Usefulness of C-Reactive Protein and Clinical Characteristics in Identifying Severe Bacterial Infection in Children with Fever without Source.

OBJECTIVE: Fever continues to be the most frequent cause of care in the pediatric population. The uses of invasive and unnecessary tests result in discomfort to the patients. Local epidemiological data could help to refine screening strategies, especially in low resources settings. The present study aims to describe the prevalence of serious bacterial infections in infants with fever without source and to evaluate the usefulness of clinical and laboratory parameters in the identification of serious bacterial infections. MATERIALS AND METHODS: We included all children aged 0-36 months presenting with fever without source between January 2015 and December 2017. Demographic and clinical characteristics, investigations, and management procedures were recorded at the time of inclusion. Potential predictors of serious bacterial infections were compared between patients with and without serious bacterial infections. RESULTS: In total, 137 patients were included. Serious bacterial infections were diagnosed in 41 patients (29.9%; 95% CI, 22%-38%). The most frequent diagnosis in serious bacterial infection patients was urinary tract infection (78%). Serum C-reactive protein levels greater than 80 mg/L (odds ratio, 2.79 [1.14,6.86]) and total days with fever (odds ratio, 2.56 [1.81,3.62]) showed a significant association to predict serious bacterial infections. CONCLUSION: Most infants with fever without source presented self-limited febrile syndromes without evidence of severe bacterial infection. C-reactive protein levels greater than 80 mg/L and the number of previous days with fever were variables associated with the presence of serious bacterial infections. Our results need to be validated in other tropical countries.

Occult bacteraemia in children with fever without focus though previously vaccinated against pneumococcus.

Pneumococcal conjugate vaccines (PCV) have reduced the rate of occult bacteraemia in developed countries. However, reports on the incidence of occult bacteraemia in tropical regions are scarce. The aim of our study was to determine its frequency in children consulting for fever without focus in Colombia after introduction of the pneumococcal conjugate vaccines. We concluded that in tropical areas, testing for occult bacteraemia should be considered regardless of previous pneumococcal conjugate vaccination status.

A review of the diagnosis and management of impacted maxillary canines.

BACKGROUND: The authors conducted a literature review regarding the clinical and radiographic diagnoses of impacted maxillary canines, as well as the interceptive treatment (including surgical and orthodontic management) used to prevent or properly treat impacted canines. TYPES OF STUDIES REVIEWED: The authors reviewed clinical and radiographic studies, literature reviews and case reports. They selected only studies that pertained to the prevalence, etiology and diagnosis of impacted maxillary canines, as well as the most recent studies regarding surgical and orthodontic techniques for the proper management of impacted maxillary canines. RESULTS: Impacted canines can be detected at an early age, and clinicians might be able to prevent them by means of proper clinical diagnosis, radiographic evaluation and timely interceptive treatment. Surgical techniques that can be used to manage impacted canines vary depending on whether the impactions are labial or palatal, and orthodontic techniques vary according to clinical judgment and experience. CLINICAL IMPLICATIONS: Canine impaction is a common occurrence, and clinicians must be prepared to manage it. With early detection, timely interception, and well-managed surgical and orthodontic treatment, impacted maxillary canines can be erupted and guided to an appropriate location in the dental arch.