Topics Discussed: febrile infection; fever; infectious diseases; systemic infection.
Sections: The Febrile- or Septic-Appearing Infant or Child: Introduction, Thermoregulation, Fever, Sepsis, Bacteremia, Presentation and History, Physical Examination, Risk of Serious Bacterial Illness, Risk of SBI in Patients with Viral Infections, Management, References.
- The risk of bacteremia appears to have been modified dramatically by the use of more advanced broad-spectrum antibiotics, advanced diagnostic testing, and immunization against Hemophilus influenza and Streptococcus pneumoniae. A positive blood culture is nearly as likely to be due to a contaminant as to a real pathogen.
- Given the extremely low risk of bacteremia and its sequelae, the best expectant therapy in the well-appearing child is close observation and follow-up pending culture results.
- Tachycardia and tachypnea may be the only indications of a serious illness in an otherwise well-appearing febrile child.
- Signs of clinical toxicity include altered or decreased mental status; significantly abnormal vital signs; dyspnea; color changes, such as cyanosis and pallor; and hypoxia, as measured by pulse oximetry. These children require immediate stabilization including airway management, oxygen, intravenous access and administration of saline fluid bolus, temperature management, rapid examination, laboratory evaluation and immediate empiric antibiotic therapy, pending further diagnosis.
- Well-appearing febrile infants who have no identifiable source and normal leukocyte count, chest radiograph and urinalysis, and who are fully immunized may be safely discharged with symptomatic care for close follow-up of cultures without presumptive antibiotic therapy.
- In the nontoxic child with no obvious clinical syndrome, risk..."
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