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Hyperpyrexia: Do Bacteria Cause Higher Fevers?

In the post–Haemophilus influenzae type b vaccination era, most children with hyperpyrexia have proven or probable viral infection.

Studies conducted before the Haemophilus influenzae type b vaccination era have shown mixed results about the risk for serious bacterial infection in children with extremely high fevers. In this observational study, researchers evaluated the risk in 103 children with temperatures of 106°F or higher who presented to an emergency department in Texas during a 2-year period after the introduction of the HIB vaccine.

Evaluations included complete blood cell counts, blood cultures, and nasopharyngeal viral cultures. Additional testing was performed as clinically indicated. Eighty-five percent of children were younger than 3 years old, and 19 children had pre-existing medical conditions. Twenty children (18%) had documented serious bacterial infections, and 22 (21%) had documented viral infections (including the one child with meningitis who also had a urinary tract infection [UTI] with bacteremia). Bacteremia and UTI were the most commonly diagnosed bacterial infections; only two children were given a diagnosis unrelated to infection. The remaining 60 children were presumed to have culture-negative febrile illnesses.

Comment: The authors conclude that all children with hyperpyrexia without a confirmed viral illness should be treated with antibiotics, but my interpretation of their data leads me to a different conclusion. Eighty percent of these children had proven or probable viral infection. Most children with bacterial infection had UTIs, infection of a central catheter from pre-existing medical conditions, or Streptococcus pneumoniae bacteremia (since this study was conducted before routine use of conjugated pneumococcal vaccine). Therefore, I would use the same criteria for prescribing antibiotics in children with hyperpyrexia as I use for other febrile patients. As with all children, careful evaluation is indicated for febrile children.

— Peggy Sue Weintrub, MD

Published in Journal Watch Pediatrics and Adolescent Medicine October 4, 2006

Citation(s):

Trautner BW et al. Prospective evaluation of the risk of serious bacterial infection in children who present to the emergency department with hyperpyrexia (temperature of 106°F or higher). Pediatrics 2006 Jul; 118:34-40.

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