Chapter 5: Common Acute Infections in Children

INTRODUCTION

Infectious diseases are a major cause of illness in children. The widespread use of antibiotics and immunizations has greatly reduced morbidity and mortality from serious bacterial infections, but infections remain one of the most common types of problems encountered by physicians who care for children.

GENERAL

FEVER WITHOUT A SOURCE

General Considerations

Fever is the primary indication of an infectious process in children of all ages. Other than fever, however, few young children display signs or symptoms indicative of an underlying disease. Even after a careful history and a complete physical examination, a portion of children will have no clear source of infection. Most of these children will have a viral infection; however, the physician must identify those children at risk for serious bacterial infection while minimizing the risks of laboratory evaluation, treatment with antibiotics, and hospitalization. A serious bacterial infection (SBI) is defined as bacteremia, meningitis, urinary tract infection (UTI), pneumonia, bacterial enterocolitis, abscess, or cellulitis.

Children are generally divided into three groups for evaluation purposes: neonates (aged ≤1 month), young infants (aged <2–3 months), and young children (aged 3 months to 3 years). There is no consensus statement or guideline available for physicians in the workup and management of febrile illnesses in children. Hamilton (2013) published a useful set of guidelines that are summarized in Table 5-1.