Occult bacteremia in young febrile children

The evaluation of nontoxic-appearing, young, febrile children has been a subject of considerable debate. Of young, nontoxic-appearing children aged 3 to 36 months with temperatures of 39 degrees C or more and no clear source, approximately 2% to 3% have occult bacteremia. Of these bacteremias, approximately 90% are caused by S. pneumoniae, 5% by nontyphoidal Salmonella sp., and 1% by N. meningitidis. Most children with occult pneumococcal bacteremia improve spontaneously, but approximately 25% of untreated patients have persistent bacteremia or develop new focal infections, including 3% to 6% who develop meningitis. Occult meningococcal bacteremia, although rare, has frequent complications, including meningitis in approximately 40% and death in approximately 4%. Less is known about the natural history of untreated occult nontyphoidal Salmonella bacteremia. Empiric antibiotic treatment of children with occult bacteremia decreases the rate of complications, including meningitis. Few disagree that febrile, young children at risk for occult bacteremia require a careful clinical evaluation and close follow-up. The benefits of laboratory screening and selective empiric antibiotic treatment of febrile children at risk for occult bacteremia have to be weighed against the costs of screening tests and blood cultures, inconvenience, temporary discomfort to patients, risk for side effects of antibiotics, and the role of antibiotics in the development of bacterial resistance. Although great debate exists concerning the role of empiric antibiotics, a strategy for obtaining blood cultures and empirically administering antibiotics on the basis of an increased ANC, in addition to close clinical follow-up, may be effective in reducing the frequency and severity of uncommon but adverse sequelae. A highly effective S. pneumoniae bacterial conjugate vaccine will soon be available, which will benefit all children, and will alter the ways that clinicians evaluate fully immunized young, febrile children.     

Low risk of bacteremia in children with febrile seizures

OBJECTIVE: To evaluate the risk of bacteremia in children with febrile seizures treated as outpatients. METHODS: A retrospective cohort study was performed involving 379 children aged 2 to 24 months presenting to an urban tertiary care children's hospital emergency department with a febrile seizure between February 1, 1993, and May 31, 1996. RESULTS: The mean patient age was 15.9 months, and 217 (57%) were male. In 40 patients (10.6%), the use of oral antibiotics before initial emergency department evaluation was reported. Bacteremia occurred in 8 (2.1%) of 379 children studied. None of the children with bacteremia had received previous antibiotics. The causative organisms were Streptococcus pneumoniae in 7 cases and group A Streptococcus in 1 case. There were 5 contaminated cultures (1.3%). Although 2 of the 8 children with bacteremia ultimately required admission, there were no serious adverse outcomes. Six of 7 episodes of S pneumoniae bacteremia were caused by serotypes included in the pneumococcal conjugate vaccine, which was not available at the time of this study. CONCLUSIONS: Children 2 to 24 months of age with febrile seizures are at similar risk for occult bacteremia as those with fever alone. Widespread use of the pneumococcal conjugate vaccine may further decrease the incidence of bacteremia in this population.     

Immunoglobulin subgroups in children with febrile seizures

BACKGROUND: The aim of the present study was to determine whether or not there was a role for immunoglobulin (Ig) or IgG subgroups in the pathogenesis of febrile seizures (FS). METHODS: Serum levels of IgA, total IgG, IgM, IgE, IgGI, IgG2, IgG3 and IgG4 were measured in 34 children with FS and in 37 healthy children used as a control group. Both patients and controls were divided into two groups according to age (group I, 6-24 months; group II, 25-72 months). RESULTS: Compared with controls, mean IgG4 levels in patients were found to be decreased in both groups I and II (group I: 95 +/- 14 vs 57 +/- 5, respectively, P = 0.01; group II: 178.5 +/- 38.5 vs 65.1 +/- 24.5, respectively, P < 0.01), while mean IgG2 levels were found to be decreased only in group II patients (170 +/- 16 vs 103 +/- 22; P < 0.05). CONCLUSIONS: The results of the present study suggest that Ig subclass deficiencies may be responsible for the infections connected with FS or that they may be related to the pathogenesis of FS in some children.     

Assessment of febrile seizures in children

Febrile seizures are the most common form of childhood seizures, affecting 2–5% of all children and usually appearing between 3 months and 5 years of age. Despite its predominantly benign nature, a febrile seizure (FS) is a terrifying experience for most parents. The condition is perhaps one of the most prevalent causes of admittance to pediatric emergency wards worldwide. FS, defined as either simple or complex, may be provoked by any febrile bacterial or (more usually) viral illness. No specific level of fever is required to diagnose FS. It is essential to exclude underlying meningitis in all children with FS, either clinically or, if any doubt remains, by lumbar puncture. There is no evidence, however, to support routine lumbar puncture in all children admitted with simple FS, especially when typical clinical signs of meningitis are lacking. The risk of epilepsy following FS is 1–6%. The association, however small, between FS and epilepsy may demonstrate a genetic link between FS and epilepsy rather than a cause and effect relationship. The effectiveness of prophylactic treatment with medication remains controversial. There is no evidence of the effectiveness of antipyretics in preventing future FS. Prophylactic use of paracetamol, ibuprofen or a combination of both in FS, is thus a questionable practice. There is reason to believe that children who have experienced a simple FS are over-investigated and over-treated. This review aims to provide physicians with adequate knowledge to make rational assessments of children with febrile seizures.     

Predictors of bacteremia in febrile children with sickle cell disease

PURPOSE: Bacteremia is an important cause of death and complications in children with sickle cell disease (SCD), yet predictors of bacteremia in these patients have not been well identified. The purpose of this study was to test whether clinical and hematologic variables commonly used to predict bacteremia in normal young children with fever could accurately predict bacteremia in febrile children with SCD. PATIENTS AND METHODS: The authors reviewed the medical records of all patients with SCD younger than 18 years of age over a 10-year period at a single institution for febrile events. They tested the univariate associations of age, height of fever, white blood cell count (WBC), absolute neutrophil count (ANC), and absolute band count (ABC) with bacteremia. Three separate multivariate analyses were performed using the predictor variables age, temperature, and one of three hematologic variables (ANC, WBC, or ABC) with the outcome bacteremia. RESULTS: There were 175 evaluable febrile events, of which 8 (4.6%) were associated with bacteremia. In the multivariate analyses, all hematologic variables, but not age or height of fever, retained significant associations with bacteremia. CONCLUSIONS: In febrile children with SCD, WBC, ANC, and ABC are all independently associated with bacteremia when adjusting for height of fever and age. Hematologic variables may be useful in developing prediction algorithms to identify febrile patients with SCD at higher risk of bacteremia. These data emphasize the need for a national trial to develop a predictive model with defined thresholds.     

Low risk of bacteremia in febrile children with recognizable viral syndromes

BACKGROUND: Previous studies of occult bacteremia in febrile children have excluded patients with recognizable viral syndromes (RVS). There is little information in the literature regarding the rate of bacteremia in febrile children with RVS. OBJECTIVE: To determine the rate of bacteremia in children 3 to 36 months of age with fever and RVS. METHODS: We performed a retrospective analysis of all patients 3 to 36 months of age with a temperature > or =39 degrees C seen during a 5 1/2-year period in the Emergency Department of a tertiary care pediatric hospital. From this group those with a discharge diagnosis of croup, varicella, bronchiolitis or stomatitis and no apparent concomitant bacterial infection were considered to have an RVS. The rate of bacteremia was determined for those subjects with RVS who had blood cultures. RESULTS: Of 21,216 patients 3 to 36 months of age with a temperature > or =39 degrees C, 1347 (6%) were diagnosed with an RVS. Blood cultures were obtained in 876 (65%) of RVS patients. Of patients who had blood cultures, true pathogens were found in only 2 of 876 (0.2%) subjects with RVS [95% confidence interval (CI) 0.01, 0.8%]. The rate of bacteremia was 1 of 411 (0.2%) for subjects with bronchiolitis, O of 249 (0%) for subjects with croup, O of 123 (0%) for subjects with stomatitis and 1 of 93 (1.1%) for subjects with varicella. CONCLUSIONS: Highly febrile children 3 to 36 months of age with uncomplicated croup, bronchiolitis, varicella or stomatitis have a very low rate of bacteremia and need not have blood drawn for culture.     

癫癎和热性惊厥患儿血清褪黑素水平的变化及其临床意义

目的：探讨癫癎和热性惊厥患儿血清褪黑素水平的变化及其临床意义,为褪黑素用于癫癎和热性惊厥的治疗提供依据。方法：该研究分为对照组,即上呼吸道感染发热无惊厥患儿;热性惊厥组,其中又分为单纯性热性惊厥(SFS组)和复杂性热性惊厥(CFS组);癫癎组。采用酶联免疫吸附法(ELISA)分别测定各组血清褪黑素水平。结果：癫癎和复杂性热性惊厥患儿血清褪黑素水平分别为8.66±1.38和14.91±2.61 ng/L,均显著低于对照组的23.93±2.01 ng/L,差异有显著性(P<0.01),单纯性热性惊厥患儿血清褪黑素水平为20.72±2.54 ng/L,低于对照组,但差异无显著性意义(P>0.05);癫癎患儿血清褪黑素水平明显低于热性惊厥患儿,差异有显著性(P<0.01)。结论：癫癎和复杂性热性惊厥患儿血清褪黑素水平降低。补充外源性褪黑素可能是治疗儿童癫癎和热性惊厥的一个新途径。［中国当代儿科杂志,2009,11（4）：288-290］     

Relationship of bacteremia to antipyretic therapy in febrile children

We undertook a prospective study of children from three to 24 months of age with rectal temperatures of greater than or equal to 40.0 degrees C (104.0 degrees F) to determine if children whose fevers fail to respond to antipyretic therapy are more likely to be bacteremic than children whose fevers are lowered by antipyretic measures. Children from two clinical settings were studied: primarily black lower-class children at an inner-city hospital (n = 188) and primarily white middle-class children at a suburban hospital (n = 45). We found an overall prevalence of bacteremia of 7.3%, which was not statistically different between two hospitals. A response to antipyretic therapy, defined as a decrease in temperature of at least 1 degrees C, was seen in 83.7% of children. Children who did not respond to antipyretics had no more increased prevalence of bacteremia than did responders. We conclude that lack of fever response to antipyretics is not a clinical marker for bacteremia in children.     

Serum zinc levels in children with simple febrile seizure

A prospective case-control study was conducted in a major tertiary care hospital for children during June 2005 to May 2006 on children aged between 3 months and 5 years to compare serum zinc levels in 38 cases of simple febrile seizure and 38 age-matched controls. The mean serum zinc levels in cases and controls were 32.17 and 87.6 microg/dL, respectively. This difference was statistically significant ( P < .001). We conclude that Indian children with febrile seizure had low serum zinc levels, and zinc supplementation to reduce the incidence of febrile seizure should be investigated.     

单纯性与复杂性热性惊厥患儿血清神经元特异性烯醇酶水平变化的研究

目的：　探讨热性惊厥(FS)患儿血清神经元特异性烯醇酶(NSE)的变化,了解单纯性FS与复杂性FS发作后脑损伤情况。方法：　采用时间分辨荧光分析法对 17例单纯性FS、2 0例复杂性FS和10例有发热而无惊厥对照患儿于发作当日及发作10日的血清NSE含量进行测定。结果：　单纯性FS发作当日与发作10日血清NSE无明显增高;复杂性FS发作当日明显高于对照组与单纯性FS组(P<0.01),但发作10日的比较则差异无显著性意义。FS发作当日 ,发作持续时间≥ 1 5min、发作次数≥2次及呈部分性发作患儿血清NSE明显增高(P<0.05),尤其是持续时间长及反复发作者差异有显著性意义(P<0.01 )。结论：血清NSE能较全面反映FS后脑损伤的程度。单纯性FS发作后血清NSE的正常水平不能排除脑神经元损伤,复杂性FS后有明显脑神经元损伤,长程发作和反复发作时神经元损伤更重。     

反复发作热性惊厥患儿海马体积动态变化的临床研究

目的 分析反复发作热性惊厥患儿海马体积(HCV)的变化及意义.方法 回顾性选择34例热性惊厥反复发作且于2013年1月1日至2019年9月30日期间完善2次头部及海马磁共振平扫患儿的临床资料和检查结果.根据随访时间,分为第1次随访组和第2次随访组;根据预后,分为热性惊厥组、无热惊厥组和癫痫组.分析比较各组患儿HCV变化...