Predictors of meningitis in 6 months to 6 years children presenting with first episode of seizure with fever

Rohit Chib; Manju Devi

Volume : VIII, Issue : IV, April - 2019

Predictors of meningitis in 6 months to 6 years children presenting with first episode of seizure with fever

Rohit Chib, Manju Devi

Abstract :

BACKGROUND: Feile seizures are seizures that occur in conjugation with high fever. Feile seizures are classified as simple or complex. Simple feile seizures are generalized, last less than 15 minutes, and do not recur within 24 hours. All others are considered complex seizure. 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: Prospective study done at Department of pediatrics SGGIM&HS, Patel Nagar, Dehradun, Uttrakhand between 1st January 2015 to 30th june 2016 for a duration of 18 months. All children between 6 months to 6 years of age having first episode of convulsions, associated with fever were included into the study. RESULTS: During study time total of 146 patients of seizure with fever between 6month to 6years of life reported to hospital, only 96 patients fulfilled the inclusion criteria of first episode of seizure with fever into our study. 58 children had simple feile seizures (SFS) and 38 children presented as atypical feile seizures (AFS). Lumbar puncture was performed in 62 children (24 with SFS and 38 with AFS). The CSF analysis was normal in all the children who presented as simple feile seizures. There was 34.2% prevalence of meningitis in children with atypical feile seizures who underwent lumbar puncture. CONCLUSION Prevalence of bacterial meningitis in children between 6months to 6year of life, having first episode of seizure with fever who underwent LP was 21%, which is quite high. Complex nature of seizures shows higher association with meningitis (34.2%). Meningeal signs, gender, duration of seizure, post ictal drowsiness, white blood cell count and CRP does not predict meningitis especially in young infants and pre-treatment with antibiotics can mask the signs of meningeal irritation. Hence we suggest that LP should be done in all cases who, present with first episode of complex feile seizures and especially those treated with prior antibiotics.