الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 97 |  |  |
| | | from | 97 | | |
Abstract
Pneumonia and other lower respiratory tract infections are the leading cause of death worldwide. Pneumonia is still one of the most common causes of death in infants and children. In developing countries pneumonia is a major cause of mortality, especially in children under age of five.
Pediatric patients presenting in the emergency department (ED) with fever are sometimes the more challenging patients that emergency physicians face. Although most febrile children who present to the ED are presumed to have a viral illness, some children with fever and no apparent source on physical examination (fever without a focus) may have serious bacterial infections.
The WBC count is the most widely studied laboratory parameter in occult bacteremia. The risk of occult bacteremia and occult pneumococcal bacteremia has been consistently found to increase with an increased WBC count.
The study aimed to determine the prevalence of pneumonia diagnosed only by chest radiographs among febrile infants and children with high leukocyte count and without any localizing sign on physical examination. This study was conducted on 160 infants and children attended outpatient clinic of Alexandria University Children’s Hospital. Their age ranged from 45 days to 42 months old.
All the cases were assessed by complete history taking and thorough physical examination. Blood samples were collected, transported to the laboratory and examined for complete blood count automatically and manually by direct microscopy after staining by leischman stain. Also quantitative CRP level was examined for each case. A postero-anterior plain X ray chest was done for all included cases. Urine analysis was done if applicable. Data were fed to the computer and Statistical analysis of the data was done.
Number of male patients was 91 cases representing 56.9% of cases while that of female patients was 69 cases representing about 43.1% with no observed association between sex and fever without source.
Eight cases (representing 5%) of infants and children included in the current study had chest X ray findings positive for pneumonia. The mean duration of fever in the eight positive cases was 4.75 days ± 2.25 SD which was statistically higher than that of negative cases. All positive cases of occult pneumonia (OP) had cough symptoms (100%) while 80.3% of negative cases had cough symptoms with no significant correlation between cough and occult pneumonia.
The white blood cell (WBC) count in positive cases of OP had mean of 20483/mm3 ± 4928SD which was statistically significant from that measured in negative cases of OP in which the WBC count had mean of 17366/mm3 ± 1703 SD. Furthermore, the mean of neutrophil count % and the mean of band cell count % were statistically significant in positive cases of OP from that measured in negative cases of OP.
The C-reactive protein (CRP) level in positive cases of OP had mean of 124.2 mg/l±108.07SD which was statistically significant from that measured in negative cases of OP in which the CRP level had mean of 18.9 mg/l ± 25.55 SD.
The findings recruited from the current study suggest that OP, is far less rare, and the finding of a high WBC count with long duration of fever in the presence of cough gives it an appreciable probability.
Routine plain chest X ray may reduce undiscovered OP in febrile infant and children without any localizing sign. Future studies should be included to show the incidence of OP among other age groups.