Overview

Definition: Fever without source (FWS) in infants aged 29 to 60 days refers to a rectal temperature of ≥38°C (100.4°F) in an infant who does not have an apparent focus of infection on initial clinical examination.
Epidemiology:
-This age group represents a critical window for serious bacterial infections (SBIs), with an incidence of SBIs ranging from 3-15% in febrile infants without a source
-Bacterial meningitis and sepsis are the most concerning diagnoses, carrying significant morbidity and mortality.
Clinical Significance:
-Accurate risk stratification is paramount to identify infants requiring aggressive diagnostic workup and management for potential SBIs while avoiding unnecessary hospitalizations and antibiotic exposure in low-risk infants
-This is a high-yield topic for DNB and NEET SS examinations.

Clinical Presentation

Symptoms:
-Fever (rectal ≥38°C)
-Irritability or lethargy
-Poor feeding
-Vomiting
-Diarrhea
-Respiratory distress
-Seizures.
Signs:
-Fever
-Tachycardia
-Tachypnea
-Signs of dehydration
-Pallor
-Jaundice
-Mottling of skin
-Poor perfusion
-Meningeal signs (irritability, nuchal rigidity - often subtle in this age group).
Diagnostic Criteria:
-No clear source of infection identified on initial history and physical examination
-Rectal temperature ≥38°C.

Diagnostic Approach

History Taking:
-Detailed birth history (gestational age, prolonged rupture of membranes, maternal fever)
-Duration and height of fever
-Feeding pattern changes
-Vomiting or diarrhea
-Respiratory symptoms
-Urinary symptoms (fussiness during urination)
-Exposure to sick contacts
-Vaccination status (e.g., pneumococcal, Hib)
-Use of antipyretics prior to presentation
-Red flags: prematurity, congenital anomalies, recent hospitalization.
Physical Examination:
-Complete physical examination, including thorough assessment of all organ systems
-Vital signs: temperature, heart rate, respiratory rate, blood pressure, oxygen saturation
-Assess for signs of distress, dehydration, and sepsis
-Careful examination of skin for rashes or lesions
-Gentle palpation of abdomen
-Neurological assessment for lethargy or irritability
-Otoscopic and oropharyngeal examination.
Investigations:
-Complete Blood Count (CBC) with differential (WBC count >15,000/µL or <5,000/µL, absolute neutrophil count >10,000/µL)
-C-reactive protein (CRP) >20 mg/L
-Urinalysis and urine culture (suprapubic aspiration or catheterization preferred for young infants)
-Blood culture (at least two sets from different sites)
-Chest X-ray if respiratory symptoms present
-Lumbar puncture for cerebrospinal fluid (CSF) analysis (cell count, protein, glucose, Gram stain, culture) if any suspicion of meningitis or high risk of SBI.
Differential Diagnosis:
-Serious Bacterial Infections (SBIs): Sepsis, meningitis, urinary tract infection (UTI), pneumonia, osteomyelitis, cellulitis
-Viral infections: Enteroviruses, RSV, influenza
-Non-infectious causes: Heat exposure, over-bundling, post-vaccination fever (less common in this age group without a clear source)
-Necrotizing enterocolitis (NEC) in premature infants.

Risk Stratification

Low Risk Criteria:
-Well-appearing infant
-No signs of respiratory distress or dehydration
-No significant laboratory abnormalities (WBC 5,000-15,000/µL, ANC <10,000/µL, negative urinalysis, negative chest X-ray)
-Clinical judgment based on established protocols (e.g., Boston, Rochester criteria).
Intermediate Risk Criteria:
-Infant with some concerning features but not meeting criteria for high risk
-May include mild lethargy, slight dehydration, or borderline lab values
-Requires careful consideration and often further observation.
High Risk Criteria:
-Infant appearing ill
-Significant laboratory abnormalities (e.g., markedly elevated WBC count, positive inflammatory markers)
-Positive blood or urine culture
-Suspicion of meningitis based on CSF findings or clinical signs
-Prematurity (<37 weeks gestation)
-Congenital anomalies
-Known immunodeficiency.
Management Based On Risk:
-Low-risk infants may be managed as outpatients with close parental education and follow-up
-Intermediate-risk infants may require brief observation and repeat examinations
-High-risk infants require hospitalization, prompt empiric antibiotic therapy, and comprehensive workup for SBIs.

Management

Initial Management:
-Assess and stabilize the infant
-Obtain vital signs
-Perform thorough physical examination
-Initiate appropriate diagnostic workup based on risk stratification
-Administer antipyretics (acetaminophen or ibuprofen) if indicated and without masking signs of infection.
Medical Management:
-Empiric antibiotic therapy is crucial for infants with high-risk features or those who appear ill
-Common regimens include ampicillin plus a third-generation cephalosporin (e.g., ceftriaxone or cefotaxime) to cover common pathogens like *Streptococcus pneumoniae*, *Escherichia coli*, and *Listeria monocytogenes*
-Dosage and duration depend on the suspected diagnosis and culture results
-Intravenous fluids for dehydration.
Supportive Care:
-Close monitoring of vital signs, fluid balance, and clinical status
-Oxygen therapy if hypoxic
-Nutritional support as needed
-Comfort measures and parental reassurance.

Complications

Early Complications:
-Sepsis with shock
-Meningitis leading to neurological sequelae (hydrocephalus, seizures, developmental delay)
-Pneumonia with respiratory failure
-Osteomyelitis leading to joint damage
-Bacteremia with metastatic infection.
Late Complications:
-Long-term neurological deficits from meningitis
-Hearing impairment
-Developmental delays
-Chronic renal insufficiency from recurrent UTIs.
Prevention Strategies:
-Prompt diagnosis and effective treatment of SBIs
-Universal newborn screening for hearing impairment
-Immunizations against common bacterial pathogens (e.g., pneumococcal conjugate vaccine, Hib vaccine).

Prognosis

Factors Affecting Prognosis:
-The causative organism
-Promptness of diagnosis and treatment
-Presence of complications (e.g., meningitis, sepsis with shock)
-Infant's underlying health status.
Outcomes:
-With timely and appropriate management, most infants with FWS recover fully
-Infants with meningitis or severe sepsis have a higher risk of long-term sequelae
-A significant proportion of febrile infants without a source do not have SBIs and can be managed safely without hospitalization.
Follow Up:
-Close follow-up is essential for all infants treated for FWS, especially those managed as outpatients
-Parents should be educated on warning signs requiring immediate medical attention
-Infants with confirmed SBIs require follow-up to monitor for complications and ensure complete recovery.

Key Points

Exam Focus:
-Differentiating between low, intermediate, and high-risk infants is critical for management decisions in DNB/NEET SS
-Understand the classic presentation and workup of sepsis, meningitis, and UTI in this age group
-Know the empiric antibiotic choices and indications for lumbar puncture.
Clinical Pearls:
-Always use rectal temperature for accuracy in infants
-A seemingly minor infection can escalate rapidly in this age group
-Trust your clinical judgment – an infant who looks ill requires thorough investigation regardless of lab values
-Educate parents thoroughly on red flags.
Common Mistakes:
-Underestimating the severity of fever in young infants
-Relying solely on laboratory tests without considering clinical presentation
-Delaying empiric antibiotics in high-risk infants
-Inadequate follow-up for outpatients with fever.