Fever without apparent source on clinical examination

Abstract

This review discusses recent literature that has focused on the epidemiology, clinical and laboratory evaluation and treatment of episodes of acute illnesses associated with fever and also of prolonged episodes of fever in children. Articles addressed the epidemiology of invasive pneumococcal disease in children in other countries that have not yet initiated vaccination with the conjugated pneumococcal vaccine. From the United States there was a report of the decreased occurrence of invasive pneumococcal disease in patients being provided primary care who had been vaccinated with conjugated pneumococcal vaccine. Another report outlined the experience at children's hospitals with invasive pneumococcal disease in the years pre- and post-introduction of pneumococcal vaccine. One of the studies found that there was a slight increase in pneumococcal disease caused by non-vaccine serotypes. Another group of articles focused on serious bacterial infections in infants with fever who are positive for respiratory syncytial virus (RSV). All studies found a significant occurrence of urinary tract infections in these patients. One report found that bacteremia may occur in such patients if less than 28 days of age. Finally articles from Turkey, Thailand, and Italy give excellent discussions about the range of diagnoses and key clinical findings that may be seen in children with prolonged fever. In the review period, there was a particular emphasis on invasive disease caused by S. pneumoniae and the impact of vaccination with conjugated pneumococcal vaccine, on the occurrence of serious bacterial infection in febrile infants with RSV infections, and on the broad spectrum of diagnoses in children with prolonged fever in varying geographic locales.