Bacteremia in children afebrile at presentation to an emergency room

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Abstract
Charts of 182 outpatient children with bacteremia caused by Streptococcus pneumoniae, Haemophilus influenzae type b or Neisseria meningitidis were reviewed. Twenty-four patients (13%) were afebrile (temperature <37.8.degree.C) at presentation. Five afebrile patients had no history of fever. Four of the five had localizing signs of infection and one appeared toxic. Afebrile patients were not strikingly different form febrile bacteremic patients by any assessments. Bacteremia in children cannot be excluded on the basis of absence of fever by history and examination. Blood cultures should be performed on afebrile children who either have localizing signs of serious bacterial infection or appear toxic.