The frequency of occult bacteremia among children treated as outpatients for simple febrile seizures has been investigated in the Dept of Pediatrics, Univ of Maryland School of Medicine and St. Agnes Hospital, Baltimore, MD. Patients seen with fever but without a history of febrile seizures had blood cultures performed more frequently than those with a history of seizures. Of 115 patients with febrile seizures, 93 had blood cultures of which 5 (5.4%) were positive, all for Streptococcus pneumoniae. Follow-up blood cultures on return to the ER were negative. Three of the 5 had been treated with amoxicillin suspension for otitis media and 2 had not received antibiotics. There was no significant difference in the occurrence of positive blood cultures in those with and without a history of febrile convulsions. The leukocyte count was the most valuable predictor of bacteremia. A temperature less than 39°C and leukocyte count less than 15 × 10 /L were predictive of a negative blood culture. Of those with a positive culture, the mean leukocyte count was 20.9 × 10 /L and the mean temperature was 40.2°C. Patients admitted to the hospital because of complications (e.g. meningitis, status epilepticus, facial cellulitis, and reactions to DPT vaccine) were excluded from the analysis. The authors recommend that the indications for blood culture are the same in patients with fever, with or without seizures. [1]

COMMENT. It is interesting that the American Academy of Pediatrics Consensus statement from 1980 regarding the workup for febrile seizures did not include mention of blood culture. The authors of the paper reviewed here point out that patients with fever complicated by seizure are at the same risk for occult bacteremia as patients with fever alone, and should receive the same attention with regard to blood cultures. My colleague, Dr. Subhash Chaudhary, Head of the Division of Pediatric Infectious Disease at SIU School of Medicine, commented on the indications for blood culture in young children with fever but with no recognized focus of infection: “a child who looks sick and/or has a WBC of 20,000 or more should receive a blood culture and initial treatment with an antibiotic effective against pneumococcus and H influenza type b pending the isolation of an organism.“