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Fever without source in infants and young children
1University of Kansas Medical Center, Kansas City, Kansas.
Insights
Febrile infants and children present a diagnostic challenge, as viral illnesses can mimic serious occult bacteremia. A structured approach combining history, physical exam, and lab tests aids management decisions for fever without source.
Area of Science:
- Pediatrics
- Infectious Diseases
- Primary Care Medicine
Background:
- Febrile infants and young children present a diagnostic challenge for primary care physicians.
- Differentiating viral illnesses from occult bacteremia in febrile children is difficult due to similar clinical presentations.
Purpose of the Study:
- To outline a structured and rational approach for evaluating febrile infants and children.
- To aid primary care physicians in making key management decisions regarding antimicrobial therapy and hospitalization for febrile children.
Main Methods:
- Comprehensive patient history.
- Thorough physical examination.
- Judicious use of laboratory studies.
Main Results:
- The evaluation process provides crucial information for clinical decision-making.
- A structured approach helps manage the uncertainty associated with fever without source in pediatric patients.
Conclusions:
- No single optimal diagnostic and therapeutic schema exists for febrile infants and children.
- Physicians should utilize clinical experience and literature to guide a rational approach to managing febrile children, balancing the risks of undertreatment and overtreatment.
Abstract:
Febrile infants and young children pose a challenge to primary care physicians because the clinical appearance of children who present with fever without source that is related to a viral illness may be similar to the appearance of those with occult bacteremia. The evaluation of the febrile infant and child comprises a comprehensive history, a thorough physical examination and judicious use of laboratory studies. The information derived from this evaluation will help clinicians with the two key management decisions that face physicians caring for this vulnerable population: the initiation and use of antimicrobial therapy, and inpatient versus outpatient management. Although no optimal diagnostic and therapeutic schema exists, physicians should take a structured and rational approach to these patients, depending on their own clinical experience and interpretation of the literature on this topic.