Children with a very high fever, defined as a rectal temperature of 106 degrees Fahrenheit or higher, have a heightened risk for serious bacterial infection and for viral illness, or both, report clinicians in the current issue of Pediatrics.
Among 103 children younger than age 18 who were seen at an emergency department with high fevers over a 2-year period, 20 (18.4 percent) had confirmed bacterial infections and 22 (21.4 percent) had confirmed viral infections. One child was infected with both types of pathogens.
"Children with underlying illnesses were at higher risk for bacterial infections," said Dr. Barbara W. Trautner from Baylor College of Medicine in Houston. Serious bacterial infection occurred 7 of 19 (36.8 percent) children with an underlying illness, compared with 13 of 84 (15.5 percent) children without an underlying illness.
Other than the presence of a preexisting medical condition, there were no factors that predicted the presence of a serious bacterial infection versus a viral infection, Trautner and colleagues report.
Specifically, the children's white blood cell count, which normally increases when an infection is present, did not help distinguish between bacterial and viral infection. "A near-normal white blood cell count may have led to failure to prescribe antibiotics to three children with serious bacterial infections," they note.
Likewise, viral symptoms were not reliable in establishing the cause of the fever, because viral symptoms overall were associated with a decreased risk of serious bacterial infection, but diarrhea was associated with an increased risk."
"The take home message," said Trautner, is that children who arrive in the "emergency department with a fever of 106F or higher are at high risk for a bacterial infection, and the physician should consider antibiotic treatment for all such children who do not have a confirmed viral infection."