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okay, so for asymptomatic pneumococcal bacteremia I have now read the Occult Bacteremia topic about not needing to treat if asymptomatic. I cannot find that anywhere at all. Emedicine discussed treating but doing so at home if the child is uncomplicated and has no focal illness. Where did you get that rec?
There’s a great UpToDate article about the subject. Also, this page on eMedicine discusses not treating it: http://emedicine.medscape.com/article/967600-overview
Here’s the except:
“Occult bacteremia now occurs in only 1 of 200 children who present with acute fever (temperature of 39o C [102.2o F] or higher) and white blood cell counts of 15,000/µL or higher. The most likely cause of bacteremia remains S pneumoniae; when there is no evidence of toxicity, such bacteremia is generally a benign, self-limited event.
Because of the extremely low yield, blood cultures are no longer routinely warranted in children aged 3-36 months who have no obvious source of infection, and empiric treatment of occult bacteremia is no longer appropriate. Almost all cases will spontaneously resolve with a low rate of subsequent focal infection. If a child remains febrile and worsens clinically, further diagnostic evaluation and possible empiric treatment with antibiotics pending results o cultures may be considered.”
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I also remember having a case like this that was discussed in great length during residency. UpToDate also discusses a watchful waiting approach for asymptomatic and incidentally found pneumococcal bacteremia. For anyone reading this… STAPH AURESUS bacteremia is always treated. Horrendous mortality so you have to be extra careful. Echo to rule out endocarditis, etc.
Updated occult bacteremia section:
OCCULT BACTEREMIA
Streptococcus pneumoniae (Pneumococcus) is the most common etiology of occult bacteremia (no obvious source). For Streptococcal bacteremia found incidentally, if there are NO symptoms, then you do NOT need to treat!
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