Fever in infants less than two months of age: spectrum of disease and predictors of outcome.

Four hundred thirty-four febrile infants two months of age or younger were evaluated in the emergency departments of five major teaching hospitals over a one-year period. A culture-proven bacterial infection was present in 3.5% of the infants; bacteremia was detected in 3.3%. Bacterial meningitis was present in 2.4%, and aseptic meningitis was noted in 13.4%. Twenty-one percent had clinically apparent serious disease including pneumonia, otitis media, and gastroenteritis with dehydration. Six variables (age less than 1 month, lethargy, no contact with an ill individual, breast-feeding, total polymorphonuclear greater than or equal to 10,000/mm3 and band count greater than or equal to 500/mm3) were correlated with bacterial infection by step-wise discriminant analysis. However, these findings were neither sensitive nor specific enough to be clinically useful. Management varied, and 62% of the infants were hospitalized. Fifty-four percent, some of whom were managed as outpatients, received antibiotics. Febrile infants two months of age or younger require a comprehensive emergency department assessment, including appropriate laboratory studies (CBC, differential, urinalysis and culture, lumbar puncture, and blood culture), since 3.5% have bacterial infection that may be life-threatening. Hospitalization is warranted if the infant appears ill, laboratory studies indicate serious infection, or follow-up care is uncertain.

Primary herpes simplex pneumonia in a neonate.

A 6-day-old male infant was treated for rapidly progressive pneumonia. The infection was not responsive to antibiotic and symptomatic treatment, and the infant died within 48 hours of admission. Herpes simplex type II grew from premortem respiratory and postmortem lung cultures, and immunoperoxidase staining confirmed the presence of this organism in lung tissue. Pathologic findings were limited to the lungs. A maternal origin for the virus was suspected but could not be proved. We believe this patient represents the first reported case of isolated herpes simplex type II pneumonia in a neonate.