- To outline a strategy for identifying children with occult bacteremia.
- To emphasize the importance of early detection and treatment to prevent serious sequelae.
Main Methods:
- Review of clinical presentation and diagnostic findings in children with occult bacteremia.
- Evaluation of the utility of fever and white blood cell (WBC) count in diagnosing bacteremia.
- Highlighting blood culture as the definitive diagnostic test.
Main Results:
- Most children with occult bacteremia present with fever (>= 39 degrees C).
- A white blood cell count greater than 15,000/microL identifies approximately two-thirds of children with occult bacteremia.
- Physical examination findings are typically non-specific.
Conclusions:
- Early identification and treatment of occult bacteremia in children are essential to prevent severe outcomes.
- While fever is common, a high WBC count aids in detecting bacteremia, but blood culture remains the gold standard.
Abstract:
Occult bacteremia precedes many serious infections in children. The vast majority of patients with occult bacteremia have an elevated temperature (> or = 39 degrees C), but fever is an extraordinarily common presenting complaint in the 3- to 36-month-old age group, which is at highest risk for S pneumoniae, H influenzae type b, and N meningitidis bacteremia. On examination, most patients with bacteremia will have no findings that distinguish them from nonbacteremic children. A white blood cell count of > 15,000/microL in a child with fever will identify about two thirds of children with occult bacteremia. Blood culture remains the most definitive test. It is important to establish a rational strategy to identify and treat these children before significant sequelae occur.