Open Access, Peer-reviewed
pISSN 2384-1079
eISSN 2384-1087
    Pediatr Infect Vaccine. 2016 Aug;23(2):128-136. Korean.
    Published online Aug 25, 2016.
    https://doi.org/10.14776/piv.2016.23.2.128
    Copyright © 2016 The Korean Society of Pediatric Infectious Diseases
    Original Article

    Clinical Characteristics of Fever without Localizing Sign in Infants Younger than 100 Days of Age in a Single Center

    Hyun Suk Lee and Kye Hyang Lee
      • Department of Pediatrics, School of Medicine, Catholic University of Daegu, Korea.
    • Corresponding author (Email: rosalia@cu.ac.kr )
    Received April 01, 2016; Revised May 05, 2016; Accepted June 08, 2016.

    Abstract

    Purpose

    This study was done to define clinical characteristics of fever without localizing signs (FWLS) in infants younger than 100 days of age with a goal of providing baseline data to establish a new diagnostic paradigm in the future.

    Methods

    We reviewed medical records of 183 patients who admitted to Daegu Catholic University Medical Center for FWLS younger than 100 days of age from January 2013 to September 2015 retrospectively. Demographic, clinical features and laboratory findings were analyzed. Patients were divided into serious bacterial infection (SBI) and non-SBI groups, and then were compared between two groups to find risk factors for SBI.

    Results

    Among 183 patients, lumbar puncture was performed in 98.9% and CSF pleocytosis was present in 35.9%. Sterile CSF pleocytosis was found in 43% of urinary tract infection (UTI) patients. None had concomitant bacterial meningitis in patients with UTI. As final diagnosis, febrile syndrome without source (25.7%) was most common. Among SBI, UTI was most common (99%). Birth weight, ESR, and CRP were significantly higher in SBI group compared to non-SBI group. Male sex (OR 4.93, 95% CI 1.60-15.24) and pyuria (OR 18.88, 95% CI 6.76-52.76) were identified as risk factors for SBI. Presence of sibling (OR 0.30, 95% CI 0.11-0.83) was significantly lower in SBI group.

    Conclusions

    Our results showed UTI was the most common SBI in young infants with FWLS. Though aseptic meningitis can be coexisting with UTI, lumbar puncture may not be necessary in all patients having UTI.

    Keywords
    Fever; Infant; Bacterial infection; Urinary tract infection

    Tables

    Table 1
    Demographic Characteristics of 183 Patients

    Table 2
    Cerebrospinal Fluid Pleocytosis in Febrile Infants Younger than 100 Days

    Table 3
    Viral Pathogens Isolated from Patients with Fever without Localizing Signs

    Table 4
    Final Diagnosis of 183 Patients with Fever without Localizing Signs Categorized by Isolated or Combined Infection Groups

    Table 5
    Comparison between Serious Bacterial Infection (SBI) and Non-SBI Groups in Clinical and Laboratory Findings

    References

      1. Baraff LJ. Management of fever without source in infants and children. Ann Emerg Med 2000;36:602–614.
      1. Mekitarian Filho E, de Carvalho WB. Current management of occult bacteremia in infants. J Pediatr (Rio J) 2015;91 6 Suppl 1:S61–S66.
      1. Seok JY, Kang JE, Cho EY, Choi EH, Lee HJ. Etiology and clinical manifestations of fever in infants younger than 3 months old: a single institution study, 2008-2010. Korean J Pediatr Infect Dis 2012;19:121–130.
      1. Kim KH, et al., editors. The Korean Pediatric Society. Immunization guideline. 8th ed. Seoul: The Korean Pediatric Society; 2015. pp. 314-321.
      1. Martínez Planas A, Muñoz Almagro C, Luaces Cubells C, Noguera Julián A, Selva L, Fernández JP, et al. Low prevalence of invasive bacterial infection in febrile infants under 3 months of age with enterovirus infection. Clin Microbiol Infect 2012;18:856–861.
      1. Sastre JB, Aparicio AR, Cotallo GD, Colomer BF, Hernández MC. Urinary tract infection in the newborn: clinical and radio imaging studies. Pediatr Nephrol 2007;22:1735–1741.
      1. Lehman RK, Schor NF. Neurologic evalulation. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, Behrman RE, editors. Nelson textbook of pediatrics. 19th ed. Philadelphia: Saunders Elsevier; 2011. pp. 1998.
      1. Mintegi S, Benito J, Astobiza E, Capapé S, Gomez B, Eguireun A. Well appearing young infants with fever without known source in the emergency department: are lumbar punctures always necessary? Eur J Emerg Med 2010;17:167–169.
      1. Ashkenazi-Hoffnung L, Livni G, Amir J, Bilavsky E. Serious bacterial infections in hospitalized febrile infants aged 90 days or younger: the traditional combination of ampicillin and gentamicin is still appropriate. Scand J Infect Dis 2011;43:489–494.
      1. Adler-Shohet FC, Cheung MM, Hill M, Lieberman JM. Aseptic meningitis in infants younger than six months of age hospitalized with urinary tract infections. Pediatr Infect Dis J 2003;22:1039–1042.
      1. Syrogiannopoulos GA, Grivea IN, Anastassiou ED, Triga MG, Dimitracopoulos GO, Beratis NG. Sterile cerebrospinal fluid pleocytosis in young infants with urinary tract infection. Pediatr Infect Dis J 2001;20:927–930.
      1. Schnadower D, Kuppermann N, Macias CG, Freedman SB, Baskin MN, Ishimine P, et al. Sterile cerebrospinal fluid pleocytosis in young febrile infants with urinary tract infections. Arch Pediatr Adolesc Med 2011;165:635–641.
      1. Shah SS, Zorc JJ, Levine DA, Platt SL, Kuppermann N. Sterile cerebrospinal fluid pleocytosis in young infants with urinary tract infections. J Pediatr 2008;153:290–292.
      1. Doby EH, Stockmann C, Korgenski EK, Blaschke AJ, Byington CL. Cerebrospinal fluid pleocytosis in febrile infants 1-90 days with urinary tract infection. Pediatr Infect Dis J 2013;32:1024–1026.
      1. Paquette K, Cheng MP, McGillivray D, Lam C, Quach C. Is a lumbar puncture necessary when evaluating febrile infants (30 to 90 days of age) with an abnormal urinalysis. Pediatr Emerg Care 2011;27:1057–1061.
      1. Tebruegge M, Pantazidou A, Curtis N. Question 1. How common is co-existing meningitis in infants with urinary tract infection. Arch Dis Child 2011;96:602–606.
      1. Shin SH, Choi CW, Lee JA, Kim EK, Choi EH, Kim HS, et al. Risk factors for serious bacterial infection in febrile young infants in a community referral hospital. J Korean Med Sci 2009;24:844–848.
      1. Gómez B, Mintegi S, Benito J, Egireun A, Garcia D, Astobiza E. Blood culture and bacteremia predictors in infants less than three months of age with fever without source. Pediatr Infect Dis J 2010;29:43–47.
      1. Wolff M, Bachur R. Serious bacterial infection in recently immunized young febrile infants. Acad Emerg Med 2009;16:1284–1289.
      1. Olaciregui I, Hernández U, Muñoz JA, Emparanza JI, Landa JJ. Markers that predict serious bacterial infection in infants under 3 months of age presenting with fever of unknown origin. Arch Dis Child 2009;94:501–505.
      1. Cho EY, Song H, Kim AS, Lee SJ, Lee DS, Kim DK, et al. Predictive factors for severe infection among febrile infants younger than three months of age. Korean J Pediatr 2009;52:898–903.
      1. Mintegi S, Garcia-Garcia JJ, Benito J, Carrasco-Colom J, Gomez B, Hernández-Bou S, et al. Rapid influenza test in young febrile infants for the identification of low-risk patients. Pediatr Infect Dis J 2009;28:1026–1028.
      1. Abanses JC, Dowd MD, Simon SD, Sharma V. Impact of rapid influenza testing at triage on management of febrile infants and young children. Pediatr Emerg Care 2006;22:145–149.
      1. Antonyrajah B, Mukundan D. Fever without apparent source on clinical examination. Curr Opin Pediatr 2008;20:96–102.
      1. Lee GM, Harper MB. Risk of bacteremia for febrile young children in the post-Haemophilus influenzae type b era. Arch Pediatr Adolesc Med 1998;152:624–628.
      1. Gomez B, Bressan S, Mintegi S, Da Dalt L, Blazquez D, Olaciregui I, et al. Diagnostic value of procalcitonin in well-appearing young febrile infants. Pediatrics 2012;130:815–822.
    Cited by
    Crossref 2
    Google Scholar 
    MeSH Terms
    Academic Medical Centers
    Bacterial Infections
    Birth Weight
    Daegu
    Diagnosis
    Fever*
    Humans
    Infant*
    Leukocytosis
    Male
    Medical Records
    Meningitis, Aseptic
    Meningitis, Bacterial
    Pyuria
    Retrospective Studies
    Risk Factors
    Siblings
    Spinal Puncture
    Urinary Tract Infections
    Metrics
    Share
    Tables
    slide
    slide
    slide
    slide
    slide

    1 / 5

    PERMALINK