Bacteremia in Febrile Children Seen in a “Walk-in” Pediatric Clinic

McGowan, John E.; Bratton, Lorna; Klein, Jerome O.; Finland, Maxwell

doi:10.1056/nejm197306212882501

Cited by 241 publications

(71 citation statements)

References 2 publications

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“…Once colonization and bacterial replication have occurred, there is the possibility of tissue invasion, each organism having a low, but finite probability of penetrating the nasopharyngeal mucosa and establishing a contiguous or distant focus from which sustained bacteremia can be maintained. Bacteremia in human beings with H. influenzae b is, in fact, not uncommon (15), but many of these individuals do not develop meningitis. The theory of independent action predicts that any organism in the bloodstream has some finite probability ibf establishing meningitis.…”

Section: Discussionmentioning

confidence: 99%

Haemophilus influenzae bacteremia and meningitis resulting from survival of a single organism

Moxon

Murphy

1978

Proc. Natl. Acad. Sci. U.S.A.

169

139

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Infant rats were infected intranasally with mixtures of streptomycin-sensitive and streptomycin-resistant strains of Haemophilus influenzae type b and cultures of nasopharyngeal washings, blood, and cerebrospinal fluid were obtained. If from independent action, as opposed to cooperative interaction of intranasally inoculated organisms. The results also suggested that the meninges were invaded by the hematogenous route. Intranasal inoculation of infant rats with Haemophilus influenzae type b results in bacteremia and meningitis and has proved to be a useful experimental model of the human disease (1-3). These studies provided evidence that the pathogenesis of meningitis involved three sequential events: nasopharyngeal colonization, bacteremia, and central nervous system invasion, although direct invasion of the meninges by contiguous spread from the nasopharynx was not precluded. The studies also revealed that an inoculum of at least 1000 organisms was a prerequisite for the induction of bacteremia and meningitis. This observation might be explained as follows. First, it is possible that every organism in the initial inoculum behaves in a manner that is uninfluenced by the other bacteria present (independent action) (4-6). Each organism has a low probability of successfully overcoming the host defenses; however, the probability is not zero. As the dose of organisms is increased, it becomes progressively more likely that one of them will establish a local or distant focus of infection. Under these circumstances, the bacteria recovered from blood or cerebrospinal fluid (CSF), for example, would be descended from a few organisms, perhaps even a single organism of the original inoculum (4-7). Alternatively, organisms en masse may possess properties that are denied to single bacteria (cooperative action). When the inoculum attains a critical magnitude, infection ensues (8, 9). Under these circumstances, bacteria cultured from the blood or CSF would be descendents of many different organisms of the original inoculum.The following study was designed to test the theory of independent action compared to that of cooperative action in the pathogenesis of H. influenzae type b, bacteremia, and meningitis. The results also provided data relevant to the relationship between nasopharyngeal colonization, bacteremia, and invasion of the central nervous system. MATERIALS AND METHODSThe Eagan strain of H. influenzae type b and its one-step streptomycin-resistant mutant, the media used for its growth, the methods of intranasal inoculation, the technique of blood and CSF sampling, and the quantitation of bacteria in blood and CSF were identical to those used previously (1-3). Natural litters of 5-day-old rats (Sprague-Dawley, strain COBS/CD) were obtained from Charles River Laboratories, Wilmington, MA. Inocula containing an approximately equal number of the streptomycin-sensitive (SMS) and streptomycin-resistant (SMR) variants were prepared as follows. Each variant was grown overnight on solid medium at 370. A few colonies ...

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Section: Discussionmentioning

confidence: 99%

Haemophilus influenzae bacteremia and meningitis resulting from survival of a single organism

Moxon

Murphy

1978

Proc. Natl. Acad. Sci. U.S.A.

169

139

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“…Isso acarretou uma intensa busca dos fatores de risco para identificação precoce dessas crianças 10,11 .…”

Section: Introductionunclassified

Fever without source: evaluation of a guideline

Machado¹,

Cardoso²,

Paulis³

et al. 2009

J Pediatr (Rio J)

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Objective: To evaluate the applicability of a standardized guideline for children up to 36 months of age with fever without source (FWS). Methods:Prospective cohort study involving children with FWS treated at the emergency department of Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil, from June 2006 to May 2007. The guideline classifies the risk of serious bacterial infection (SBI) according to the presence or absence of toxemia, age, and temperature. Laboratory screening was based on risk assessment: complete blood count, blood culture, urinalysis, urine culture, and, if necessary, chest radiography, cerebrospinal fluid, and coproculture. Results:We studied 251 children and, of these, 215 were followed up until the final diagnosis. Toxemia was found in 20 children, and 195 were well-appearing (30 up to 3 months old and 165 from 3 to 36 months old). Among those children from 3 to 36 months without toxemia, 95 had axillary temperature > 39 ºC. In 107 (49.8%) children, there was spontaneous resolution of fever; in 88 (40.9%), benign self-limited disease was identified; and in 20 (9.3%), there was SBI. Among the cases of SBI, we identified 16 urinary tract infections, three cases of pneumonia and one occult bacteremia. Of the 215 children, 129 (60%) received no antibiotics, and 86 received antibiotics at some point (45 empirically). Empirical antibiotic treatment was maintained for an average of 72 hours. Conclusion:The guideline was shown to be appropriate to follow up these children using simple laboratory tests that can be carried out at most health facilities. The most frequent SBI in this sample was urinary tract infection. J Pediatr (Rio J)

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“…Several investigators have explored the utility of the CBC for identifying young febrile children with bacteremia. [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] Most cases of bacteremia in these studies, however, were due to Streptococcus pneumoniae, a Gram-positive organism, and Haemophilus influenzae, type b, a cause of bacteremia rarely observed in the United States since the introduction of a conjugated vaccine against this organism. 42 In these studies, the WBC and/or the ANC was the component of the CBC most frequently cited as distinguishing children with unsuspected bacteremia from culture-negative patients.…”

Section: Tablementioning

confidence: 99%

Clinical and Hematologic Features Do Not Reliably Identify Children With Unsuspected Meningococcal Disease

et al. 1999

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ABSTRACT. Objective. To determine the frequency of unsuspected meningococcal disease (UMD) in young febrile children with meningococcal infections and evaluate whether clinical and laboratory parameters commonly used in the evaluation of fever can help identify children with UMD.Methods. We reviewed the records of children with meningococcal disease from 1985 to 1996 at four referral centers. Children who were evaluated as outpatients and then discharged to home, from whom Neisseria meningitidis was isolated from blood or cerebrospinal fluid cultures obtained during these outpatient visits, were considered to have UMD. We compared clinical and laboratory parameters between these children and 6414 febrile outpatients 3 to 36 months old with negative blood cultures enrolled in a separate study of occult bacteremia.Results. We identified 381 children with meningococcal disease, of whom 45 (12%) had UMD. Of the 45 with UMD, 37 (82%) were 3 to 36 months old. Compared with the 6414 culture-negative patients, these 37 patients with UMD were significantly younger (8.9 ؎ 5.4 vs 14.2 ؎ 8.1 months) and had significantly higher band counts (14.3 ؎ 11.1 vs 7.3 ؎ 7.5%). There were no significant differences, however, in temperature, white blood cell counts, and absolute neutrophil counts. Multivariate analysis identified young age and the band count as independent predictors of UMD.Conclusions. Children ultimately diagnosed with meningococcal disease have commonly been evaluated as outpatients and discharged to home before diagnosis. Of the hematologic parameters frequently used in the evaluation of fever, only the band count differs significantly between young febrile children with UMD and those with negative cultures. Because UMD is uncommon in young febrile pediatric outpatients, however, the predictive value of the band count is low. Thus, the complete blood count is not routinely helpful for the diagnosis of UMD. Pediatrics 1999;103(2). URL: http://www. pediatrics.org/cgi/content/full/103/2/e20; Neisseria meningitidis, meningococcal infections, bacteremia, complete blood count, neutrophil.

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Bacteremia in Febrile Children Seen in a “Walk-in” Pediatric Clinic

Cited by 241 publications

References 2 publications

Haemophilus influenzae bacteremia and meningitis resulting from survival of a single organism

Haemophilus influenzae bacteremia and meningitis resulting from survival of a single organism

Fever without source: evaluation of a guideline

Clinical and Hematologic Features Do Not Reliably Identify Children With Unsuspected Meningococcal Disease

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