eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Pneumococcal Bacteremia: Differential Diagnoses & Workup

Author: Martha L Miller, MD, Associate Professor of Pediatrics, Division of Infectious Diseases, University of New Mexico School of Medicine
Contributor Information and Disclosures

Updated: May 5, 2009

Differential Diagnoses

Appendicitis
Pyelonephritis
Bacteremia
Retropharyngeal Abscess
Herpesvirus 6 Infection
Rhinovirus Infection
Meningitis, Aseptic
Salmonella Infection
Meningitis, Bacterial
Shigella Infection
Meningococcal Infections
Staphylococcus Aureus Infection
Pneumococcal Infections
Streptococcal Infection, Group A
Pneumonia
Varicella

Other Problems to Be Considered

Sepsis

Workup

Laboratory Studies

  • In young patients with high fever, a careful history and physical examination are needed to identify possible sources of infection, including pneumococcal bacteremia.
  • In patients aged 3-36 months who have a temperature of greater than 39°C and no identifiable source of fever based on examination, a screening WBC count can be used to identify those at highest risk for bacteremia. Since the introduction of the heptavalent vaccine, this strategy is mostly used for patients younger than 6 months who, because of age alone, cannot be fully vaccinated. In those older than 6 months who are immunocompetent and fully vaccinated, a WBC count might be useful but is not routine for all patients who have fever without a source. In those with focal infections, a blood culture is useful to identify a pathogen or to alter therapy.
    • A WBC count of more than 15,000/mcL or an absolute neutrophil count more than 10,000/mcL is 86% sensitive for identifying occult pneumococcal bacteremia. These estimates are still based in the pre–universal vaccine era.
    • Temperature alone and absolute band counts are inferior predictors of bacteremia.
  • A blood culture should be considered in patients aged 3-36 months who are thought to be at risk for bacteremia as determined by ill-appearance, focal infection, or high fever.
  • An elevated WBC count in a healthy-appearing child with high fever should prompt consideration of other occult infections that may be missed by examination alone, such as urinary tract infection or pneumonia.

Imaging Studies

  • A chest radiograph is indicated in patients who are being evaluated for pneumococcal bacteremia and are found to have leukocytosis to investigate the possibility of pneumonia.

More on Pneumococcal Bacteremia

Overview: Pneumococcal Bacteremia
Differential Diagnoses & Workup: Pneumococcal Bacteremia
Treatment & Medication: Pneumococcal Bacteremia
Follow-up: Pneumococcal Bacteremia
Multimedia: Pneumococcal Bacteremia
References
Further Reading
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References

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Keywords

pneumococcal bacteremia, Streptococcus pneumoniae bacteremia, Streptococcus pneumoniae, S pneumoniae, pneumococcus, gram-positive sepsis, occult bacteremia, OB, meningitis, bacteremia, pneumonia, upper respiratory infection, URI, septic arthritis, osteomyelitis, cellulitis, sickle cell disease, HIV, stomatitis, croup, bronchiolitis, varicella, mononucleosis, treatment, diagnosis

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Contributor Information and Disclosures

Author

Martha L Miller, MD, Associate Professor of Pediatrics, Division of Infectious Diseases, University of New Mexico School of Medicine
Disclosure: Nothing to disclose.

Medical Editor

David Jaimovich, MD, Chief Medical Officer, Joint Commission International and Joint Commission Resources
David Jaimovich, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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