Predictors of meningitis in children presenting with first episode of febrile seizure

Abstract

INTRODUCTIONFebrile seizure is the most common cause of seizures in infants and toddlers presenting in the pediatric emergency department. Two to five percent of children experience at least one or more episodes of febrile seizures. 1Febrile seizures are classified into simple and complex febrile seizures. Simple febrile seizures are defined as generalized seizures occurring only once in a 24-hour period and lasting less than 15 minutes. Whereas, complex/atypical febrile seizures are described as focal seizures, lasting more than 15 minutes and occurring more than one time in 24 hours.2 Simple febrile seizures are benign and self-limiting. They have better prognosis and carry very low risk for further epilepsy. Probability of acute bacterial meningitis presenting as fever with seizures varies from 0.6 % to 6.7 %. 2 ABSTRACTBackground: Febrile seizure is the most common cause of seizures in infants and toddlers presenting to the paediatric emergency department. Two to five percent of children experience at least one or more episodes of febrile seizures. Simple febrile seizures are benign and self-limiting. They have good prognosis and carry very low risk for epilepsy. Probability of acute bacterial meningitis presenting as fever with seizures varies from 0.6% to 6.7%. The American Academy of Paediatrics (AAP) strongly recommends lumbar puncture (for CSF analysis) in the work up of every child under 18 months of age with a first episode of febrile seizure to rule out acute bacterial meningitis. The objective of this study was to determine the occurrence of meningitis in children who presented with first episode of seizure and fever and also the predictors of meningitis among them. Methods: The records of children admitted to Father Muller Medical College and Hospital between 1 st January 2014 to 31 st December 2015 were reviewed. All children between 6 months to 6 years of age having first episode of convulsions, associated with fever were included in the study and subjected to retrospective analysis of data collected from the case sheets. Results: Our study included 105 children with febrile seizures, 49 children had simple febrile seizures (SFS) and 56 children presented as atypical febrile seizures (AFS). Lumbar puncture was performed in 43 children (15 with SFS and 28 with AFS). The CSF analysis was normal in all the children who presented as simple febrile seizures. There was 25.87% prevalence of meningitis in children with atypical febrile seizures who underwent lumbar puncture. The CSF yield suggestive of bacterial meningitis was as high as 50% in children below 1 year in whom lumbar puncture was done. Conclusions: Children presenting with Atypical/Complex febrile seizures who were treated with antibiotics have more likelihood of having meningitis rather than those presenting with simple febrile seizures.

Frequency of meningitis in children 6-18 months of age presenting with 1st episode of seizure and fever at Sahiwal Teaching Hospital Sahiwal, Punjab, Pakistan.

“…The prevalence of meningitis reported by a study was almost 25.9%. 7 Another study presented their findings with 9.0% occurring rate. 8 Results of a study indicated that among a group of FS patients 62% went through LP.…”

“…[4][5][6] Among children reported with introductory FS; a study mentioned the occurrence of meningitis as 25.87%. 7 According to another description 9.0% was the incidence rate for the same. 8 In addition to, the incidence of meningitis was found to be 4.5% among children presenting simple FS for the first time.…”

“…Sufficient statistical data is available all over the world which describes the incidence of meningitis among FS presenting children. 6,7 Some of the researchers recommend that if the typical signs of meningitis are not evident, it is needed to do LP in children presenting complex seizures, before starting antibiotics and under 12 months of age or with a history of partial vaccination. 8,9 In the perspective of fever, there are chances for seizures to have an association with bacterial meningitis; it is hard to make a decision for LP in the FS children, more specifically in infants aging https://doi.org/10.29309/TPMJ/2023.30.05.7359 less than 12 months and in which the chances of clinical symptoms of bacterial meningitis are not quite evident.…”

“Frequency of Meningitis in Children Aged 06 Months to 59 Months Presenting with First Episode of Fits with Fever in Pediatric Emergency Department”

“…In 16.7% of children and in one-third of these patients, seizures are the earliest indication of meningitis; nevertheless, meningeal signs and symptoms may not be obvious (12). Other symptoms, such as being sick for a few days, vomiting, drowsiness, petechiae, decreased feeding, or complicated febrile seizures, are frequently present in children under two who have meningitis without meningism (13). Even in young infants, the absence of meningeal symptoms does not rule out meningitis, and pretreatment with antibiotics can conceal the symptoms of meningeal irritation.…”