Kamidani Satoshi, Shoji Kensuke, Ogawa Eiki, Funaki Takanori, Mishina Hiroki, Miyairi Isao
From the Division of Infectious Diseases, Department of Medical Specialties, National Center for Child Health and Development, Tokyo, Japan.
Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
Pediatr Emerg Care. 2020 Apr;36(4):e199-e203. doi: 10.1097/PEC.0000000000001274.
Fever of 39°C or higher and a white blood cell (WBC) count of 15,000/μL or greater are known predictors of occult bacteremia (OB). However, because of a decreasing prevalence of OB, WBC counts have become poor predictors of OB in populations of routinely immunized children. Thus, we aim to evaluate the clinical characteristics of OB in Japanese children and identify potential risk factors for OB.
We conducted an observational study of children aged 3 to 36 months old with positive blood cultures for Streptococcus pneumoniae or Haemophilus influenzae at an emergency department in a tertiary care children's hospital between April 2002 and December 2015. Patients with significant underlying diseases, a proven source of infection, or toxic appearance, were excluded.
Positive blood cultures were recorded in 231 patients; of these, 110 were included in the study (S. pneumoniae, n = 102; H. influenzae, n = 8). Median age was 16 (3-34) months. Patients had a high median body temperature of 39.2 (interquartile range, 38.6-39.9) °C and median WBC of 21,120 (interquartile range, 16,408-24,242)/μL. A high rate of febrile seizures (58 patients, 53%) was observed, with complex febrile seizures accounting for 43% of the episodes. Frequency of febrile seizures was positively associated with age (P = 0.001).
Our study revealed a high rate of children presenting with febrile seizures, especially complex seizures, among children with OB in Japan. A further study is necessary to evaluate the role of febrile seizures as a predictor for OB.
体温达到39°C或更高且白细胞（WBC）计数为15,000/μL或更高是已知的隐匿性菌血症（OB）预测指标。然而，由于OB的患病率下降，在常规免疫儿童群体中，WBC计数已成为OB的不良预测指标。因此，我们旨在评估日本儿童OB的临床特征，并确定OB的潜在危险因素。
我们对2002年4月至2015年12月在一家三级儿童专科医院急诊科血培养肺炎链球菌或流感嗜血杆菌呈阳性的3至36个月大儿童进行了一项观察性研究。排除有重大基础疾病、已证实的感染源或中毒面容的患者。
231例患者血培养呈阳性；其中110例纳入研究（肺炎链球菌，n = 102；流感嗜血杆菌，n = 8）。中位年龄为16（3 - 34）个月。患者中位体温较高，为39.2（四分位间距，38.6 - 39.9）°C，中位WBC为21,120（四分位间距，16,408 - 24,242）/μL。观察到高热惊厥发生率较高（58例患者，53%），复杂性高热惊厥占发作次数的43%。高热惊厥频率与年龄呈正相关（P = 0.001）。
我们的研究显示，在日本患有OB的儿童中，高热惊厥发生率较高，尤其是复杂性惊厥。有必要进一步研究以评估高热惊厥作为OB预测指标的作用。
