Fever without Focus in Children Aged 1 to 36 Months- Aetiological Profile and Predictors of Specific Aetiology- A Prospective Observational Study

This study aimed to describe the aetiological profile of fever without focus (FWF) in children aged one to thirty-six months and to identify clinical and laboratory predictors of specific aetiologies, especially serious bacterial infection (SBI).

Children in the age range of one to thirty-six months, who were hospitalised due to FWF were included in this study. This prospective study was done over a period of 20 months in a medical college hospital in southern India. CBC (complete blood count) and CRP (c-reactive protein) tests, urine microscopic examination, blood and urine culture, Dengue antigen testing, and chest X-ray test were done for all feverish children. For those with fever beyond 5 days, additional tests including serological tests for Dengue, scrub typhus, and leptospirosis as well as Widal test were done. The final diagnosis was recorded, and clinical and laboratory parameters were analysed.

Among 141 children with FWF, 41 (29%) had SBI, and 21(14.9%) had Dengue fever (DF). Leucocytosis, neutrophilia, and raised CRP levels were good predictors of SBI. Thrombocytopenia was an excellent predictor of DF. High fever was significantly associated with SBI and Dengue (p=.004), and fever beyond 3 days at presentation was significantly associated with SBI (p=<.001). Pyuria had a high specificity (94.5%) for identifying urinary tract infection (UTI). About 50% of UTIs were caused by extended spectrum beta lactamase (ESBL) producing organisms.

SBI and DF were the most common causes of FWF. High fever, fever beyond 3 days at presentation, leucocytosis, neutrophilia, and a positive CRP test were predictors of SBI. Pyuria suggests UTI. Empirical antibiotic therapy should cover ESBL producing organisms. High fever and thrombocytopenia suggest Dengue fever.