Occult pneumococcal bacteremia and the febrile infant and young child.

Occult pneumonoccemia (OP) is unsuspected Streptococcus pneumoniae bacteremia occurring in a previously well child who presents with fever associated with either no focus or an upper respiratory focus infection. In this report, four cases of OP are presented and the literature is reviewed. The risk of OP appears highest for children, seen in urban emergency rooms and clinics, who are 6 to 24 months of age with rectal temperatures greater than or equal to 38.9 C (102 F) and who have white blood cell counts greater than or equal to 15,000/mm3. Other symptoms associated with OP include irritability, rhinorrhea, and febrile seizures. When recalled because of positive blood cultures, 40 per cent of untreated patients with OP had had spontaneous resolution of their illness, 29 per cent had persistent fever or symptoms and sterile blood cultures, 22 per cent had persistent fever or symptoms and positive blood cultures, while 10 per cent had a febrile course complicated by pneumococcal meningitis.