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46 - The Febrile Child

from Part II - Pediatrics

Published online by Cambridge University Press:  15 December 2009

By
Paul Ishimine
Edited by
Rachel L. Chin
Paul Ishimine
Affiliation:
Associate Clinical Professor of Medicine and Pediatrics, University of California, San Diego School of Medicine; Director, Pediatric Emergency Medicine, Department of Emergency Medicine; Associate Director, Pediatric Emergency Medicine Fellowship, San Diego Rady Children's Hosptial and Health Center, San Diego, CA
Rachel L. Chin
Affiliation:
University of California, San Francisco
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Summary

INTRODUCTION

The challenge for the emergency physician faced with a febrile child is to identify the patient at high risk for serious underlying infection, while limiting unnecessary testing and treatment. Because immune function, likely pathogens, and exam findings vary significantly from birth to early childhood, the risk of serious bacterial illness in febrile children is usually stratified by age.

EPIDEMIOLOGY

Neonates (birth to 1 month) are at particularly high risk for serious bacterial infection (SBI), including bacteremia, meningitis, pneumonia, urinary tract infections (UTIs), bacterial gastroenteritis, and osteomyelitis (see Chapter 45, Work-Up of Newborn Fever). About 12% of all febrile neonates presenting to a pediatric emergency department (ED) have SBI. The most common types of bacterial infection in this age group are UTIs and bacteremia, and the predominant bacterial pathogen overall is Escherichia coli. Neonates are typically infected by more virulent bacteria (e.g., group B streptococci) than older children. Only a small percentage of neonates are infected with other streptococcal species, such as Streptococcus pneumoniae, and there has been an overall decline in invasive pneumococcal disease since the introduction of the heptavalent pneumococcal conjugate vaccine (PCV7), even in this unvaccinated age group. In addition, neonates are more likely than older children to develop serious sequelae from viral infections (e.g., herpes simplex virus meningitis).

Type
Chapter
Information
Emergency Management of Infectious Diseases , pp. 279 - 282
Publisher: Cambridge University Press
Print publication year: 2008

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References

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  • The Febrile Child
    • By Paul Ishimine, Associate Clinical Professor of Medicine and Pediatrics, University of California, San Diego School of Medicine; Director, Pediatric Emergency Medicine, Department of Emergency Medicine; Associate Director, Pediatric Emergency Medicine Fellowship, San Diego Rady Children's Hosptial and Health Center, San Diego, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.047
Available formats
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  • The Febrile Child
    • By Paul Ishimine, Associate Clinical Professor of Medicine and Pediatrics, University of California, San Diego School of Medicine; Director, Pediatric Emergency Medicine, Department of Emergency Medicine; Associate Director, Pediatric Emergency Medicine Fellowship, San Diego Rady Children's Hosptial and Health Center, San Diego, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.047
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • The Febrile Child
    • By Paul Ishimine, Associate Clinical Professor of Medicine and Pediatrics, University of California, San Diego School of Medicine; Director, Pediatric Emergency Medicine, Department of Emergency Medicine; Associate Director, Pediatric Emergency Medicine Fellowship, San Diego Rady Children's Hosptial and Health Center, San Diego, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.047
Available formats
×