Occult bacteremia in children is characterized by the presence of freely circulating bacteria in the blood of young children who have no other specific source of infection elsewhere in the body. Fever may be the only symptom, and the child may not seem particularly ill.

• Fever may be the only symptom present in the affected child. Blood tests help diagnose occult bacteremia.
• Streptococcus pneumoniae is the most common cause of occult bacteremia.
• This infection is effectively treated with antibiotic therapy.

Fevers are very common in children below 3 years of age. They indicate some infection or inflammation in the body, and are usually accompanied by other obvious symptoms such as runny nose, throat pain or cough. These additional symptoms help the doctor to identify the cause of the fever. In about one third of the cases, any symptom other than fever may be absent. Viral infections are the usual reason in most of such cases, and the fever eventually subsides without any specific treatment. In about three percent of cases, fever may be caused by the presence of bacteria in the bloodstream. It is referred to as occult bacteremia, as the infection is hidden and can be detected only by blood tests.

A type of bacteria named Streptococcus pneumoniae is the usual cause of occult bacteremia in children. Neither adults, nor older children, usually have freely circulating bacteria in their blood without having any symptoms other than fever as an indication. The presence of bacteria in the blood raises the risk of developing dangerous infections in the different organ systems of the body. Even though less than 10% of young children who have occult bacteremia actually develop meningitis, pneumonia or such other serious illnesses, doctors try to identify the causative organism by culturing the blood, so that the infection can be treated before complications develop.  If the WBC count is higher than normal, it indicates a bacterial infection. In such cases, the doctors may straight away initiate antibiotic therapy without waiting for the result of the blood culture.

Since only a blood culture can accurately detect occult bacteremia, any child below the age of 3 years, having a high fever without any other accompanying symptoms, is subjected to further investigations, to rule out this condition. The blood cell count is tested, and a blood sample is sent for culture. Children older than 3 years do not require blood culture as occult bacteremia is rare in older children.

When the results of the blood culture become available, usually within one or two days, the cases are reevaluated. If the result is positive for occult bacteremia, but the child is not visibly ill, oral antibiotics are prescribed, and the child is sent home. If the child appears severely ill, hospitalization may be necessary, and antibiotics are given intravenously. Severely ill children, and those who have high white blood cell count, may have been given a shot of an antibiotic drug like ceftriaxone, even before the culture results are ready. Such cases are also reassessed based on the results.

Vaccines have been developed to avoid occult bacteremia in children. A conjugate vaccine against Haemophilus influenzae type b, given to almost all young children in the US, has successfully wiped out occult bacteremia caused by type b Haemophilus influenzae. Another conjugate vaccine is also available, which provides protection from Streptococcus pneumoniae. When administered to infants, it has helped prevent occult pneumococcal bacteremia in them. Neisseria meningitidis is another bacteria causing occult bacteremia in young children. A newly developed vaccine against this type of bacteria is in the testing stage. Occult bacteremia is expected to be completely eliminated by the combined use of all these vaccines.

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery

Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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