pediatrics
Occult Bacteremia and Fever Without Apparent Source in Infants and Young Children
Symptoms and Signs
The major symptom of occult bacteremia is fever—temperature≥39° C (≥38° C for infants < 3 months). By definition, children with apparent focal disease (eg, cough, dyspnea, and pulmonary crackles suggesting pneumonia; skin erythema suggesting cellulitis or septic arthritis) are excluded (ie, because their disease is not occult). A toxic appearance (eg, limpness and listlessness, lethargy, signs of poor perfusion, cyanosis, marked hypoventilation or hyperventilation) suggests sepsis or septic shock; bacteremia in such children is also not classified as occult or fever without a source. However, early sepsis can be difficult to distinguish from occult bacteremia. 