Hyperpyrexia signals a high risk of serious bacterial infection

September 1, 2006
Michael G. Burke, MD
Michael G. Burke, MD

DR. BURKE, section editor for Journal Club, is chairman of the department of pediatrics at Saint Agnes Hospital, Baltimore. He is a contributing editor for <italic>Contemporary Pediatrics</italic>. He has nothing to disclose in regard to affiliations with

Researchers conducted a study to 1) determine the risk of serious bacterial infection in children who have a rectal temperature of 106°F or higher (hyperpyrexia) and 2) identify variables that predict such an infection. The study was conducted in the 103 hyperpyrexic children who visited the emergency department of a tertiary-care pediatric hospital in Houston during the two-year study period. The children ranged in age from 3 months to 16.9 years (median, 17 months). In addition to the high fever, their symptoms included rhinorrhea, vomiting, diarrhea, injected conjunctivae, and other viral symptoms. Nineteen had a pre-existing condition.

Of the 103 subjects, 20 (18.4%) had a culture-proven serious bacterial infection, including one child who had both a bacterial and a viral infection. Eleven children had bacteremia; two of those were bacteremic secondary to a urinary tract infection (eight subjects had such an infection) and two others were bacteremic secondary to infection of an indwelling central venous catheter.

Infecting micro-organisms included Enterobacter cloacae, Escherichia coli, Citrobacter freundii, Stenotrophomonas maltophilia, Pseudomonas spp, Shigella flexneri, Streptococcus pneumoniae, and Peptostreptococcus magnus. None of the children with a positive bacterial culture appeared to have otitis media.

Of the remaining 62 subjects with hyperpyrexia, 60 had a diagnosis of a febrile illness with negative cultures. Of these 60, 13 had a chest radiograph with a lobar infiltrate compatible with pneumonia, and 11 were given a diagnosis of otitis media. (Of the remaining two children, one developed neuroleptic malignant syndrome, and the other was given a diagnosis of systemic lupus erythematosus.)