Sterile cerebrospinal fluid pleocytosis in young infants with urinary tract infections.
ABSTRACT In a multicenter prospective study, 91 of 1025 febrile infants <or=60 days of age had urinary tract infections. Among patients with urinary tract infections and without traumatic lumbar punctures, sterile cerebrospinal fluid pleocytosis was uncommon (0%-8%, depending on the definition) in contrast to earlier studies reporting this association.
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ABSTRACT: The objective of this study was to describe the characteristics of the enteroviral meningitis diagnosed in a pediatric emergency department among infants younger than 3 months with fever without source and its short-term evolution. This was a retrospective, cross-sectional, 6-year descriptive study including all infants younger than 3 months who presented with fever without source and who were diagnosed with enteroviral meningitis. A lumbar puncture was practiced at their first emergency visit in 398 (29.5%) of 1348 infants, and 65 (4.8%) were diagnosed with enteroviral meningitis, 33 of them (50.7%) between May and July. Among these 65 infants, 61 were classified as well-appearing; parents referred irritability in 16 (25.3%) of them (without statistical significance when compared with infants without meningitis). Forty-one (63.0%) had no altered infectious parameters (white blood cell [WBC] count between 5000 and 15,000/μL, absolute neutrophil count less than 10,000/μL, and C-reactive protein less than 20 g/L), and 39 (60%) had no pleocytosis. All of the 65 infants recovered well, and none of them developed short-term complications. The symptoms in infants younger than 3 months with enteroviral meningitis were similar to those in infants with a self-limited febrile process without intracranial infection. C-reactive protein and WBC count were not good enteroviral meningitis predictors. Cerebrospinal fluid WBC count was normal in many of these infants, so performing a viral test is recommended for febrile infants younger than 3 months in which a lumbar puncture is practiced during warm months. The short-term evolution was benign.Pediatric emergency care 05/2012; 28(6):518-23. · 0.92 Impact Factor
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ABSTRACT: Objective:Urinary tract infections (UTI) are common in the neonatal intensive care unit (NICU). Blood, urine and cerebrospinal fluid (CSF) cultures are frequently obtained to evaluate for infection. We sought to determine the concordance between positive urine cultures and blood or CSF cultures.Study Design:Infants <121 days of age with a UTI admitted to 322 NICUs managed by the Pediatrix Medical Group from 1997 to 2010 were identified. UTIs were defined by isolation of a single pathogenic organism in a urine sample obtained by catheterization or suprapubic tap. The UTI was concordant if the same organism was identified in the blood or CSF within 3 days of the urine culture.Result:Of 5681 infants with a urine culture, 984 had 1162 UTIs. In total, 976 UTIs (84%) had a blood culture collected within 3 days, and 127 (13%) were concordant. Of the 1162 UTIs, 77 (7%) had a CSF culture collected within 3 days, and 2 (3%) were concordant.Conclusion:Collection of a urine culture in infants evaluated for late-onset sepsis is important. Concordance was observed in 13% of blood cultures and 3% of CSF cultures. These findings may be related to the initiation of empirical antimicrobial therapy before evaluation for disseminated infection or poor blood culture sensitivity.Journal of Perinatology advance online publication, 30 August 2012; doi:10.1038/jp.2012.111.Journal of perinatology: official journal of the California Perinatal Association 08/2012; · 1.59 Impact Factor
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ABSTRACT: Sterile CSF pleocytosis occurs in febrile infants with UTI. Co-infection with enterovirus is a possible cause. We evaluated 57 infants with UTI and CSF pleocytosis. All had enterovirus testing by PCR. An explanation for pleocytosis was determined for 24 infants (42%). EV infection was detected in four and is an uncommon cause of CSF pleocytosis in infants with UTI.The Pediatric Infectious Disease Journal 04/2013; · 3.57 Impact Factor