O.V. ZAYTSEVA¹, M.V. BESEDINA¹, E.M. TOLSTOVA¹, E.V. STRIGA¹, N.S. ZAYTSEVA¹, E.E. LOKSHINA¹, I.V. TURISHCHEV², T.Yu. BELYAEVA²

 ¹Moscow State Medical and Dentistry University named after A. I. Evdokimov, Moscow

²St Vladimir Children’s Municipal Clinical Hospital of Moscow Healthcare Department, Moscow

Contact:

Tolstova E.M. — PhD (medicine), Assistant Lecturer of the Department of Pediatrics

Address: 20 Delegatskaya Str., building 1, 127473, Moscow, Russian Federation, tel. +7-926-810-63-59, e-mail: [email protected]

Fever remains the most common reason for pediatrician consultation. In some cases, an increase in body temperature is the single sign of the disease. The most important task for a pediatrician is to identify a risk group for a severe bacterial infection development. However, one should remember about a large group of non-infectious fevers. The article provides an overview of the latest data on fever without source, as well as an analysis of two clinical cases of fever in young children.

Key words: fever in children, fever without source, fever of unknown origin, histiocytosis, epidural abscess.

REFERENCES

1. Polyakova A.S., Bakradze M.D., Tatochenko V.K., Gadliya D.D. The significance of fever in children. Voprosy sovremennoy pediatrii, 2015, no. 14 (2), pp. 271-275 (in Russ.). doi: 10.15690/vsp.v14i2.1297.
2. World Health Organization. IMCI Distance learning course. module 5. Fever, 2014, pp. 1-52.
3. Likhoradka u detey, pod red. A. Saiba El’-Radkhi, Dzh. Kerrolla, N. Kleyna [Fever in children. Ed. by A. Saib El-Radh, J. Carroll, N. Klein]. Moscow: GEOTAR-Media, 2014. 390 p.
4. National Collaborating Centre for Women’s and Children’s Health. NG143. Fever in under 5s: assessment and initial management. NICE Guideline Updates Team (UK). National Institute for Health and Care Excellence (UK). London, 2019.
5. Baranov A.A., Tatochenko V.K., Bakradze M.D. Likhoradyashchiy rebenok. Protokoly diagnostiki i lecheniya [Febrile child. Diagnostic and treatment protocols]. Moscow: Pediatr, 2017. 320 p.
6. Likhoradka bez vidimogo ochaga infektsii. Klinicheskie rekomendatsii [Fever without a visible focus of infection. Clinical recommendations]. Soyuz pediatrov Rossii. MZ RF, 2016.
7. Mintegi S., Gomez B., Carro A., Diaz H., Benito J. Invasive bacterial infections in young afebrile infants with a history of fever. Arch Dis Child, 2018, no. 103(7), pp. 665-669. doi: 10.1136/archdischild-2017-313578.
8. Pikuza O.I., Zakirova A.M., Suleymanova Z.Ya., Samorodnova E.A. Inflammatory and non-inflammatory causes of fever of unknown origin in children. Prakticheskaya meditsina, 2017, no. 10 (111), pp. 22-25 (in Russ.).
9. Colvin J.M., Muenzer J.T., Jaffe D.M. et al. Detection of viruses in young children with fever without an apparent source. Pediatrics, 2012, no. 130 (6), pp. 1455–e1462. doi:10.1542/peds.2012-1391.
10. Lafolie J., Labbé A., L’Honneur A.S. Assessment of blood enterovirus PCR testing in paediatric populations with fever without source, sepsis-like disease, or suspected meningitis: a prospective, multicentre, observational cohort study. Lancet Infect Dis, 2018, no. 18(12), pp. 1385-1396. doi: 10.1016/S1473-3099(18)30479-1.
11. Hayakawa I., Nomura O., Uda K. Incidence and aetiology of serious viral infections in young febrile infants. J Paediatr Child Health, 2019. doi: 10.1111/jpc.14692.
12. Elhassanien A.F., Hesham A.A., Alrefaee F. Fever without source in infants and young children: dilemma in diagnosis and management. Risk Manag Healthc Policy, 2013, no. 6, pp. 7-12. doi:10.2147/RMHP.S40553.
13. Irwin A.D., Grant A., Williams R., Kolamunnage-Dona R. et al. Predicting Risk of Serious Bacterial Infections in Febrile Children in the Emergency Department. Pediatrics, 2017, no. 140(2). doi: 10.1542/peds.2016-285.
14. Pathak A., Upadhayay R., Mathur A., Rathi S., Lundborg C.S. Incidence, clinical profile, and risk factors for serious bacterial infections in children hospitalized with fever in Ujjain, India. BMC Infect Dis, 2020, 20(1). p. 162. doi: 10.1186/s12879-020-4890-6.
15. Bakradze M.D., Chashchina I.V., Tatochenko V.K., Mityushin I.L. How to distinguish a bacterial infection from a viral one, and how to treat it. PF, 2013, no. 4, pp. 139-144 (in Russ.).
16. Arora R., Mahajan P. Evaluation of child with fever without source: Review of literature and update. Pediatr Clin. N. Am, 2013, no. 60, pp. 1049–1062. doi: 10.1016/j.pcl.2013.06.009.
17. González M., Salmón A., García S., Arana E., Mintegi S., Benito J. Prevalence of urinary tract infection in infants with high fever in the emergency department. An Pediatr (Barc), 2019, no. 91(6), pp. 386-393. doi: 10.1016/j.anpedi.2019.01.027.
18. Polyakova A.C., Bakradze M.D., Tatochenko V.K., and Gadliya D.D. Diagnostic value of determining the level of procalcitonin in the practice of an infectious disease specialist. Voprosy sovremennoy pediatrii, 2017, vol. 16, no. 4, 2017, pp. 334-341 (in Russ.).
19. Herrero M., Alcalde M., Gómez B., Hernández J.L. et al. Invasive bacterial infections in a paediatric emergency department in the era of the heptavalent pneumococcal conjugate vaccine. Eur J Emerg Med, 2012, no. 19 (2), pp. 89-94. doi: 10.1097/MEJ.0b013e3283484bbc.
20. Bonilla L., Gomez B., Pintos C., Benito J., Mintegi S. Prevalence of Bacterial Infection in Febrile Infant 61-90 Days Old Compared With Younger Infants. Pediatr Infect Dis J, 2019, no. 38 (12), pp. 1163-1167. doi: 10.1097/INF.0000000000002461.
21. Van Houten C.B., Naaktgeboren C., Buiteman B.J.M., van der Lee M. et al. Antibiotic Overuse in Children with Respiratory Syncytial Virus Lower Respiratory Tract Infection. Pediatr Infect Dis J, 2018, no. 37 (11), pp. 1077-1081. doi: 10.1097/INF.0000000000001981.
22. Lee H.N., Kwak Y.H., Jung J.Y., Lee S.U., Park J.W., Kim D.K. Are parents’ statements reliable for diagnosis of serious bacterial infection among children with fever without an apparent source? A retrospective study. Medicine (Baltimore), 2019, no. 98 (42):e17530. doi:10.1097/MD.0000000000017530.
23. Nadal D., Berner R. Fever of unknown Source in young Infants. Monatsschrift kinderheilkunde, 2019, vol. 167, pp. 929-943.
24. Hubert-Dibon G., Danjou L., Feildel-Fournial C., Vrignaud B., Masson D., Launay E., Gras-Le Guen C. Procalcitonin and C-reactive protein may help to detect invasive bacterial infections in children who have fever without source. Acta Paediatr, 2018, no. 107 (7), pp. 1262-1269. doi: 10.1111/apa.14248.
25. Gunduz, Ahmet & Tekin, Mehmet & Konca, Capan. Effectiveness of Laboratory Markers in Determining Serious Bacterial Infection in Children with Fever without Source. Journal of Pediatric Infectious Diseases, 3.4, pp. 287-292 DOI: 10.1055/s-0038-1673666.
26. Leroy S., Bressan S., Lacroix L., Andreola B. Refined Lab-score, a Risk Score Predicting Serious Bacterial Infection in Febrile Children Less Than 3 Years of Age. Pediatr Infect Dis J, 2018, 37(5):387-393. doi: 10.1097/INF.0000000000001915.
27. Moldovan D.A., Baghiu M.D., Balas A., Truta S.T. The Value of the «Lab-Score» Method in Identifying Febrile Infants at Risk for Serious Bacterial Infections. J Crit Care Med (Targu Mures), 2015, no. 1 (1), pp. 11-17. doi:10.1515/jccm-2015-0003.
28. Blaschke A.J., Korgenski E.K. et al. Rhinovirus in Febrile Infants and Risk of Bacterial Infection. Pediatrics, 2018, no. 141 (2) e20172384.
29. Greenhow T.L., Hung Y.Y., Herz A.M. et al. The changing epidemiology of serious bacterial infections in young infants. Pediatr Infect Dis J, 2014, no. 33 (6), pp. 595-599.
30. Epalza C., Hallin, Busson M. et al. Role of Viral Molecular Panels in Diagnosing the Etiology of Fever in Infants Younger Than 3 Months. Clinical Pediatrics, no. 59 (1), pp. 45-52.
31. Woll C., Neuman M.I., Pruitt C.M. Epidemiology and Etiology of Invasive Bacterial Infection in Infants ≤60 Days Old Treated in Emergency Departments. J Pediatr, 2018, no. 200, pp. 210-217.e1. doi: 10.1016/j.jpeds.2018.04.033.
32. Calvo C., de Ceano-Vivas M. Fever without source in infants less than 3 months of age. What’s new? An Pediatr (Barc), 2017, no. 87 (1), pp. 1-2. doi: 10.1016/j.anpedi.2017.02.013.
33. Greenhow T.L., Hung Y.Y., Herz A. Bacteremia in Children 3 to 36 Months Old After Introduction of Conjugated Pneumococcal Vaccines. Pediatrics, 2017, no. 139 (4). pii: e20162098. doi: 10.1542/peds.2016-2098.
34. Hernández-Bou S., Gómez B., Mintegi S. Occult bacteremia etiology following the introduction of 13-valent pneumococcal conjugate vaccine: a multicenter study in Spain. Eur J Clin Microbiol Infect Dis, 2018, no. 37 (8), pp. 1449-1455. doi: 10.1007/s10096-018-3270-2.
35. Albridi A.I., Alotibi K.M.F., Alzahrani N.S. et al. Fever in family practice. Indo American Journal of Pharmaceutical Sciences, 2018, no. 5 (12), pp. 16480-16485.
36. Torreggiani, Sofia et al. Recurrent Fever in Children. International journal of molecular sciences, 2016, vol. 17, pp. 4-448. doi:10.3390/ijms17040448.
37. Anirban Das. Approach to a child with pallor and hepatosplenomegaly. Practical Pediatric Hematology 3rd Edition, 2018, pp. 119-126.
38. Tokmakov K.A., Gorbacheva S.M., Unzhakov V.V., Gorbachev V.I. Hyperthermia in patients with damage to the central nervous system. Politravma, 2017, no. 2, 2017, pp. 77-84 (in Russ.).
39. Barbi E., Marzuillo P., Neri E., Naviglio S., Krauss B.S. Fever in Children: Pearls and Pitfalls. Children (Basel), 2017, no. 4 (9), p. 81. doi:10.3390/children4090081.
40. Yoshizato R., Koga H. Comparison of initial and final diagnoses in children with acute febrile illness: A retrospective, descriptive study: Initial and final diagnoses in children with acute fever. J Infect Chemother, 2020, no. 26(3), pp. 251-256. doi:0.1016/j.jiac.2019.09.015.
41. Gattorno M. Auto-inflammatory diseases in children. Voprosy sovremennoy pediatrii, 2014, no. 13 (2), pp. 55-64 (in Russ.).
42. Kumar R., Singh V. Benign intradural extramedullary masses in children of northern India. Pediatr Neurosurg, 2005, no. 41 (1), pp. 22-28.
43. Vergori A. et al. Pediatric spinal epidural abscess in an immunocompetent host without risk factors: Case report and review of the literature. IDCases, vol. 2(4), pp. 109-115. doi:10.1016/j.idcr.2015.09.008.