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Febrile seizures with leukocytosis as a predictor for occult bacteremia
Author(s) -
Ogawa Eiki,
Shoji Kensuke,
Kamidani Satoshi,
Miyairi Isao
Publication year - 2019
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.13862
Subject(s) - medicine , bacteremia , leukocytosis , febrile seizure , white blood cell , emergency department , population , pediatrics , blood culture , occult , epilepsy , pathology , biology , environmental health , psychiatry , microbiology and biotechnology , antibiotics , alternative medicine
Background Febrile children 3–36 months old, who had a body temperature >39°C and white blood cell ( WBC ) count >15 000/mm 3 were known to be at risk for occult pneumococcal bacteremia ( OPB ) in the pre‐pneumococcal conjugate vaccine ( PCV ) era. The positive predictive value of these criteria, however, decreased dramatically after the introduction of PCV , indicating a need for alternative criteria. A high rate of febrile seizures has been noted in children with OPB , suggesting that screening may still be practical in this population. We performed a retrospective analysis to evaluate factors that predict OPB in patients visiting the emergency department ( ED ) with febrile seizures. Methods Children 3–36 months old who visited the ED for febrile seizures and had blood cultures taken were included. Patients with underlying diseases were excluded from analysis. We performed statistical analyses comparing patient demographics according to the presence or absence of OPB . Results One thousand and eighty‐two patients visited the ED with febrile seizure, and blood cultures were taken in 397, of whom 87% had received more than three doses of PCV . Of the nine patients with OPB , eight (89%) met the risk criteria. In contrast, only 12% (48/388) of those without OPB met the criteria. In this population, those who fulfilled the risk criteria were more likely to have OPB than those who did not (14.3% vs 0.3%; likelihood ratio, 7.17). Conclusions High WBC count and fever may effectively predict OPB in pediatric patients with febrile seizure in the post‐ PCV era.