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Abstract
Introduction. Fever in infants under three months of age is a diagnostic and therapeutic emergency, as clinical signs are non-specific and the risk of serious bacterial infection is high. Precise epidemiological and microbiological data are lacking in several sub-Saharan African regions. This study aimed to describe the etiological profile, clinical-biological characteristics, and outcomes of infants aged 29 to 90 days hospitalized for fever in Yaoundé, Cameroon Methodology. This was a descriptive cross-sectional study, with retrospective data collection from 1 January 2019 to 31 December 2023, conducted at the Yaoundé Gynaecology -Obstetrics and Paediatrics Hospital in Yaoundé, including 200 infants aged 29 to 90 days hospitalised for fever who underwent blood culture, cytobacteriological analysis of cerebrospinal fluid and urine. Results. The most common signs were anaemia (84%), hyperleukocytosis (40%), positive C-reactive protein (94.5%); positive blood, urine and cerebrospinal fluid cultures in 23%, 19% and 6.5% of cases, respectively. The clinical forms found were sepsis (45%), pneumonia (20%), urinary tract infection (19%), meningitis (6.5%), malaria (6%) and viral infections (bronchiolitis and gastroenteritis 3.5%. The main germs isolated were: streptococci (22.9%), staphylococci (22.9%), Klebsiella pneumoniae (21.9%) and Escherichia coli (20.8%). The mortality rate was 1%. Conclusion. Bacterial infections, dominated by sepsis, are the primary cause of fever in young infants in this study. The high prevalence of anemia and inflammatory syndrome underscores the potential severity. These findings support the need for broad and rapid empirical antibiotic therapy, specifically targeting Gram-positive cocci and Enterobacteriaceae, and for strengthening microbiological diagnostic capacity.
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References
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- 2. Calejo A, Pinto de Carvalho Queirós I, Paiva Ferreira A, Monteiro Barroso D, et al. Fever without a source under 3 months of age: any predictive factors of serious bacterial infection?. Pediatric Oncall Journal.2023 ;3(2) :37-43.
- 3. Zea-Vera A, Ochoa TJ. Challenges in the diagnosis and management of neonatal sepsis. J Trop Pediatr. 2015 Feb;61(1):1-13.
- 4. Tanoh-Aka A, Siallou-Avi C, Iburaima A, Yeboua R, Yao Kouassi C, Sahi L, et al. Etiologies of Fever in Children Under 3 Months of Age at The University Teaching Hospital of Bouake (Cote D’ivoire). Archives of Pediatrics and Neonatology. 2020 ;3(2) :16‑26.
- 5. Guo BC, Chen YT, Chang YJ, Chen CY, Lin WY, Wu HP. Predictors of bacteremia in febrile infants under 3 months old in the pediatric emergency department. BMC Pediatrics. 2023 ;23(1) :444-9.
- 6. Carmon L, Goldbart A, Greenberg D, Ben-Shimol S. Serious Bacterial Infections in Hospitalized Febrile Infants in the First and Second Months of Life. Pediatric Infectious Disease Journal. 2017 ; 36 (10) :924‑9.
- 7. Gajdos V, L’Hélias LF, Mollet-Boudjemline A, Perreaux F, Trioche P, Labrune P. Facteurs prédictifs de la présence d’une infection bactérienne sévère chez les nourrissons fébriles âgés de moins de trois mois : analyse multivariée. Archives de Pédiatrie. 2005 ;12(4) :397‑403.
- 8. Mahajan P, Browne LR, Levine DA, Cohen DM, Gattu R, Linakis JG, et al. Risk of Bacterial Coinfections in Febrile Infants 60 Days Old and Younger with Documented Viral Infections. The Journal of Pediatrics.2018 ;203 :86-91.
- 9. Cioffredi LA, Jhaveri R. Evaluation and Management of Febrile Children: A Review. JAMA Pediatrics. 2016 ;170(8) :794‑800.
- 10. Bachur RG, Harper MB. Predictive Model for Serious Bacterial Infections Among Infants Younger Than 3 Months of Age. Pediatrics. 2001 ;108(2) :311‑6.
- 11. Hamiel U, Bahat H, Kozer E, Hamiel Y, Ziv-Baran T, Goldman M. Diagnostic markers of acute infections in infants aged 1 week to 3 months : a retrospective cohort study. BMJ Open.2018 ;8(1) : e018092.
- 12. Aldridge P, Rao A, Sethumadavan R, Briggs N. Fever under 3 months and the full septic screen : Time to think again ? A retrospective cohort study at a tertiary‐level paediatric hospital. J Paediatrics Child Health. 2018 ;54(3) :272‑8.
- 13. Yen TY. How to predict serious bacterial infections in young febrile infants in the emergency department ?. Pediatrics & Neonatology. 2019 ;60(2) :117‑8.
- 14. Milstone AM, Voskertchian A, Koontz DW, Khamash DF, Ross T, Aucott SW, et al. Effect of Treating Parents Colonized With Staphylococcus aureus on Transmission to Neonates in the Intensive Care Unit : A Randomized Clinical Trial. JAMA. 2020 ;323(4) :319-8.
- 15. Haji S, Ouchinsky Z, Djoumoi B, Benoit-Cattin T, Chamouine A. Epidemiology of serious bacterial infection in febrile infants under 3 months of age and diagnostic management in Mayotte. Arch Pediatr. 2021 Oct;28(7):553-558.
- 16. Gómez B, Mintegi S, Benito J, Egireun A, Garcia D, Astobiza E. Blood Culture and Bacteremia Predictors in Infants Less Than Three Months of Age With Fever Without Source. Pediatric Infectious Disease Journal.2010 ;29(1) :43‑7.
- 17. Klein V, Tchomakov D, Dillenseger L, Astruc D, Kuhn P. Fièvre du nouveau-né et du nourrisson de moins de 3 mois. 2018 ;24(1) :39-44.
- 18. Tzimenatos L, Mahajan P, Dayan PS, Vitale M, Linakis JG, Blumberg S, Borgialli D, Ruddy RM, Van Buren J, Ramilo O, Kuppermann N; Pediatric Emergency Care Applied Research Network (PECARN). Accuracy of the Urinalysis for Urinary Tract Infections in Febrile Infants 60 Days and Younger. Pediatrics. 2018 Feb;141(2):e20173068.
- 19. Méndez-Espinola BM, Gallardo-Aravena E. Diagnosis of urinary tract infection in infants under 3 months with fever without a source: reliability of urinalysis and urine culture. Bol Med Hosp Infant Mex. 2023;80(5):288-295.
- 20. Erickson TA, Munoz FM, Troisi CL, Nolan MS, Hasbun R, Brown EL, Murray KO. The Epidemiology of Meningitis in Infants under 90 Days of Age in a Large Pediatric Hospital. Microorganisms. 2021 Mar 4;9(3):526.
- 21. Greenhow TL, Hung YY, Herz AM, Losada E, Pantell RH. The Changing Epidemiology of Serious Bacterial Infections in Young Infants. Pediatric Infectious Disease Journal. 2014 ;33(6) :595‑9.
References
1. Woll C, Neuman MI, Pruitt CM, Wang ME, Shapiro ED, Shah SS, et al. Epidemiology and Etiology of Invasive Bacterial Infection in Infants ≤60 Days Old Treated in Emergency Departments. The Journal of Pediatrics.2018 ;200 :210-17.
2. Calejo A, Pinto de Carvalho Queirós I, Paiva Ferreira A, Monteiro Barroso D, et al. Fever without a source under 3 months of age: any predictive factors of serious bacterial infection?. Pediatric Oncall Journal.2023 ;3(2) :37-43.
3. Zea-Vera A, Ochoa TJ. Challenges in the diagnosis and management of neonatal sepsis. J Trop Pediatr. 2015 Feb;61(1):1-13.
4. Tanoh-Aka A, Siallou-Avi C, Iburaima A, Yeboua R, Yao Kouassi C, Sahi L, et al. Etiologies of Fever in Children Under 3 Months of Age at The University Teaching Hospital of Bouake (Cote D’ivoire). Archives of Pediatrics and Neonatology. 2020 ;3(2) :16‑26.
5. Guo BC, Chen YT, Chang YJ, Chen CY, Lin WY, Wu HP. Predictors of bacteremia in febrile infants under 3 months old in the pediatric emergency department. BMC Pediatrics. 2023 ;23(1) :444-9.
6. Carmon L, Goldbart A, Greenberg D, Ben-Shimol S. Serious Bacterial Infections in Hospitalized Febrile Infants in the First and Second Months of Life. Pediatric Infectious Disease Journal. 2017 ; 36 (10) :924‑9.
7. Gajdos V, L’Hélias LF, Mollet-Boudjemline A, Perreaux F, Trioche P, Labrune P. Facteurs prédictifs de la présence d’une infection bactérienne sévère chez les nourrissons fébriles âgés de moins de trois mois : analyse multivariée. Archives de Pédiatrie. 2005 ;12(4) :397‑403.
8. Mahajan P, Browne LR, Levine DA, Cohen DM, Gattu R, Linakis JG, et al. Risk of Bacterial Coinfections in Febrile Infants 60 Days Old and Younger with Documented Viral Infections. The Journal of Pediatrics.2018 ;203 :86-91.
9. Cioffredi LA, Jhaveri R. Evaluation and Management of Febrile Children: A Review. JAMA Pediatrics. 2016 ;170(8) :794‑800.
10. Bachur RG, Harper MB. Predictive Model for Serious Bacterial Infections Among Infants Younger Than 3 Months of Age. Pediatrics. 2001 ;108(2) :311‑6.
11. Hamiel U, Bahat H, Kozer E, Hamiel Y, Ziv-Baran T, Goldman M. Diagnostic markers of acute infections in infants aged 1 week to 3 months : a retrospective cohort study. BMJ Open.2018 ;8(1) : e018092.
12. Aldridge P, Rao A, Sethumadavan R, Briggs N. Fever under 3 months and the full septic screen : Time to think again ? A retrospective cohort study at a tertiary‐level paediatric hospital. J Paediatrics Child Health. 2018 ;54(3) :272‑8.
13. Yen TY. How to predict serious bacterial infections in young febrile infants in the emergency department ?. Pediatrics & Neonatology. 2019 ;60(2) :117‑8.
14. Milstone AM, Voskertchian A, Koontz DW, Khamash DF, Ross T, Aucott SW, et al. Effect of Treating Parents Colonized With Staphylococcus aureus on Transmission to Neonates in the Intensive Care Unit : A Randomized Clinical Trial. JAMA. 2020 ;323(4) :319-8.
15. Haji S, Ouchinsky Z, Djoumoi B, Benoit-Cattin T, Chamouine A. Epidemiology of serious bacterial infection in febrile infants under 3 months of age and diagnostic management in Mayotte. Arch Pediatr. 2021 Oct;28(7):553-558.
16. Gómez B, Mintegi S, Benito J, Egireun A, Garcia D, Astobiza E. Blood Culture and Bacteremia Predictors in Infants Less Than Three Months of Age With Fever Without Source. Pediatric Infectious Disease Journal.2010 ;29(1) :43‑7.
17. Klein V, Tchomakov D, Dillenseger L, Astruc D, Kuhn P. Fièvre du nouveau-né et du nourrisson de moins de 3 mois. 2018 ;24(1) :39-44.
18. Tzimenatos L, Mahajan P, Dayan PS, Vitale M, Linakis JG, Blumberg S, Borgialli D, Ruddy RM, Van Buren J, Ramilo O, Kuppermann N; Pediatric Emergency Care Applied Research Network (PECARN). Accuracy of the Urinalysis for Urinary Tract Infections in Febrile Infants 60 Days and Younger. Pediatrics. 2018 Feb;141(2):e20173068.
19. Méndez-Espinola BM, Gallardo-Aravena E. Diagnosis of urinary tract infection in infants under 3 months with fever without a source: reliability of urinalysis and urine culture. Bol Med Hosp Infant Mex. 2023;80(5):288-295.
20. Erickson TA, Munoz FM, Troisi CL, Nolan MS, Hasbun R, Brown EL, Murray KO. The Epidemiology of Meningitis in Infants under 90 Days of Age in a Large Pediatric Hospital. Microorganisms. 2021 Mar 4;9(3):526.
21. Greenhow TL, Hung YY, Herz AM, Losada E, Pantell RH. The Changing Epidemiology of Serious Bacterial Infections in Young Infants. Pediatric Infectious Disease Journal. 2014 ;33(6) :595‑9.