TABLE 94.1 MOST COMMON CAUSES OF PEDIATRIC OCCULT BACTEREMIA IN THE POSTPNEUMOCOCCAL CONJUGATE VACCINE ERA OTHER SYSTEMIC INFECTIOUS EMERGENCIES Goals of Treatment The goals of treatment are to rapidly identify children at risk for some less common pathogens that can result in fulminant infection and to plan an empiric treatment course while awaiting diagnostic testing CLINICAL PEARLS AND PITFALLS If rickettsial disease is suspected based upon epidemiologic risk factors and clinical presentation, doxycycline should be started immediately Doxycycline is the treatment of choice for the most deadly rickettsial disease in the United States, Rocky Mountain spotted fever (RMSF); this is true for all age groups (including children younger than years of age) The “classic” triad for RMSF of fever, headache, and a rash is present in approximately 60% of cases Babesiosis presents with symptoms similar to malaria, but in a child who lacks a travel history to a malaria-endemic region Treatment is similar to that for malaria Asplenic patients are at highest risk for babesiosis complications