title: Detection of viruses in young children with fever without an apparent source.
abstract: OBJECTIVE
  Fever without an apparent source is common in young children. Currently in the United States, serious bacterial infection is unusual. Our objective was to determine specific viruses that might be responsible.
  
  
  METHODS
  We enrolled children aged 2 to 36 months with temperature of 38°C or greater without an apparent source or with definite or probable bacterial infection being evaluated in the St Louis Children's Hospital Emergency Department and afebrile children having ambulatory surgery. Blood and nasopharyngeal swab samples were tested with an extensive battery of virus-specific polymerase chain reaction assays.
  
  
  RESULTS
  One or more viruses were detected in 76% of 75 children with fever without an apparent source, 40% of 15 children with fever and a definite or probable bacterial infection, and 35% of 116 afebrile children (P < .001). Four viruses (adenovirus, human herpesvirus 6, enterovirus, and parechovirus) were predominant, being detected in 57% of children with fever without a source, 13% of children with fever and definite or probable bacterial infection, and 7% of afebrile children (P < .001). Thirty-four percent of 146 viral infections were detected only by polymerase chain reaction performed on blood. Fifty-one percent of children with viral infections and no evidence of bacterial infection were treated with antibiotics.
  
  
  CONCLUSIONS
  Viral infections are frequent in children with fever without an apparent source. Testing of blood in addition to nasopharyngeal secretions expanded the range of viruses detected. Future studies should explore the utility of testing for the implicated viruses. Better recognition of viruses that cause undifferentiated fever in young children may help limit unnecessary antibiotic use.
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Colvin
authors.forename: Jared T
authors.initials: JT
authors.lastname: Muenzer
authors.forename: David M
authors.initials: DM
authors.lastname: Jaffe
authors.forename: Avraham
authors.initials: A
authors.lastname: Smason
authors.forename: Elena
authors.initials: E
authors.lastname: Deych
authors.forename: William D
authors.initials: WD
authors.lastname: Shannon
authors.forename: Max Q
authors.initials: MQ
authors.lastname: Arens
authors.forename: Richard S
authors.initials: RS
authors.lastname: Buller
authors.forename: Wai-Ming
authors.initials: WM
authors.lastname: Lee
authors.forename: Erica J Sodergren
authors.initials: EJ
authors.lastname: Weinstock
authors.forename: George M
authors.initials: GM
authors.lastname: Weinstock
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Storch
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology; D001769:Blood / Q000821:virology; D015984:Causality; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005335:Fever of Unknown Origin / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology*; D006801:Humans; D007223:Infant; D008297:Male; D008923:Missouri; D060885:Multiplex Polymerase Chain Reaction; D015999:Multivariate Analysis; D009305:Nasopharynx / Q000821:virology; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014777:Virus Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology*
chemical_list: D000900:Anti-Bacterial Agents