Fever without apparent source on clinical examination, lower respiratory infections in children, and enterovirus infections

Current Opinion in Pediatrics

Volumn 12, Issue 1, 2000, Pages 77-95

  McCarthy, Paul L ^a   Klig, Jean E ^a   Kennedy, William P ^a   Kahn, Jeffrey S ^a  

^a YALE UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANTIBIOTIC AGENT; ANTIPYRETIC AGENT; AZITHROMYCIN; BETA ADRENERGIC RECEPTOR STIMULATING AGENT; CEFTRIAXONE; CLARITHROMYCIN; ERYTHROMYCIN; IBUPROFEN; IMMUNOGLOBULIN; MACROLIDE; PALIVIZUMAB; PARACETAMOL; PENICILLIN DERIVATIVE; PLECONARIL;

ANTIBIOTIC SENSITIVITY; ANTIBIOTIC THERAPY; BACTERIAL INFECTION; CHILD; CLINICAL TRIAL; DRUG EFFICACY; DRUG MECHANISM; ENTEROVIRUS; ENTEROVIRUS INFECTION; FEBRILE CONVULSION; FEVER; HAEMOPHILUS INFLUENZAE; HUMAN; INFANT; LABORATORY DIAGNOSIS; LOWER RESPIRATORY TRACT INFECTION; MYCOPLASMA PNEUMONIA; NEUROLOGIC DISEASE; PARENTERAL DRUG ADMINISTRATION; PATHOPHYSIOLOGY; PRIORITY JOURNAL; PYREXIA IDIOPATHICA; RESPIRATORY SYNCYTIAL PNEUMOVIRUS; REVIEW; STREPTOCOCCUS PNEUMONIAE; URINARY TRACT INFECTION; VIRUS INFECTION; VIRUS MENINGITIS;

ACETAMINOPHEN; CHILD, PRESCHOOL; ENTEROVIRUS INFECTIONS; FEMALE; FEVER OF UNKNOWN ORIGIN; HAEMOPHILUS INFECTIONS; HAEMOPHILUS INFLUENZAE; HUMANS; INFANT; INFANT, NEWBORN; MALE; POLIOMYELITIS; RESPIRATORY TRACT INFECTIONS;

EID: 0033976578     PISSN: 10408703     EISSN: None     Source Type: Journal    
DOI: 10.1097/00008480-200002000-00015     Document Type: Review

References (90)

1. 1 Khan WA, Dhar U, Salam MA, Griffiths JK, Rand W, Bennish MD: Central nervous system manifestations of childhood Shigellosis: prevalence, risk factors and outcome. Pediatrics 1999, 103:488-489, e18. URL:http:// www.pediatrics.org/cgi/content/full/103/2/e18. Accessed 13 September 1999.
2. 2 Lichenstein R, King JC Jr, Farley JJ, Su P, Nair P, Vink PE: Bacteremia in febrile human immunodeficiency virus-infected children presenting to ambulatory care settings. Ped Infectious Dis J. 1998, 17:381-385.
3. 3 Van Stuijvenberg M, Jansen NE, Steyerberg EW, Derksen-Lubsen G, Mill HA: Frequency of fever episodes related to febrile seizure recurrence. Acta Paediatr 1999, 88:52-55.
4. 4 Van Stuijvenberg M, Steyerberg EW, Derksen-Lubsen G, Moll HA: Temperature, age, and recurrence of febile seizure. Arch Pediatr Adolesc Med 1998, 152:1170-1175.
5. 5 Garvey MA, Gaillard WD, Rusin JA, Ochsenschlager D, Weinstein S, Controy JA, et al.: Emergency brain computed tomography in children with seizures: who is most likely to benefit. Jour Pediatr 1998, 133:664-669.
6. 6 al-Qudah AA: Value of brain CT scan in children with febrile convulsions. Jour Neurol Sci 1995, 128:107-110.
7. 7 Robinson JL, Seal RF, Spady DW, Joffres MR: Comparison of esophageal, rectal, axillary, bladder, tympanic and pulmonary artery temperature in children. Jour Pediatr 1998, 133:553-556.
8. 8 Thebaud B, Husson B, Navelet Y, Huault G, Landrieu P, Devictor D, Sebire G: Haemorrhagic shock and encephalopathy syndrome: neurological course and predictors of outcome. Intensive Care Med 1999, 25:293-299.
9. 9 Brandts CH, Ndjavé M, Graninger W, Kremsner PG: Effect of paracetamol on parasite clearance time in Plasmodium falciparium malaria. Lancet 1997, 350:704-709.
10. 10 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. The article underscores the impact that vaccination against H. influenzae b has had on infections by the organism. In a 48 month period, 9465 children between 3-36 months of age with temperature ≥39.5°C and no source of infection other than otitis media were discharged home after being evaluated in an Emergency Department. Of these, 149 had positive blood cultures; none grew H. influenzae b. (Historically, 13% of ambulatory bacteremias were caused by H.influenzae b). On the other hand, 137 blood cultures grew S. pneumoniae. A white blood count ≥ 15000 per cu mm had a sensitivity and specificity of 86% and 77%, respectively, for bacteremia.
11. 11 Teach SJ, Geil PA: Incidence of bacteremia, urinary tract infections, and unsuspected bacterial meningitis in children with febrile seizures. Pediatr Emerg Care 1999, 15:9-12.
12. 12 Shaw KN, Gorelick M, McGowan KL, Yakscoe NM, Schwartz JS: Prevalence of urinary tract infection in febrile young children in the emergency department Pediatrics 1998, 102:390, e16. Available at: URL:http://www.pediatrics.org/cgi/content/full/102/2/e16. Accessed 14 September 1999.
13. 13 Kuppermann N, Walton EA: Immature neutrophils in the blood smears of young febrile children. Arch Pediatr Adolesc Med 1999, 153:261-266.
14. 14 Kuppermann N, Malley R, Inkelis SH, Fleisher GR: Clinical and hematologic features do not reliably identify children with unsuspected meningococcal disease. Pediatrics 1999, 103:490, e20. Available at: URL:http://www.-pediatrics.org/cgi/content/full/103/2/e20. Accessed 14 September 1999.
15. 2 in 278 children with fever equal to or greater than 39.0° and age of 5 years or less was associated with a 40% occurrence of radiographic pneumonia in those with respiratory symptoms and a 26% occurrence in those without respiratory symptoms.
16. 16 Nelson DG, Leake J, Bradley J, Kuppermann N: Evaluation of febrile children with petechial rashes: Is there a consensus among pediatricians? Pediatr Infect Dis J 1998, 17:1135-1140.
17. 17 Green SM, Rothrock SG: Evaluation styles for well-appearing febrile children: are you a "risk-minimizer" or a "test minimizer"? Ann Emerg Med 1999, 33:211-214.
18. 18 Greenes DS, Harper MB: Low risk of bacteremia in febrile children with recognizable viral syndromes. Pediatr Infect Dis J 1999, 18:258-261. This study is based on retrospective Emergency Department data and documents a low occurrence of bacteremia in children with recognizable viral syndromes. Of 876 patients with the recognizable viral syndromes of bronchiolitis (n = 411), croup (249), stomatitis (123) and varicella (93) and who had blood cultures performed, the rates of bacteremia were low: 0.2%, 0%, 0% and 1.1% respectively.
19. 19 American Academy of Pediatrics, Committee on Quality Improvement, Subcommittee on Urinary Tract Infection: Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics 1999, 103:843-852. These guidelines are based on an extensive literature review, which generated evidence tables, decision trees and risk tables, and the expert opinion of Subcommittee members. The guidelines, eleven in total, are formatted superbly, with a statement of the strength of supporting evidence and a crisp discussion of that evidence. The recommendations are quite sensible. This article is required reading for all physicians who care for acutely ill children.
20. 20 Downs SM: Technical Report: urinary tract infections in febrile infants and young children. Pediatrics 1999, 103:810, e54. Available at: URL:http://www.pediatrics.org/cgi/content/full/103/4/e54. Accessed September 14, 1999.
21. 21 Nelson DS, Gurr MB, Schunk JE: Management of febrile children with urinary tract infections. Am J Emerg Med 1998, 16:643-647.
22. 22 Silverstein M, Bachur R, Harper MB: Clinical implications of penicillin and Ceftriaxone resistance among children with pneumococcal bacteremia. Pediatr Infect Dis J 1999, 18:35-41.
23. 23 Van Stuijvenberg M, Derksen-Lubsen G, Steyerberg EW, Habbema JDF, Moll HA: Randomized controlled trial of ibuprofen syrup administered during febrile illnesses to prevent febrile seizure recurrences. Pediatrics 1998, 102:1200-1201, e51. Available at: URL:http://www.pediatrics.org/ cgi/content/full/102/5/e51. Accessed September 14, 1999.
24. 24 Baker MD, Bell LM: Unpredictability of serious bacterial illness in febrile infants from birth to 1 month of age. Arch Pediatr Adolesc Med 1999, 153:508-511. The Philadelphia Guidelines were developed to identify febrile infants between 29 to 60 days of age with serious bacterial illnesses, and also to identify those infants unlikely to have serious bacterial infections. This report studied 254 febrile infants who were younger, 3 to 28 days of age. The occurrence and spectrum of bacterial illnesses was similiar to that documented in febrile infants 29 to 60 days of age. Five of 32 serious bacterial illnesses in these 254 infants occured in 109 infants classified by the Guidelines as being unlikely to have a serious bacterial illness. The authors note that the Philadelphia Guidelines lack appropriate sensitivity and negative predictive value in febrile infants 3 to 28 days.
25. 25 Baker MD, Bell LM, Avner JR: The management of 1-2 month old febrile infants: an 8-year report card. Paper presented at: 38th Annual Meeting of the Ambulatory Pediatric Association; May 4,1998; New Orleans, LA.
26. 26 Byington CL, Taggart BS, Carroll KC, Hillyard DR: A polymerase chain reaction-based epidemiologic investigation of the incidence of nonpolio enteroviral infections in febrile and afebrile infants 90 days and younger. Pediatrics 1999, 103:656, e27. Available at: URL:http://www.pediatrics. org/cgi/content/full/103/3/e27. Accessed September 14,1999.
27. 27 Leggiadro RJ, Darras BT: Viral and bacterial pathogens of suspected sepsis in young infants. Pediatr Infect Dis J 1983, 2:287-289.
28. 28 Dagan R, Powell KR, Hall CB, Menegus MA: Identification of infants unlikely to have serious bacterial infection although hospitalized for suspected sepsis. J Pediatr 1985, 107:855-860.
29. 29 McCarthy PL, Klig JE, Kahn JS: Fever without apparent source on clinical examination, Lower respiratory infections in children, and Other infectious disease. Curr Opin Pediatr 1999, 11:89-106.
30. 30 Kuppermann N, Bank DE, Walton EA, Senac MO, McCaslin I: Risks for bacteremia and urinary tract infections in young febrile children with bronchiolitis. Arch Pediatr Adolesc Med 1997, 151:1207-1214.
31. 31 Antonow JA, Hansen K, McKinstry CA, Byington CL: Sepsis evaluations in hospitalized infants with bronchiolitis. Ped Infect Dis J 1998, 17:231 -236.
32. 32 Dhaliwal HS: Bacteremia and urinary tract infections in young febrile children with bronchiolitis [letter]. Arch Pediatr Adolesc Med 1998, 152:818-819.
33. 33 St. Jacques DM, Barton LL, Rhee KH: Risk of serious bacterial infections in infants with bronchiolitis [letter]. Arch Pediatr Adolesc Med 1998, 17:819.
34. 34 Baker MD, Bell LM, Avner JR: Outpatient management without antibiotics of fever in selected infants. N Engl J Med 1993, 329:1437-1441.
35. 35 Baker MD, Bell LM, Avner JR: The efficacy of routine outpatient management without antibiotics of fever in selected infants. Pediatrics 1999, 103:627-631.
36. 36 Pichichero ME, McLinn S, Rotbart HA, Menegus MA, Cascino M, Reidenberg BE: Clinical and economic impact of enterovirus illness in private pediatric practice. Pediatrics 1998, 102:1126-1134.
37. 37 Bradley JS, Kaplan SL, Tan TQ, Barson WJ, Arditi M, Schutze GE, et al., and The Pediatric Multicenter Pneumoccocal Surveillance Study Group (PMP SSG): Pediatric pneumococcal bone and joint infections. Pediatrics 1998, 102:1376-1382. The authors and the Study Group, which represent eight children's hospitals, report on 42 children with either osteomyelitis (n = 21) or septic arthritis (n = 21) caused by S. pneumonias and seen over a 36-month period. Twenty-nine of the children had been seen at least once previously. For the entire group, the mean duration of fever before hospitalisation was 5.6 days with a standard deviation of plus or minus 5.6 days. Blood cultures were positive in 19 of the 42 children, and were the only site of pathogen isolation in six children with osteomyelitis and two children with septic arthritis. The results support the wisdom of considering bone and joint infection in children with prolonged fever and of obtaining blood cultures in children with FUO.
38. 38 Mulley JC: The genetic basis for periodic fever. AM J. Human Genet 1999, 64:939-942.
39. 39 McCarthy PL, Kahn JS, Shapiro E, Klig J: Fever without apparent source on clinical examination, Infectious diseases, and Lower respiratory infections in children. Curr Opin Pediatr 1998, 10:101-116.
40. 40 White PD, Thomas JM, Amess J, Crawford DH, Grover SA, Kangro HO, Clare AW: Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever. Br J Psychiatry 1996, 173:475-481.
41. 41 Hizli S, Ozdemir S, Bakkaloglu A: Anhidrotic ectodermal dysplasia (Christ-Siemens-Touraine syndrome) presenting as a fever of unknown origin in an infant. Int J Dermatol 1998, 37:128-144.
42. 42 West T, Goetghebuer T, Milligan P, Mulholland E, Weber M: Long-term morbidity and mortality following hypoxaemic lower respiratory tract infection in Gambian children. Bullet World Health Org 1999, 77:144-148.
43. 43 Cropp GJ: Regional differences in prevalence and risks of respiratory diseases in children. Pediatr Pulmonol Suppl 1999, 18:37-40. This is an interesting summary of the global impact of LRI illness.
44. 44 Nafstad P, Hagen JA, Oie L, Magnus P, Jaakkola JJ: Day care centers and respiratory health. Pediatrics 1999, 103:753-758.
45. 45 Li JS, Peat JK, Xuan W, Berry G: Meta-analysis on the association between environmental tobacco smoke (ETS) exposure and the prevalence of lower respiratory tract infection in early childhood. Pediatr Pulmonol 1998, 27:5-13.
46. 46 Lewis PR, Hensley MJ, Wlodarczyk J, et al.: Outdoor air pollution and children's respiratory symptoms in the steel cities of New South Wales. Med J Aust 1998, 169:459-463.
47. 47 Cesar JA, Victora CG, Barros FC, Santos IS, Flores JA: Impact of breast feeding on admission for pneumonia during postneonatal period in Brazil: nested case-control study. Br Med J 1999, 318:1316-1320.
48. 48 Sinaniotis C: Community-acquired pneumonia: Diagnosis and treatment. Pediatr Pulmonol Suppl 1999, 18:144-145. This is a brief summary of the clinical issues in distinguishing bacterial from viral pneumonia.
49. 49 Usen S, Weber M, Mulholland K, Jaffar S, Oparango A, Omosigho C, et al.: Clinical predictors of hypoxaemia in Gambian children with acute lower respiratory tract infection: Prospective cohort study. Br Med J 1999, 318:86-91.
50. 50 Donnelly LF: Maximizing the usefulness of imaging in children with community-acquired pneumonia. AJR Am J Roentgenol 1999, 172:505-512. This is a comprehensive review of chest imaging for LRI illness.
51. 51 Bachur R, Perry H, Harper MB: Occult pneumonias: empiric chest radiographs in febrile children with leukocytosis. Ann Emer Med 1999, 33:166-173. This is an interesting study on a challenging clinical issue.
52. 52 Heiskanen-Kosma T, Korppi M, Jokinen C, Kurhi S, Heiskanen L, Juvonen H, et al.: Etiology of childhood pneumonia: Serologic results of a prospective, population-based study. Pediatr Infect Dis J 1998, 17:986-991.
53. 53 Djuretic T, Ryan M, Miller E, Fairley CK, Goldblatt D: Hospital admissions in children due to pneumococcal pneumonia in England. J Infect 1998, 37:54-58.
54. 54 Korppi M, Leinonen M: Pneumococcal immune complexes in the diagnosis of lower respiratory infections in children. Pediatr Infect Dis J 1998, 17:992-995.
55. 55 Hoppe JE: Update on respiratory infection caused by Bordetella parapertussis. Pediatr Infect Dis J 1999, 18:375-381. This is a comprehensive and interesting review of the subject.
56. 56 Butler CC, Rollnick S, Kinnersley P, Jones A, Stott N: Reducing antibiotics for respiratory tract symptoms in primary care: consolidating "why" and considering "how." Br J Gen Prac 1998, 48:1865-1870.
57. 57 Schaad UB: Antibiotic therapy of childhood pneumonia. Pediatr Pulmonol Suppl 1999, 18:146-149. This is a critical review of the issues in clinical assessment and the decision to treat LRI illness with antibiotics.
58. 58 Cimolai N: Mycoplasma pneumoniae respiratory infection. Pediatr Rev 1998, 19:327-332. This is a comprehensive and clinically relevent review.
59. 59 Waris ME, Toikka P, Saarinen T, Nikkari S, Meurman O, Vainionpaa R, et al.: Diagnosis of mycoplasma pneumoniae pneumonia in children. J Clin Microbiol 1998, 36:3155-3159.
60. 60 Grondahl B, Puppe W, Hoppe A, Kuhne I, Weigl JA, Schmitt HJ: Rapid identification of nine microorganisms causing acute respiratory tract infections by single-tube multiplex reverse transcription-PCR: feasibility study. J Clin Microbiol 1999, 37:1-7.
61. 61 Carlisle LK: Bilateral spontaneous pneumothorax associated with mycoplasma pneumoniae Infection. Clin Pediatr 1999, 38:301-304.
62. 62 Wang C-H, Chou M-L, Huang C-H: Benign isolated abducens nerve palsy in mycoplasma pneumoniae infection. Pediatr Neurol 1998, 18:71-72.
63. 63 Hagiwara K, Ouchi K, Tashiro N, Azuma M, Kobayashi K: An epidemic of a pertussis-like illness caused by chlamydia pneumoniae. Pediatr Infect Dis J 1999, 18:271-275.
64. 64 Hahn DL, McDonald R: Can acute chlamydia pneumoniae respiratory tract infection initiate chronic asthma? Ann Allergy Asthma Immunol 1998, 81:339-344.
65. 65 Rakes GP, Aurruda E, Ingram JM, Hoover GE, Zambrano JC, Hayden FG, et al.: Rhinovirus and respiratory syncytial virus in wheezing children requiring emergency care. Am J Respir Crit Care Med 1999, 159:785-790.
66. 66 Karanfil LV, Conlon M, Lykens K, Masters CF, Forman M, Griffith ME, et al.: Reducing the rate of nosocomially transmitted respiratory synctial virus. Am J Infect Control 1999, 27:91-96.
67. 67 Rodriguez WJ, Arrobio J, Fink R, Kim HW, Milburn C: Prospective follow-up and pulmonary functions from a placebo-controlled randomized trial of ribavirin therapy in respiratory syncytial virus bronchiolitis. Arch Pediatr Adolesc Med 1999, 153:469-474.
68. 68 Redding GJ, Brawn S, Mayock D: Impact of respiratory syncytial virus immune globulin in 1996-1997. Arch Pediatr Adolesc Med 1999, 153:503-507.
69. 69 Canfield SD, Simoes EA: Prevention of respiratory synctial virus (RSV) infection: RSV immune globulin intravenous and palivizumab. Pediatr Ann 1999, 28:507-514. This is a useful review of these two preventive therapies.
70. 70 Committee on Infectious Diseases: Prevention of respiratory syncytial viraus infections: indications for the use of palivizumab and update on the use of RSV-IGIV. Pediatr 1998, 102:1211-1216. These are critical guidelines from the American Academy of Pediatrics.
71. 71 Palivizumab for prevention of RSV infection. Med Lett 1999, 41:3-4.
72. 72 Castro-Rodriguez JA, Holberg CJ, Wright AL, Halonen M, Taussig LM, Morgan WJ, Martinez FD: Association of radiologically ascertained pneumonia before age 3 years with asthmalike symptoms and pulmonary function during childhood. Am J Respir Crit Care Med 1999, 159:1891-1897.
73. 73 McCarthy PL, Lembo RM, Baron MA, Fink HD, Cicchetti DV: Predictive value of abnormal physical examination findings in ill appearing and well appearing febrile children. Pediatrics 1985, 76:167-171.
74. 74 Mandel G, Bennet J, Dolin R: Principles and Practice of Infectious Disease, edn 4. New York, NY: Churchill Livingstone; 1995.
75. 75 Long S, Pickering L, Prober C: Principles and Practice of Pediatric Infectious Disease. New York, NY: Churchill Livingstone; 1997:1287.
76. 76 Muir P, Kammerer U, Korn K, Mulders M, Poyrt T, Weissbrich B, et al.: Molecular typing of enteroviruses: current status and future requirements. Clin Microb Rev 1998, 11:202-227.
77. 77 Hyypia T, Hovi T, Knowles N, Stanway G: Classification of enteroviruses based on molecular and biological properties. J Gen Virol 1997, 78:1-11.
78. 78 Shepley M, Racaniello V: A monoclonal antibody that blocks poliovirus attachment recognizes the lymphocyte homing receptor CD44. J Virol 1994, 68:1301-1308.
79. 79 Pulli T, Kodimies P, Hyypia T: Molecular comparison of Coxsackie A virus serotypes. Virology 1995, 212:30-38.
80. 80 Fredericks D, Relman D: Applications of polymerase chain reaction to the diagnosis of infectious diseases. Clin Inf Dis 1999, 29:475-488.
81. 81 Byington C, Taggart E, Carroll K, Hillyard D: Apolymerase chain reaction-based epidemiological investigation of the incidence of nonpolio enteroviral infectins in febrile and afebrile infants 90 days and younger. Pediatrics 1999, 103:e27. Available at: URL:http://www.pediatrics.org/cgi/ content/full/103/e27.
82. 82 Hamilton M, Jackson M, Abel D: Clinical utility of polymerase chain reaction testing for enteroviral meningitis. Pediatr Infect Dis J 1999, 18:533-537.
83. 83 Taggart B, Hillyard D, Robinson J, Carroll K: Enterovirus detection in cerbrospinal fluid by spin amplified shellviral culture and polymerase chain reaction. Paper presented at: 14th Annual Pan-American Society for Clinical Virology; April 26-29, 1998; Clearwater, FL.
84. 84 Rotbart H, McCracken G, Whitley R, Modlin J, Cascino M, Shah S, Blum D: Clinical significance of enteroviruses in serious summer febrile illnesses in children. Pediatr Infec Dis J 1999, 18: 869-874.
85. 85 Deaths among children during an outbreak of hand, foot, and mouth disease - Taiwan, Republic of China, April-July, 1998. MMWR Morb Mortal Wkly Rep 1998, 47:629-632.
86. 86 Ho M, Chen E, Hsu K, Twu S, Chen K, Tsai S, et al.: An epidemic of enterovirus 71 infections in Taiwan. New Engl J Med 1999, 341:929-935.
87. 87 Huang C, Liu C, Chang Y, Chen C, Wang S, Yeh T: Neurological complications in children with enterovirus 71 infections. New Engl J Med 1999, 341:936-942.
88. 88 Cardosa M, Krishnan S, Tio P, Perera D, Wong S: Isolation of subgenus B adenovirus during a fatal outbreak of enterovirus 71-associated hand, foot, and mouth disease in Sibu, Sarawak. Lancet 1999, 354:987-991.
89. 89 World Health Organization. Wkly Epidemiol Rec 1997, 72:184, 211.
90. 90 Pevear D, Tull T, Seipel M, Groarke J: Activity of pleconaril against enteroviruses. Antimicbro Agents Chemother 1999, 43:2109-2115.