Incidence of meningitis in infants with simple febrile seizures. Experience in a 3th level hospital
PDF (Español)
HTML (Español)

Keywords

Simple febrile seizure
meningitis
lumbar puncture
cerebrospinal fluid
fever
infants (MeSH)

Abstract

Introducction. Febrile seizures (FS) are defined as generalized, self limited crisis lasting less than 15 minutes with no recurrence in 24 hours and without neurological inpairment in the post ictal period. FS are the most common cause for convulsions in patients less than 5 years old. These type of crisis are benign and self-limited . FS Lifetime incidence has been calculated between 2-4% in pediatric population.

Objective. To determine the inicidence of meningitis in children under 18 months with first simple febrile seizure (FS).

Materials and Methods. A retrospective review of medical records of patients 3 to 18 months of age who visited the emergency room at the Hospital Universitario San Vicente Fundación (HUSVF) after first episode of simple febrile seizure (FS), between January 2005 and December 2010.

Results. We analized 286 clinical records of patients between 3 and 18 months of age with febrile seizures, 79 (27%) were considered a single FS. Fifty-patients were under 12 months of age (63%). Lumbar puncture was performed in 45 children (57%) and there were 6 children with pleocytosis, one of them was considered as bacterial meningitis, and three as aseptic meningitis. Two cases had diagnosis of partially treated meningitis. Children with suspected meningitis had abnormal neurological signs, had previously received antibiotics or had incomplete vaccination.

Conclusion. Meningitis in children with simple FS is not frequent and all cases could be detected according to the criteria of the American Academy of Pediatrics to perform lumbar puncture in children who previously received antibiotics, had incomplete vaccination or have positive neurological signs. Routine lumbar puncture in children with simple CF must be discouraged. The current state of pneumococcal infections in Colombia after implementation of immunization 10 serotypes vaccine must be assessed, in order to know the effect of vaccination status on the risk of meningitis in children with FS.


PDF (Español)
HTML (Español)

References

HAUSER WA. The prevalence and incidence of convulsive disorders in children. Epilepsia. 1994; 35:S1-S6.

VERITY CM, BUTLER NR, GOLDING J. Febrile convulsions in a national cohort followed up from birth. I--Prevalence and recurrence in the first five years of life. Br Med J (Clin Res Ed). 1985; 290:1307-10.

Febrile Seizures. The National Institute of Health. Consensus Development Conference Statement. NIH. 1980; 3:1-10.

Guidelines for the management of convulsions with fever. Joint Working Group of the Research Unit of the Royal College of Physicians and the British Paediatric Association. BMJ. 1991; 303:634-6.

NELSON KB, ELLENBERG JH. Predictors of epilepsy in children who have experienced febrile seizures. N Engl J Med. 1976; 295:1029-33.

Practice parameter: the neurodiagnostic evaluation of the child with a first simple febrile seizure. American Academy of Pediatrics. Provisional Committee on Quality Improvement, Subcommittee on Febrile Seizures. Pediatrics. 1996; 97:769-72.

GERBER MA, BERLINER BC. The child with a 'simple' febrile seizure. Appropriate diagnostic evaluation. Am J Dis Child. 1981;135:431-3.

RUTTER N, SMALES OR. Role of routine investigations in children presenting with their first febrile convulsion. Arch Dis Child. 1977; 52:188-91.

TRAINOR JL, HAMPERS LC, KRUG SE, LISTERNICK R. Children with first-time simple febrile seizures are at low risk of serious bacterial illness. Acad Emerg Med. 2001; 8:781-7.

TEACH SJ, GEIL PA. Incidence of bacteremia, urinary tract infections, and unsuspected bacterial meningitis in children with febrile seizures. Pediatr Emerg Care. 1999; 15:9-12.

CHAMBERLAIN JM, GORMAN RL. Occult bacteremia in children with simple febrile seizures. Am J Dis Child. 1988; 142:1073-6.

GREEN SM, ROTHROCK SG, CLEM KJ, ZURCHER RF, MELLICK L. Can seizures be the sole manifestation of meningitis in febrile children? Pediatrics 1993; 92:527-34.

KIMIA AA, CAPRARO AJ, HUMMEL D, JOHN-STON P, HARPER MB. Utility of lumbar puncture for first simple febrile seizure among children 6 to 18 months of age. Pediatrics. 2009; 123:6-12.

Subcommittee on Febrile Seizures; American Academy of Pediatrics. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011; 127:389-94.

Guidelines for epidemiologic studies on epilepsy. Commission on Epidemiology and Prognosis, International League Against Epilepsy. Epilepsia. 1993; 34:592-6.

KLEIN JO, FEIGIN RD, MCCRACKEN GHJR. Report of the Task Force on Diagnosis and Management of Meningitis. Pediatrics. 1986; 78:959-82.

NEUMAN MI, TOLFORD S, HARPER MB. Test characteristics and interpretation of cerebrospinal fluid gram stain in children. Pediatr Infect Dis J. 2008; 27:309-13.

WEARS RL, LUTEN RC, LYONS RG. Which laboratory tests should be performed on children with apparent febrile convulsions? An analysis and review of the literature. Pediatr Emerg Care. 1986; 2:191-6.

JOFFE A, MCCORMICK M, DEAnGELIS C. Which children with febrile seizures need lumbar puncture? A decision analysis approach. Am J Dis Child. 1983; 137:1153-6.

JAFFE M, BAR-JOSEPH G, TIROSH E. Fever and convulsions--indications for laboratory investigations. Pediatrics. 1981; 67:729-31.

CARROLL W, BROOKFIELD D. Lumbar puncture following febrile convulsion. Arch Dis Child. 2002; 87:238-40.

AKPEDE GO, SYKES RM. Convulsions with fever as a presenting feature of bacterial meningitis among preschool children in developing countries. Dev Med Child Neurol. 1992; 34:524-9.

BATRA P, GUPTA S, GOMBER S, SAHA A. Predictors of meningitis in children presenting with first febrile seizures. Pediatr Neurol. 2011; 44:35-9.

GHOTBI F, SHIVA F. An assessment of the necessity of lumbar puncture in children with seizure and fever. J Pak Med Assoc. 2009; 59:292-5.

NAJAF-ZADEH A, DUBOS, HUE V, PRUVOST I, BENNOUR A, MARTINOT A. Risk of Bacterial Meningitis in Young Children with a First Seizure in the Context of Fever: A Systematic Review and Meta-Analysis. PLoS oNE 8 (1): e55270. doi:10.1371/ journal.pone.0055270.

JOSHI BR, RAYAMAJHI A, MAHASETH C. Children with first episode of fever with seizure: is lumbar puncture necessary? J Nepal Med Assoc. 2008; 47:109-12.

LAMAN M, MANNING L, HWAIWHANGE I, VINCE J, AIPIT S, MARE T, ET AL. Lumbar puncture in children from an area of malaria endemicity who present with a febrile seizure. Clin Infect Dis. 2010; 51:534-40.

OWUSU-OFORI A, AGBEYEGA T, ANSONG A, SCHELD WM. Routine lunbar puncture in children with febril seizures in Ghana: Shoul it continue?. Int J Infect Dis. 2004; 8:353-61.

ADLER-SHOHET FC, CHEUNG MM, HILL M, LIEBERMAN JM. Aseptic meningitis in infants younger than six months of age hospitalized with urinary tract infections. Pediatr Infect Dis J. 2003; 22:1039-42.

SYROGIANNOPOULOS GA, GRIVEA IN, ANASTASSIOU ED, TRIGA MG, DIMITRACOPOU-LOS GO, BERATIS NG. Sterile cerebrospinal fluid pleocytosis in young infants with urinary tract infection. Pediatr Infect Dis J. 2001; 20:927-30.

YAM AO, ANDRESEN D, KESSON AM, ISAACS D. Incidence of sterile cerebrospinal fluid pleocytosis in infants with urinary tract infection. J Paediatr Child Health. 2009; 45:364-7.

ROSMAN NP. Evaluation of the child who convulses with fever. Paediatr Drugs. 2003; 5:457-61.

BERG AT, SHINNAR S, SHAPIRO ED, SALOMON ME, CRAIN EF, HAUSER WA. Risk factors for a first febrile seizure: a matched case-control study. Epilepsia. 1995; 36:334-41.

AGUDELO CI, SANABRIA OM, OVALLE MV, MORENO J, CASTAÑEDA E. Vigilancia de los serotipos y susceptibilidad a la penicilina de aislamientos invasores de Streptococcus pneumoniae de niños menores de 6 años. Actualización de datos 2004. Instituto Nacional de Salud, Subdirección de vigilancia y control en salud pública; 2005.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Downloads

Download data is not yet available.