tetano
Editor, Senior Moderator
Eur J Pediatr
. 2021 Feb 19.
doi: 10.1007/s00431-021-03973-9. Online ahead of print.
Fever without source as the first manifestation of SARS-CoV-2 infection in infants less than 90 days old
Daniel Bl?zquez-Gamero[SUP] 1 2 [/SUP], Cristina Epalza[SUP] 3 4 [/SUP], Jos? Antonio Alonso Cadenas[SUP] 5 [/SUP], Lourdes Calleja Gero[SUP] 5 [/SUP], Cristina Calvo[SUP] 4 6 [/SUP], Paula Rodr?guez-Molino[SUP] 6 [/SUP], Mar?a M?ndez[SUP] 7 [/SUP], Maria Del Mar Santos[SUP] 4 8 [/SUP], Victoria Fumad?[SUP] 9 [/SUP], Mar?a Fernanda Guzm?n[SUP] 10 [/SUP], Antoni Soriano-Arandes[SUP] 4 11 [/SUP], Ana B Jim?nez[SUP] 12 [/SUP], Maria Penin[SUP] 13 [/SUP], Elvira Cobo-Vazquez[SUP] 14 [/SUP], Marta Pareja[SUP] 15 [/SUP], Zulema Lobato[SUP] 16 [/SUP], Miquel Serna[SUP] 4 17 [/SUP], Rafael Delgado[SUP] 18 [/SUP], Cinta Moraleda[SUP] #[/SUP][SUP] 3 4 17 [/SUP], Alfredo Tagarro[SUP] #[/SUP][SUP] 4 17 19 [/SUP]
Affiliations
Abstract
Fever without source (FWS) in infants is a frequent cause of consultation at the emergency department, and the emergence of SARS-CoV-2 could affect the approach to those infants. The aim of this study is to define the clinical characteristics and rates of bacterial coinfections of infants < 90 days with FWS as the first manifestation of SARS-CoV-2 infection. This is a cross-sectional study of infants under 90 days of age with FWS and positive SARS-CoV2 PCR in nasopharyngeal swab/aspirate, attended at the emergency departments of 49 Spanish hospitals (EPICO-AEP cohort) from March 1 to June 26, 2020. Three hundred and thirty-three children with COVID-19 were included in EPICO-AEP. A total of 67/336 (20%) were infants less than 90 days old, and 27/67(40%) presented with FWS. Blood cultures were performed in 24/27(89%) and were negative in all but one (4%) who presented a Streptococcus mitis bacteremia. Urine culture was performed in 26/27(97%) children and was negative in all, except in two (7%) patients. Lumbar puncture was performed in 6/27(22%) cases, with no growth of bacteria. Two children had bacterial coinfections: 1 had UTI and bacteremia, and 1 had UTI. C-reactive was protein over 20 mg/L in two children (one with bacterial coinfection), and procalcitonin was normal in all. One child was admitted to the pediatric intensive care unit because of apnea episodes. No patients died.Conclusion: FWS was frequent in infants under 90 days of age with SARS-CoV-2 infection. Standardized markers to rule out bacterial infections remain useful in this population, and the outcome is generally good. What is Known: • Fever without source (FWS) in infants is a common cause of consultation at the emergency department, and young infants have a higher risk of serious bacterial infections (SBI). • The emergence of the new coronavirus SARS-CoV-2 could affect the approach to young infants with FWS in the emergency department. management of those children is a challenge because information about bacterial coinfection and prognosis is scarce. What is New: • SARS-CoV-2 infection should be ruled out in young infants (< 90 days of age) with FWS in areas with community transmission. • Bacterial coinfection rarely coexists in those infants. • Inflammatory markers were not increased in children without bacterial coinfection. • Outcome is good in most patients.
Keywords: COVID-19; Coronavirus; Fever without source; Infant; SARS-CoV2; Serious bacterial infections.
. 2021 Feb 19.
doi: 10.1007/s00431-021-03973-9. Online ahead of print.
Fever without source as the first manifestation of SARS-CoV-2 infection in infants less than 90 days old
Daniel Bl?zquez-Gamero[SUP] 1 2 [/SUP], Cristina Epalza[SUP] 3 4 [/SUP], Jos? Antonio Alonso Cadenas[SUP] 5 [/SUP], Lourdes Calleja Gero[SUP] 5 [/SUP], Cristina Calvo[SUP] 4 6 [/SUP], Paula Rodr?guez-Molino[SUP] 6 [/SUP], Mar?a M?ndez[SUP] 7 [/SUP], Maria Del Mar Santos[SUP] 4 8 [/SUP], Victoria Fumad?[SUP] 9 [/SUP], Mar?a Fernanda Guzm?n[SUP] 10 [/SUP], Antoni Soriano-Arandes[SUP] 4 11 [/SUP], Ana B Jim?nez[SUP] 12 [/SUP], Maria Penin[SUP] 13 [/SUP], Elvira Cobo-Vazquez[SUP] 14 [/SUP], Marta Pareja[SUP] 15 [/SUP], Zulema Lobato[SUP] 16 [/SUP], Miquel Serna[SUP] 4 17 [/SUP], Rafael Delgado[SUP] 18 [/SUP], Cinta Moraleda[SUP] #[/SUP][SUP] 3 4 17 [/SUP], Alfredo Tagarro[SUP] #[/SUP][SUP] 4 17 19 [/SUP]
Affiliations
- PMID: 33606120
- DOI: 10.1007/s00431-021-03973-9
Abstract
Fever without source (FWS) in infants is a frequent cause of consultation at the emergency department, and the emergence of SARS-CoV-2 could affect the approach to those infants. The aim of this study is to define the clinical characteristics and rates of bacterial coinfections of infants < 90 days with FWS as the first manifestation of SARS-CoV-2 infection. This is a cross-sectional study of infants under 90 days of age with FWS and positive SARS-CoV2 PCR in nasopharyngeal swab/aspirate, attended at the emergency departments of 49 Spanish hospitals (EPICO-AEP cohort) from March 1 to June 26, 2020. Three hundred and thirty-three children with COVID-19 were included in EPICO-AEP. A total of 67/336 (20%) were infants less than 90 days old, and 27/67(40%) presented with FWS. Blood cultures were performed in 24/27(89%) and were negative in all but one (4%) who presented a Streptococcus mitis bacteremia. Urine culture was performed in 26/27(97%) children and was negative in all, except in two (7%) patients. Lumbar puncture was performed in 6/27(22%) cases, with no growth of bacteria. Two children had bacterial coinfections: 1 had UTI and bacteremia, and 1 had UTI. C-reactive was protein over 20 mg/L in two children (one with bacterial coinfection), and procalcitonin was normal in all. One child was admitted to the pediatric intensive care unit because of apnea episodes. No patients died.Conclusion: FWS was frequent in infants under 90 days of age with SARS-CoV-2 infection. Standardized markers to rule out bacterial infections remain useful in this population, and the outcome is generally good. What is Known: • Fever without source (FWS) in infants is a common cause of consultation at the emergency department, and young infants have a higher risk of serious bacterial infections (SBI). • The emergence of the new coronavirus SARS-CoV-2 could affect the approach to young infants with FWS in the emergency department. management of those children is a challenge because information about bacterial coinfection and prognosis is scarce. What is New: • SARS-CoV-2 infection should be ruled out in young infants (< 90 days of age) with FWS in areas with community transmission. • Bacterial coinfection rarely coexists in those infants. • Inflammatory markers were not increased in children without bacterial coinfection. • Outcome is good in most patients.
Keywords: COVID-19; Coronavirus; Fever without source; Infant; SARS-CoV2; Serious bacterial infections.