ABSTRACT
UNLABELLED: Fever is a frequent symptom of consultation in Pediatric Emergency Department. OBJECTIVES: to describe causes of acute fever of unknown origin (FUO) in infants under 36 months of age, the utility of requested tests and pediatrician decisions. PATIENTS AND METHODS: 309 cards of children under 36 months who consulted at Emergency Department for acute FUO were reviewed. RESULTS: 64 % were classified with well clinical condition. Most frequent causes were: probable viral respiratory infections (72%), urinary tract infection (7.4%), pneumonia (2.9%), bacteremia (1.9%), and bacterial meningitis (1.3%). Streptococcus pneumoniae was the most frequent agent isolated from blood cultures. Tests of best utility were: urine analysis and urine culture. Leukocytes count < 15.000/mm(3) and PCR < 4.0 mg/dl had a negative predictive value of 96 %. Nine point seven percent of the patients were hospitalized, while 14.2% received antibiotic treatment at home. CONCLUSIONS: We suggest to perform urine analysis and culture as the initial study for children with acute FUO and well clinical condition.
Subject(s)
Bacterial Infections/complications , Fever of Unknown Origin/etiology , Acute Disease , Algorithms , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Child, Preschool , Emergency Service, Hospital , Fever of Unknown Origin/drug therapy , Humans , Infant , Infant, Newborn , Leukocyte Count , Retrospective Studies , Sensitivity and Specificity , Severity of Illness IndexABSTRACT
La fiebre es uno de los síntomas frecuentes de consulta en Servicios de Urgencia pediátricos. Objetivos: Describir causas del síndrome febril agudo sin foco evidente (SFASF) en niños bajo 36 meses de edad, utilidad de exámenes solicitados y conducta del médico. Pacientes y Métodos: Se analizaron 309 fichas de niños bajo 36 meses, que consultaron en el servicio de urgencia por SFASF. Resultados: 64 por ciento fue catalogado de buen aspecto clínico al ingreso. Las causas más frecuentes fueron infecciones probablemente virales respiratorias 72 por ciento, infección urinaria 7,4 por ciento, neumonía 2,9 por ciento, bacteriemia 1,9 por ciento y meningitis bacteriana 1,3 por ciento. Streptococcus pneumoniae fue el agente más frecuentemente aislado de sangre. Los exámenes de mayor utilidad fueron sedimento de orina y urocultivo. Un recuento de leucocitos < 15.000/mm³ y PCR < 4,0 mg/dL tuvieron un valor predictor negativo de 96 por ciento. Se hospitalizó a 9,7 por ciento de los niños, 14,2 por ciento recibió antimicrobianos ambulatorios. Conclusiones: Sugerimos como estudio inicial del niño con SFASF y de buen aspecto general, la realización de un examen de orina con urocultivo.
Fever is a frequent symptom of consultation in Pediatric Emergency Department. Objectives: to describe causes of acute fever of unknown origin (FUO) in infants under 36 months of age, the utility of requested tests and pediatrician decisions. Patients and Methods: 309 cards of children under 36 months who consulted at Emergency Department for acute FUO were reviewed. Results: 64 percent were classified with well clinical condition. Most frequent causes were: probable viral respiratory infections (72 percent), urinary tract infection (7.4 percent), pneumonia (2.9 percent), bacteremia (1.9 percent), and bacterial meningitis (1.3 percent). Streptococcus pneumoniae was the most frequent agent isolated from blood cultures. Tests of best utility were: urine analysis and urine culture. Leukocytes count < 15.000/mm³ and PCR < 4.0 mg/dl had a negative predictive value of 96 percent. Nine point seven percent of the patients were hospitalized, while 14.2 percent received antibiotic treatment at home. Conclusions: We suggest to perform urine analysis and culture as the initial study for children with acute FUO and well clinical condition.
