Children With Fever Without a Source: Use of Blood PCR Testing

Abstract

Research Article| May 01 2020 Children With Fever Without a Source: Use of Blood PCR Testing AAP Grand Rounds (2020) 43 (5): 53. https://doi.org/10.1542/gr.43-5-53 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Children With Fever Without a Source: Use of Blood PCR Testing. AAP Grand Rounds May 2020; 43 (5): 53. https://doi.org/10.1542/gr.43-5-53 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: fever, polymerase chain reaction, bacterial infection, serious Source: L’Huillier AG, Mardegan C, Cordey S, et al. Enterovirus, parechovirus, adenovirus and herpes virus type 6 viraemia in fever without source. Arch Dis Child. 2020; 105(2): 180– 186; doi: https://doi.org/10.1136/archdischild-2019-317382Google Scholar Investigators from Geneva, Switzerland, conducted a prospective cross-sectional study to assess whether rates of serious bacterial infection (SBI) differed among children with fever without a source (FWS) who were, or were not, positive for human enterovirus (HEV), human parechovirus (HPeV), adenovirus (AdV), and human herpesvirus type 6 (HHV-6). Children <3 years old were eligible if they presented to the study institution’s ED with fever for <7 days and had no identified focus of infection on exam. Participants received usual care and had blood polymerase chain reaction (PCR) testing for HEV, HPeV, AdV, and HHV-6. Treating physicians remained blinded to PCR test results. A control group of similarly aged children without FWS presenting to dental or fracture clinics were enrolled and received PCR testing. Among participants with FWS, demographics, clinical symptoms and course, and laboratory findings were abstracted from the medical chart. The primary exposure variable was PCR test results, with participants considered positive if either HEV, HPeV, AdV, or HHV-6 were detected. The primary outcome was rate of SBI, defined as a positive blood, urine, or cerebrospinal fluid (CSF) culture judged not to be a contaminant. Secondary outcomes included rates of hospital admission and receipt of antibiotics. Investigators compared the prevalence of virus detection among participants with FWS to controls as well as outcomes among virus-positive and virus-negative participants with FWS. There were 135 participants with FWS and 50 controls included in analysis. There were significantly more participants with FWS (vs controls) who had a least one virus detected (34.8% vs 6%; P < .001). The most common virus detected in participants with FWS was HEV. Blood, urine, or CSF cultures were obtained in 96%, 94%, and 26% of participants with FWS, respectively, with no difference between virus-negative and virus-positive groups in whether cultures were obtained. Among those with culture results, there were significantly higher rates of SBI in virus-negative (vs virus-positive) participants (20.5% vs 4.3%; P = .011). All SBIs in the virus-positive group were UTIs. There was no difference between the 2 groups in receipt of antibiotics, but significantly fewer virus-positive participants were hospitalized. The investigators conclude that HEV, HPeV, AdV, and HHV-6 are common in children with FWS and are associated with a lower risk of SBI. Dr Chung has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Identifying the source of fever in young children in the absence of other symptoms continues to be the subject of much debate, in large part related to the extent to which clinicians test for SBI, treat with antibiotics, and hospitalize patients for further evaluation and monitoring.1,2 Over the past 3 decades, investigators have proposed a number... You do not currently have access to this content.