Etiological Profile of Fever of Short Duration without Focus in Children Aged 1- 36 months

INTRODUCTION: Febrile illnesses in infants and children account for 20% of paediatric visits.1,2Various set temperatures have been used to define fever, but commonly accepted definition for fever is temperature of > 38.08C (100.48F). This value derived from studies done by Wunderlich, who took 1 million measurements on 25,000 patients and proposed that this temperature was the upper limit ofnormal3. Though there is less invasive means of measuring temperature exist, such as axillary and aural thermometry, there is a difference in measurements exists.4,5it warrants using the current outpatient reference standard, rectal thermometry, when measuring temperatures in young children. An accurate temperature measurement is especially important if one chooses to use fever guidelines, because the implementation of these guidelines is initiated once a patient meets a certain temperature threshold.Fever occurs when infectious and non infectious process interacts with the host defence mechanism. AIM OF THE STUDY: This study aims to find out etiology of fever of short duration without foci. DISCUSSION: The present Study was conducted in children who aged between1month to 36 months of age admitted in institute of child health with fever without localising sign. During the study period 837 cases was identified as having fever without localising sign. Among these 209 children who met inclusion and exclusion criteria. Out of 209 patients 62 patients (29.66%) had serious bacterial infection. In 101(48.33%) patients focus was not identified. Since they had self limiting illness probable viral illness other than dengue was considered. Among the patients with serous bacterial infection UTI was the most common serious bacterial infection which was found in 18(8.61%) cases. Bacteremia was found in 15(7.17%) patients. Other bacterial infection include occult pneumonia in 14 (6.86%) cases, bacterial meningitis in 5 (2.39%), septic arthritis 1n 2 patients(0.96%), leptospirosis in 5(2.39%), enteric fever in 2 (0.96%) patients. Malaria was found in13 cases (6.22%). Dengue was diagnosed in 33 cases (15.79%). Incidence of serous bacterial infection various quit high (28.2%) in our population compared to western studies37,38. In a similar study conducted by Vinchurkar et al23 in 2002 in 2002 showed serious bacterial infection in 36.2 % of cases.not many studies available in india. Another study conducted by Omolola et al in Nigeria in 2002 showed 39% of bacteremia in 1- 12months age. The epidemiology of bacterial infections ever changing in children.39 Bacteremia was found in 12 patients (7.17%). prevalence of bacteremia in children is 5%18 in 1 -3 months age group. In this study it was 8.69%. Prevalence bacteremia in 3month – 12 month was 4.9%. Most of the bacteremia was due to gram negative bacteria. Klepsiella was the most common organism isolated. Staph areus was the second most common organism isolated. Study done by Vinchurkar S et all found staph.areus as the most common agent. George O. Akpede, et al25 in 1992 in Nigeria studied Six-hundred-and-forty-two previously healthy children aged 1 month to 5 years with fever without localizing signs of infection. Their study showed Gram-negative bacteraemia was overall commoner than Grampositivebacteraemia,Staphylococcus aureus was the commonest single organism. Study conducted by Omolola et al 1n Nigeria 2002 showed Escherichia coli (35.9%), Staphylococcus aureus(33.3%). Many western studies39,40 showed stretocooci pneumonia as most common organism causing bacteremia. In this study no isolate of streptococcus pneumonia was identified. CONCLUSION: To conclude serious bacterial was found in 29.66% of cases and UTI was the most common SBI. Any child between 1 to 36 months who present with toxic symptoms should be evaluated for the presence serious bacterial infections in the age group of 1 to 36 months. Gram negative bacteremia is more common than gram positive