Occult bacteremia - symptoms, signs and treatment
Occult bacteremia - symptoms, signs and treatment
Occult bacteremia- This is the presence of bacteria in the blood of a febrile feverish young child who has no clear foci of infection and is feeling well. The diagnosis is made on the basis of blood cultures and exclusion of a local infection. Treatment is carried out with antibacterial drugs either in the hospital or outpatient; individual children are treated until the results of blood cultures are obtained.
Approximately 3% of children aged 1 to 36 months with febrile fever and no focal disorders show bacteremia, which is therefore considered occult. Of these, approximately 5–10% develop bacterial infectious foci or sepsis, which can be minimized by early detection and treatment of bacteremia. The probability of progression to the development of severe focal disease depends on the cause: from 7 to 25% with Haemophylus influenzae type b bacteremia and from 4 to 6% with Streptococcus pneumoniae bacteremia.
Etiology.In the 80s, up to 80% of all occult bacteremia was caused by Streptococcus pneumoniae. The rest was caused by Hib, Neisseria meningitidis, and others. In the USA, the routine vaccination of infants with the conjugated H / L vaccine has been carried out since the 1990s, which virtually eliminated H / L bacteremia. The later routine vaccination of infants with the S. pneumoniae conjugate vaccine reduced the incidence of invasive pneumococcal disease in young children by more than 66%, and it is expected that its expanded use will almost eliminate the problem. When efficacy is proven in this age group and a meningococcal conjugate vaccine is registered, the vast majority of cases of occult bacteremia will be prevented.
Occult bacteremia - symptoms, signs and diagnosis
The main symptom is an increase in body temperature; By definition, children with obvious signs of infection are excluded. Signs of intoxication suggest sepsis or septic shock; bacteremia in these children does not belong to the occult. At the same time, sepsis in the early stages can be difficult to distinguish from occult bacteremia.
Diagnosis requires blood culture; usually use one blood sample, results are available within 24 hours. A general urine test and stool examination for the presence of leukocytes will help identify foci of infection and determine the risk. Recommendations on the selection of children for examination and the choice of specific methods of examination vary depending on age, body temperature, condition of the child and clinical manifestations; the goal is to minimize the survey while maintaining high sensitivity. These recommendations are sensitive, but relatively non-specific, which makes them more likely to be effective in identifying children with a low risk of developing an infectious process, who can use waiting strategies rather than identifying children with true bacteremia.
In general, a blood test is usually marked leukocytosis; however, only about 10% of children with leukocytosis more than 15,000 / μl have bacteremia, therefore the specificity of this study is low. Acute phase indicators are used by some doctors, but not very informative; At the same time, in combination with an increase in the level of procalcitonin, the acute phase indicators may be more specific for severe disease.In children up to 3 months, the number of stab neutrophils is more than 1500 / mm3 and either a low or high number of leukocytes may indicate bacteremia. Care by medical staff. Re-examination within 24 hours.
Evaluation and treatment of fever in children younger than 3 months. Prognosis and treatment
In children who received antibacterial therapy before bacteremia is confirmed by blood culture, focal lesions appear less frequently, although the data are contradictory. However, due to the low overall bacteremia rate, many children would not receive the treatment they needed if everyone who was tested for bacteriuria received empirical therapy.
Febrile temperature child between 3 and 36 months
Evaluation of clinical manifestations
Signs of intoxication
IC develops in 3-6% of children from 2 months to 2 years. The ratio of girls to boys increases with age, so at the age of 2 months to 1 year it is 2: 1, for 2 years - 4: 1 and more 5: 1 after 4 years. In girls, as a rule, the infection path is upward, and bacteremia develops less frequently. A significant prevalence of girls among patients with IC is associated with a shorter urethra; in boys circumcision can reduce the risk of developing IC.Other predisposing factors are permanent catheterization, constipation, Hirschsprung's disease and anatomical abnormalities of the urinary system. Risk factors in older children include diabetes, trauma, and sex life in adolescents.
IC in children are a marker of the possible presence of abnormalities of the urinary system; they most often lead to the development of an infection if the child also has a vesicoureteral reflux. The probability of PMR is inversely proportional to the age of occurrence of the 1st episode of IC. About 30–40% of children in their early years with IC find PMR. The severity of reflux may determine the likelihood of subsequent development of hypertension and renal failure, but there is insufficient evidence. PMR is classified by degrees. Reflux of infected urine to the renal pelvis or the presence of infected urine below the site of obstruction may lead to the development of chronic pyelonephritis, scarring of the kidneys, impaired growth of the kidneys and renal failure.
In anatomical disorders of the urinary system, the infectious process can be caused by numerous microorganisms.Assign them parenteral forms of antibiotics in anticipation of the results of sowing blood, urine and cerebrospinal fluid.
All children are re-examined after 24-48 hours. While maintaining febrile temperature or positive blood or urine cultures, children are again sampled for biological culture fluids and examined for sepsis, and parenteral forms of antibiotics are prescribed. At normal temperature and a satisfactory condition, but the presence in the blood of S. pneumoniae during the initial seeding or positive primary seeding of urine, children should be given the appropriate oral antibacterial drug.
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