{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:52:21Z","timestamp":1787237541093,"version":"build-2736575974"},"reference-count":52,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1999,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective.\u2003<\/jats:title>\n                    <jats:p>To determine the frequency of unsuspected meningococcal disease (UMD) in young febrile children with meningococcal infections and evaluate whether clinical and laboratory parameters commonly used in the evaluation of fever can help identify children with UMD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods.\u2003<\/jats:title>\n                    <jats:p>We reviewed the records of children with meningococcal disease from 1985 to 1996 at four referral centers. Children who were evaluated as outpatients and then discharged to home, from whom Neisseria meningitidis was isolated from blood or cerebrospinal fluid cultures obtained during these outpatient visits, were considered to have UMD. We compared clinical and laboratory parameters between these children and 6414 febrile outpatients 3 to 36 months old with negative blood cultures enrolled in a separate study of occult bacteremia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results.\u2003<\/jats:title>\n                    <jats:p>We identified 381 children with meningococcal disease, of whom 45 (12%) had UMD. Of the 45 with UMD, 37 (82%) were 3 to 36 months old. Compared with the 6414 culture-negative patients, these 37 patients with UMD were significantly younger (8.9 \u00b1 5.4 vs 14.2 \u00b1 8.1 months) and had significantly higher band counts (14.3 \u00b1 11.1 vs 7.3 \u00b1 7.5%). There were no significant differences, however, in temperature, white blood cell counts, and absolute neutrophil counts. Multivariate analysis identified young age and the band count as independent predictors of UMD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions.\u2003<\/jats:title>\n                    <jats:p>Children ultimately diagnosed with meningococcal disease have commonly been evaluated as outpatients and discharged to home before diagnosis. Of the hematologic parameters frequently used in the evaluation of fever, only the band count differs significantly between young febrile children with UMD and those with negative cultures. Because UMD is uncommon in young febrile pediatric outpatients, however, the predictive value of the band count is low. Thus, the complete blood count is not routinely helpful for the diagnosis of UMD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.103.2.e20","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T19:45:45Z","timestamp":1092426345000},"page":"e20-e20","source":"Crossref","is-referenced-by-count":54,"title":["Clinical and Hematologic Features Do Not Reliably Identify Children With Unsuspected Meningococcal Disease"],"prefix":"10.1542","volume":"103","author":[{"given":"Nathan","family":"Kuppermann","sequence":"first","affiliation":[{"name":"From the Department of Pediatrics and Division of Emergency Medicine, Department of Internal Medicine, University of California, Davis, School of Medicine, Davis, California; Divisions of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Malley","sequence":"additional","affiliation":[{"name":"Emergency Medicine and"},{"name":"Infectious Diseases, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanley H.","family":"Inkelis","sequence":"additional","affiliation":[{"name":"Departments of Emergency Medicine and Pediatrics, Harbor-UCLA Medical Center, Torrance, California."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary R.","family":"Fleisher","sequence":"additional","affiliation":[{"name":"Emergency Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[1999,2,1]]},"reference":[{"key":"2021121019343597600_B1","first-page":"1","article-title":"Control and prevention of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP).","volume":"46","author":"Jafari","year":"1997","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"2021121019343597600_B2","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/00006454-198901000-00003","article-title":"Trends in mortality in children hospitalized with meningococcal infections, 1957 to 1987.","volume":"8","author":"Havens","year":"1989","journal-title":"Pediatr Infect Dis J."},{"key":"2021121019343597600_B3","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1097\/00006454-199611000-00009","article-title":"Pathophysiology, treatment and outcome of meningococcemia: a review and recent experience.","volume":"15","author":"Kirsch","year":"1996","journal-title":"Pediatr Infect Dis J."},{"key":"2021121019343597600_B4","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1097\/00006454-199508000-00001","article-title":"Epidemiology and prevention of meningococcal disease.","volume":"14","author":"Riedo","year":"1995","journal-title":"Pediatr Infect Dis J."},{"key":"2021121019343597600_B5","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1542\/peds.97.3.404","article-title":"Meningococcal disease prevention and control strategies for practice-based physicians.","volume":"97","author":"American Academy of Pediatrics, Committee on Infectious Diseases; Canadian Paediatric Society, Infectious Diseases and Immunization Committee","year":"1996","journal-title":"Pediatrics"},{"key":"2021121019343597600_B6","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1001\/jama.1995.03520290042027","article-title":"The changing epidemiology of invasive meningococcal disease in Canada, 1985 through 1992. Emergence of a virulent clone of","volume":"273","author":"Whalen","year":"1995","journal-title":"Neisseria meningitidis. JAMA."},{"key":"2021121019343597600_B7","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1007\/BF01712247","article-title":"The outcome of children admitted to intensive care with meningococcal septicaemia.","volume":"22","author":"Mok","year":"1996","journal-title":"Intensive Care Med."},{"key":"2021121019343597600_B8","first-page":"21","article-title":"Laboratory-based surveillance for meningococcal disease in selected areas, United States, 1989\u20131991.","volume":"42","author":"Jackson","year":"1993","journal-title":"MMWR CDC Surveill Summ."},{"key":"2021121019343597600_B9","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/S0022-3476(96)70153-1","article-title":"Multivariable predictive models for adverse outcome of invasive meningococcal disease in children.","volume":"129","author":"Malley","year":"1996","journal-title":"J Pediatr."},{"key":"2021121019343597600_B10","first-page":"224","article-title":"Meningococcal infections in children: a review of 100. cases.","volume":"8","author":"Wong","year":"1989","journal-title":"Pediatr Infect Dis J."},{"key":"2021121019343597600_B11","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/S0022-3476(83)80290-X","article-title":"Unsuspected meningococcemia.","volume":"102","author":"Dashefsky","year":"1983","journal-title":"J Pediatr."},{"key":"2021121019343597600_B12","doi-asserted-by":"crossref","first-page":"S156","DOI":"10.1093\/clinids\/13.Supplement_2.S156","article-title":"Management of children with occult bacteremia who are treated in the emergency department.","volume":"13","author":"Fleisher","year":"1991","journal-title":"Rev Infect Dis."},{"key":"2021121019343597600_B13","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/S0022-3476(05)83126-9","article-title":"Intramuscular versus oral antibiotic therapy for the prevention of meningitis and other bacterial sequelae in young, febrile children at risk for occult bacteremia.","volume":"124","author":"Fleisher","year":"1994","journal-title":"J Pediatr."},{"key":"2021121019343597600_B14","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1097\/00006454-198201000-00011","article-title":"Unsuspected meningococcemia treated with orally administered amoxicillin.","volume":"1","author":"Friedman","year":"1982","journal-title":"Pediatr Infect Dis J."},{"key":"2021121019343597600_B15","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1542\/peds.80.1.63","article-title":"Neisseria meningitidis bacteremia in children: quantitation of bacteremia and spontaneous clinical recovery without antibiotic therapy.","volume":"80","author":"Sullivan","year":"1987","journal-title":"Pediatrics."},{"key":"2021121019343597600_B16","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1177\/000992288502401101","article-title":"Clinical features of mild systemic meningococcal disease with characterization of bacterial isolates.","volume":"24","author":"Edwards","year":"1985","journal-title":"Clin Pediatr."},{"key":"2021121019343597600_B17","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1001\/archpedi.1977.02120220067011","article-title":"Meningococcal bacteremia: clinical and serologic studies of infants with mild illness.","volume":"131","author":"Baltimore","year":"1977","journal-title":"Am J Dis Child."},{"key":"2021121019343597600_B18","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1097\/00006454-199410000-00004","article-title":"The role of heparin in the prevention of extremity and digit necrosis in meningococcal purpura fulminans.","volume":"13","author":"Kuppermann","year":"1994","journal-title":"Pediatr Infect Dis J."},{"key":"2021121019343597600_B19","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1097\/00003246-199305000-00014","article-title":"Coagulopathy as a predictor of outcome in meningococcal sepsis and the systemic inflammatory response syndrome with purpura.","volume":"21","author":"McManus","year":"1993","journal-title":"Crit Care Med."},{"key":"2021121019343597600_B20"},{"key":"2021121019343597600_B21"},{"key":"2021121019343597600_B22","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1001\/jama.1995.03520290035026","article-title":"Serogroup C meningococcal outbreaks in the United States. 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