Síndrome febril sin foco. Una historia interminable

20 de enero de 2021 |
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Síndrome febril sin foco. Una historia interminable


La fiebre es uno de los motivos de consulta más frecuentes en las consultas de Atención Primaria y los Servicios de Urgencias Hospitalarios, especialmente durante la primera infancia. La fiebre sin foco (FSF) es la elevación de la temperatura rectal por encima de los 38ºC, de menos de 72 horas de evolución, sin conocerse el origen de la misma después de una historia y una exploración física cuidadosas.

La valoración del niño con FSF es uno de los mayores retos a los que se enfrenta el pediatra. La mayoría de casos se deben a infecciones víricas benignas y autolimitadas, que no precisarán de un tratamiento específico. Sin embargo, una pequeña proporción de pacientes con FSF presentarán una enfermedad bacteriana potencialmente grave (EBPG) subyacente, como son la bacteriemia oculta, la infección osteoarticular, la meningitis o la infección del tracto urinario (ITU). De todas ellas, la más frecuente es la ITU, especialmente en los pacientes menores de 2 años. Recientemente algunos autores defienden un manejo ambulatorio de la ITU sin riesgo para el paciente, dejando así de considerarla como una como EBPG aunque este concepto todavía no tiene una práctica generalizada.

Por otra parte, en los últimos años, la introducción de la vacuna antineumocócica conjugada ha supuesto una disminución de la prevalencia de EBPG, especialmente de la bacteriemia oculta neumocócica, modificando el manejo diagnóstico-terapéutico de los niños menores de 3 años con FSF.

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