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August 23/30, 2016

Genetics and the Evaluation of the Febrile Child

Author Affiliations
  • 1Editor in Chief, JAMA, Chicago, Illinois

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2016;316(8):824-825. doi:10.1001/jama.2016.11137

Clinicians who care for children have encountered the same questions for decades: does the child have an infection, is it likely bacterial or viral, and is an antibiotic indicated? These questions were further complicated by the “discovery” of bacteremia. In 1973-1974, Teele et al1 obtained blood cultures from 600 consecutive febrile children younger than 2 years with temperatures of 38.3°C or higher and found that 19 (3.2%) had pathogens in their blood. Streptococcus pneumoniae was the most common pathogen (n = 15), followed by Haemophilus influenzae type b (n = 2). Further analysis suggested that children with a temperature higher than 38.9°C and a white blood cell count greater than 15 000/μL had about an 8% to 10% risk of “bacteremia.” For the following 3 decades, the focus was on determining how to identify these children; how these children could be differentiated into groups at high and low risk for bacteremia by various clinical scores or laboratory tests, such as C-reactive protein, erythrocyte sedimentation rate, or neutrophil-to-band ratio; and if expectant antibiotics are necessary.2,3

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