Kawashima Hisashi, Kobayashi Kusukazu, Aritaki Kentarou, Takami Takeshi, Ioi Hiroaki, Kashiwagi Yasuyo, Takekuma Kouji, Hoshika Akinori
Department of Paediatrics, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
J Infect. 2006 Jul;53(1):16-20. doi: 10.1016/j.jinf.2005.09.017. Epub 2005 Nov 23.
In order to establish an effective management for febrile infants under 4 months of age we analysed the causes of fever by using bacterial work up and a highly sensitive RT-PCR method during a 3-year-period. From February 1998 to January 2001, 263 infants under 4 months of age were admitted to our hospital because of fever (>38.0 degrees C) and enrolled in this study.
Eighty-nine cases (33.8%) were diagnosed as lower respiratory infections, and 62 (23.5%) as urinary tract infections. Aseptic meningitis was found in 35 cases (13.2%) and fever of unknown origin in 22 (8.3%). Sepsis and purulent meningitis were found in three and two infants, respectively. Aseptic meningitis was the most common disease in infants below 30 days. Aseptic meningitis and fever of unknown origin revealed no seasonable tendency. Twelve cases out of 20 tested infants with aseptic meningitis showed positive results for enterovirus in CSF.
Clinicians should consider age, sex and seasons when evaluating and treating infants with fever. Previously lumbar puncture, urinalysis and chest X-ray were recommended to avoid useless assays. These results also revealed that RT-PCR is a useful and significant assay to establish an exact diagnosis in very young infants.
为建立针对4个月以下发热婴儿的有效管理方法，我们在3年期间采用细菌学检查及高灵敏度逆转录聚合酶链反应（RT-PCR）方法分析发热原因。1998年2月至2001年1月，263例4个月以下因发热（体温>38.0℃）入院的婴儿纳入本研究。
89例（33.8%）被诊断为下呼吸道感染，62例（23.5%）为尿路感染。35例（13.2%）发现无菌性脑膜炎，22例（8.3%）为不明原因发热。分别有3例和2例婴儿发现败血症和化脓性脑膜炎。无菌性脑膜炎是30天以下婴儿最常见的疾病。无菌性脑膜炎和不明原因发热无季节性倾向。20例接受检测的无菌性脑膜炎婴儿中有12例脑脊液中肠道病毒检测呈阳性。
临床医生在评估和治疗发热婴儿时应考虑年龄、性别和季节因素。以往建议进行腰椎穿刺、尿液分析和胸部X线检查以避免不必要的检测。这些结果还表明，RT-PCR是在非常年幼的婴儿中建立准确诊断的一种有用且重要的检测方法。
