Trautner et al evaluated pediatric patients presenting to the Emergency Department with hyperpyrexia. The authors are from Baylor College of Medicine, DeBakey Veterans Affairs Medical Center, Medical City Hospital and Acute Kids Urgent Care in Houston and Dallas.


Patient selection: sick pediatric patient (age < 18 years) in the Emergency Department


Hyperpyrexia was defined as a rectal temperature >= 106°F.


Potential outcome of prolonged hyperpyrexia: heat stress


Risk factors for hyperpyrexia:

(1) serious bacterial infection (SBI)

(2) viral infection

(3) mixed bacterial and viral infection

(4) intoxication

(5) heat stroke

(6) neuroleptic malignant syndrome


Findings suggestive of bacterial infection:

(1) history of chronic underlying disease

(2) diarrhea


Findings suggestive of viral infection:

(1) rhinorrhea


Rapid diagnostic methods using molecular techniques can help to specifically identify significant pathogens and to help guide management.


The authors recommended antibiotic therapy for pediatric patients with hyperpyrexia:

(1) without confirmed viral infection

(2) with confirmed viral infection if sick enough to require hospitalization


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