Detection of viruses in young children with fever without an apparent source

Pediatrics. 2012 Dec;130(6):e1455-62. doi: 10.1542/peds.2012-1391. Epub 2012 Nov 5.


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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Bacterial Infections / diagnosis
  • Bacterial Infections / drug therapy
  • Bacterial Infections / epidemiology
  • Bacterial Infections / virology
  • Blood / virology
  • Causality
  • Child, Preschool
  • Cross-Sectional Studies
  • Drug Utilization / statistics & numerical data
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Fever of Unknown Origin / diagnosis
  • Fever of Unknown Origin / drug therapy
  • Fever of Unknown Origin / epidemiology
  • Fever of Unknown Origin / virology*
  • Humans
  • Infant
  • Male
  • Missouri
  • Multiplex Polymerase Chain Reaction
  • Multivariate Analysis
  • Nasopharynx / virology
  • Reverse Transcriptase Polymerase Chain Reaction
  • Virus Diseases / diagnosis*
  • Virus Diseases / drug therapy
  • Virus Diseases / epidemiology
  • Virus Diseases / virology*


  • Anti-Bacterial Agents