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Title: Prevalence and prediction of serious bacterial infection in febrile children : a role for cytokines?
Author: Osman, O. G.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2009
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Background: To date, no consensus has been reached regarding the evaluation and management of young febrile children, and no single laboratory test has been shown to reliably identify young children at high or low risk of having serious bacterial illness. Knowing the local prevalence of SBI is essential in formulating management strategies because extrapolation from studies done elsewhere is difficult. Aims: i) To determine the prevalence of SBI in young febrile children served by a paediatric hospital. Ii) To evaluate the role of cytokines in predicting SBI in these children. Hypothesis: IL-6, IL-8 and sICAM-1 can accurately predict SBI in young febrile children. Methodology: The study population was children seen at the emergency department of the Edinburgh Royal Hospital for Sick Children. All children < 5 years old with a temperature of > 38.5°C were studied over a 12-month period. Demographic, clinical and laboratory data were collected prospectively. Serum IL-6, IL-8 and sICAM-1 were measured by ELISA. The performance characteristics of the cytokines in predicting SBI were compared to those of the traditional tests (WBC, ANC, CRP, ESR). Results: 618 patients fulfilled the study criteria of age and temperature. 26.7% of the patients had a SBI. The commonest SBI was pneumonia. 2.7% of blood cultures were positive, over half were streptococcus pneumoniae. 40% of positive blood cultures were from patients discharged with an apparently benign illness. The modest gain in the posttest probability of SBI was comparable between the cytokines and the traditional tests. Serum IL-6 and IL-8 was elevated in all patients with bacteraemia or meningitis. A model based on the respiratory rate, CRP, and sICAM-1 correctly identified 70% of SBI. Conclusion: The prevalence of SBI, and bacteraemia, in young febrile children is still high in spite of the decline in immunizable diseases. Highly febrile young children should continue to be evaluated with a blood culture and close follow up, and UTI should be excluded in all infants. IL-6 and IL-8 appear to be sensitive markers for bacteraemia and meningitis and their role requires further evaluation.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available