Infection and inflammation

Despite dramatic advances in its prevention and treatment, infection remains a major cause of morbidity in children, accounting for approximately 30% of childhood deaths worldwide.1 The development of powerful antimicrobial agents has improved patient survival, but timely diagnosis is equally, if not more, important. In adults, most infections can be diagnosed with a thorough history, a complete physical examination, and appropriate laboratory tests. In the pediatric population, unfortunately, this is a difficult task. Children do not, or will not, verbalize their feelings, and the history is often little more than secondhand information obtained from a parent. The physical examination of an ailing child can be difficult, if not impossible. Further complicating matters is the fact that inflammatory conditions such as vasculitis and inflammatory disease may mimic infection. Consequently, empiric treatment with antibiotics, which may be neither appropriate nor effective, is often instituted. Imaging procedures are usually reserved for those patients in whom symptomatology or physical findings point to a specific region of the body.