Published online July 3, 2006
PEDIATRICS Vol. 118 No. 1 July 2006, pp. 34-40 (doi:10.1542/peds.2005-2823)

This Article Full Text Full Text (PDF) View eLetters Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Web of Science (8) Citing Articles via Google Scholar Google Scholar Articles by Trautner, B. W. Articles by Macias, C. G. Search for Related Content PubMed PubMed Citation Articles by Trautner, B. W. Articles by Macias, C. G. Related Collections Infectious Disease & Immunity Social Bookmarking                         What's this?

Prospective Evaluation of the Risk of Serious Bacterial Infection in Children Who Present to the Emergency Department With Hyperpyrexia (Temperature of 106°F or Higher)

Barbara W. Trautner, MD^a,b, A. Chantal Caviness, MD, MPH^c, Gary R. Gerlacher, MD^d, Gail Demmler, MD^e, Charles G. Macias, MD, MPH^c

^a Departments of Medicine
^e Pediatrics, Section of Infectious Diseases
^c Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas
^b Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
^d Medical City Hospital and Acute Kids Urgent Care, Dallas, Texas

BACKGROUND. Previous studies of children with temperatures 106°F (hyperpyrexia) disagree as to whether hyperpyrexia confers a high risk of serious bacterial infection.

OBJECTIVES. The purpose of this study was to determine (1) the risk of serious bacterial infection in children with hyperpyrexia and (2) whether clinical presentation can identify hyperpyrexic patients at risk for serious bacterial infection.

METHODS. Data were collected prospectively on all children <18 years of age presenting to a pediatric emergency department during a 2-year period with rectal temperatures of 106°F. History, physical examination, complete blood cell counts, blood cultures, and nasopharyngeal viral cultures were obtained on all of the patients.

RESULTS. Of 130828 visits, 103 children had hyperpyrexia (1 per 1270 patient visits). Of the 103 subjects, 20 had serious bacterial infection, and 22 had laboratory-proven viral illness (including 1 subject with bacterial/viral coinfection). The presence of a chronic underlying illness was associated with an increased risk of serious bacterial infection. The presence of rhinorrhea or any viral symptom was associated with a decreased risk of serious bacterial infection, although diarrhea itself was associated with an increased risk of serious bacterial infection. Age, maximum temperature, and total white blood cell count were not predictive of either bacterial or viral illness.

CONCLUSIONS. Children with hyperpyrexia are at equally high risk for serious bacterial infection and for viral illness. Bacterial and viral coinfection also occurs. No aspect of the clinical presentation reliably distinguishes between bacterial and viral illness. We recommend consideration of antibiotic treatment for all children presenting to the emergency department with hyperpyrexia without confirmed viral illness.

---

Key Words: hyperpyrexia • emergency department • pediatric

Abbreviations: ED—emergency department • SBI—serious bacterial infection • RSV—respiratory syncytial virus • UTI—urinary tract infection • CXR—chest radiograph • WBC—white blood cell • CSF—cerebrospinal fluid • CI—confidence interval • OR—odds ratio • ANC—absolute neutrophil count • IQR—interquartile range

---

Accepted Jan 19, 2006.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				J. R. Avner Acute Fever Pediatr. Rev., January 1, 2009; 30(1): 5 - 13. [Full Text] [PDF]

				M v. Veen, E. W Steyerberg, M. Ruige, A. H J v. Meurs, J. Roukema, J. v. d. Lei, and H. A Moll Manchester triage system in paediatric emergency care: prospective observational study BMJ, September 22, 2008; 337(sep22_1): a1501 - a1501. [Abstract] [Full Text] [PDF]

				A. Golnik Pneumococcal Meningitis Presenting With a Simple Febrile Seizure and Negative Blood-Culture Result Pediatrics, August 1, 2007; 120(2): e428 - e431. [Abstract] [Full Text] [PDF]

				Journal Watch Arch. Dis. Child., January 1, 2007; 92(1): 85 - 86. [Full Text] [PDF]

				J. DiTraglia High Fever Pediatrics, December 1, 2006; 118(6): 2604 - 2604. [Full Text] [PDF]

				H. Gunasekera, P. Patradoon-Ho, and N. Cheng Febrile Confusion: Do the Hyperpyrexia Study Conclusions Fit? Pediatrics, December 1, 2006; 118(6): 2605 - 2606. [Full Text] [PDF]

				B. W. Trautner, C. G. Macias, and A. C. Caviness Febrile Confusion: Do the Hyperpyrexia Study Conclusions Fit?: In Reply. Pediatrics, December 1, 2006; 118(6): 2606 - 2607. [Full Text] [PDF]

				B. W. Trautner, C. G. Macias, and A. C. Caviness High Fever: In Reply. Pediatrics, December 1, 2006; 118(6): 2604a - 2605. [Full Text] [PDF]

				G. Cattermole and J. Wyatt Sophia Emerg. Med. J., November 1, 2006; 23(11): 890 - 890. [Full Text] [PDF]

				Hyperpyrexia: Do Bacteria Cause Higher Fevers? Journal Watch Pediatrics and Adolescent Medicine, October 4, 2006; 2006(1004): 1 - 1. [Full Text]

				Children with very high temperatures are equally likely to have bacterial or viral infections BMJ, August 26, 2006; 333(7565): . [Full Text] [PDF]

eLetters:

Read all eLetters

Add a Grain of Salt to Antibiotics for High Fever

Kevin C. Osterhoudt

Pediatrics Online, 8 Aug 2006 [Full text]