A Hospital Based, Cross-Sectional Study to Determine the Prevalence of Meningitis in 6-18 months Old Children with First Episode of Febrile Seizure
Authors/Creators
- 1. Assistant Professor, Department of Pediatrics, Tripura Medical College and Dr. BRAM Teaching Hospital, Hapania, Agartala, Tripura, India.
- 2. Professor, Department of Pediatrics, Tripura Medical College and Dr. BRAM Teaching Hospital, Hapania, Agartala, Tripura, India.
Description
Introduction: In spite of the fact that there are epidemiological differences between India and the United States, the AAP 2010 guiding principles are adhered to perform Lumbar Puncture in the first occurrence of febrile seizures, having incidence of 2-5% in >1month old children and most frequently between 6 months to 5 years old children. Aim and Objectives: To determine the prevalence and risk factors for meningitis for the first incidence of febrile seizures among children between the ages of 6 and 18 months. Materials and Methods: In a tertiary care centre in northeastern India, 200 children between the ages of 6 and 18 months who had been admitted with their first episode of FS underwent this cross-sectional research. The lumbar puncture was carried out, and clinical, blood, CSF variables were analyzed by the SPSS version 21.0. Results: Children aged 6 to 18 months who presented with the initial episode of FS had a meningitis prevalence of 16% (n=32). In 3% (n=6) of patients, bacterial meningitis (BM) was seen. Higher Total Leukocyte Count (TLC) i.e. >16500 cells/mm3 with positive C – reactive protein (CRP) were the independent predictors of meningitis. Seven patients (3 of S. pneumoniae, 2 of MRSA, 1 each of K. pneumoniae, and N. meningitidis) had positive blood cultures. In 56.2% (n=18) among the meningitis cases, monocytes were the most prevalent kind of cell to be found. Conclusion: Given that meningitis is more common in kids with initial episodes of FS in India as compared to the USA and that India has a much lower immunization rate for the Haemophilus (Hib) & pneumococcal vaccine (PCV) than the USA; India have to develop its own criteria to perform lumbar puncture in instances with initial occurrence of FS. In patients who have elevated TLC (>16500 cells/mm3) and positive CRP, meningitis might be anticipated.
Abstract (English)
Introduction: In spite of the fact that there are epidemiological differences between India and the United States, the AAP 2010 guiding principles are adhered to perform Lumbar Puncture in the first occurrence of febrile seizures, having incidence of 2-5% in >1month old children and most frequently between 6 months to 5 years old children. Aim and Objectives: To determine the prevalence and risk factors for meningitis for the first incidence of febrile seizures among children between the ages of 6 and 18 months. Materials and Methods: In a tertiary care centre in northeastern India, 200 children between the ages of 6 and 18 months who had been admitted with their first episode of FS underwent this cross-sectional research. The lumbar puncture was carried out, and clinical, blood, CSF variables were analyzed by the SPSS version 21.0. Results: Children aged 6 to 18 months who presented with the initial episode of FS had a meningitis prevalence of 16% (n=32). In 3% (n=6) of patients, bacterial meningitis (BM) was seen. Higher Total Leukocyte Count (TLC) i.e. >16500 cells/mm3 with positive C – reactive protein (CRP) were the independent predictors of meningitis. Seven patients (3 of S. pneumoniae, 2 of MRSA, 1 each of K. pneumoniae, and N. meningitidis) had positive blood cultures. In 56.2% (n=18) among the meningitis cases, monocytes were the most prevalent kind of cell to be found. Conclusion: Given that meningitis is more common in kids with initial episodes of FS in India as compared to the USA and that India has a much lower immunization rate for the Haemophilus (Hib) & pneumococcal vaccine (PCV) than the USA; India have to develop its own criteria to perform lumbar puncture in instances with initial occurrence of FS. In patients who have elevated TLC (>16500 cells/mm3) and positive CRP, meningitis might be anticipated.
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IJTPR,Vol13,Issue4,Article31.pdf
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Additional details
Dates
- Accepted
-
2023-04-08
Software
References
- 1. Kimia A, Ben-Joseph EP, Rudloe T, Capraro A, Sarco D, Hummel D, et al. Yield of lumbar puncture among children who present with their first complex febrile seizure. Pediatrics. 2010; 126:62- 69. 2. Horn J, Medwid K. The low rate of bacterial meningitis in children, ages 6 to 18 months, with simple febrile seizures. Acad Emerg Med. 2011; 18:1114-20. 3. Fetveit A. Assessment of febrile seizures in children. Eur J Paediatr.1998;167:17- 27. 4. Subcommittee on Febrile Seizures. Febrile seizures: Guidelines for the neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011; 127:389-94. 5. Rosman NP. Evaluation of the child who convulses with fever. Paediatr Drugs.2003;5:457-61. 6. Najaf-Zadeh A, Dubos F, 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. 2013;8. 7. Reddy DS, Khan H, Hegde P. Predictors of meningitis in children presenting with first episode of febrile seizure. Int J Contemp Paediatr. 2017; 4:136-39. 8. Prober C, Srinivas N, Mathew R. Central Nervous System Infections. In: Klegman R, Stanton B, St. Geme JW, Schor NF, Behrman RE, eds. Nelson textbook of paediatrics 20th ed.Philadelphia: Elsevier; 2016.Pp.2937-8. 9. WHO and UNICEF estimates of immunization coverage: 2016 revision [Internet] available from http://www.who.int/immunisation/monit oring_surveillance/data/ind.pdf. 10. CDC Certified [Internet] Coverage of PCV vaccine in USA.inc.; available from :https://www.cdc.gov/nchs/fastats/immu nise. 11. Amber R. AAP updates guidelines for evaluating simple febrile seizures in children. Am Fam Physician. 2011; 83:1348-50. 12. Tavasoli A, Afsharkhas L, Edraki A. Frequency of meningitis in children presenting with febrile seizure at Ali Asghar Hospital. Iran J child Neurol. 2014; 8:51-56. 13. Prober C, Srinivas N, Mathew R. Central Nervous System Infections. In: Klegman R, Stanton B, St. Geme JW, Schor NF, Behrman RE, eds. Nelson textbook of paediatrics 20th ed. Philadelphia: Elsevier; 2016. Pp.2929-30. 14. Casasoprana A, Hachon Le, Camus C, Claudet I, Grouteau E, Chaix Y, et al. Value of lumbar puncture after a first febrile seizure in children aged less than 18 months. A retrospective study of 157 cases. Arch Paediatr. 2013; 12:455-67. 15. Tinsa F, Gharbi A, Ncibi N, Bouguerra C, Aissia W, Zouari B, et al. Role of lumbar puncture for febrile seizure among infants under one year old. La Tunsie Medicale. 2010; 88:178-83. 16. Kanik A, Eliacik K, Yesiloglu S, Anil M, Ciftdogan DY, Karadas U. The possibility of bacterial meningitis in first simple or complex febrile seizures among children 6-24 months of age: an evaluation of 564 patient. HK J Paediatr. 2016; 21:156-61. 17. Siddiqui HB, Haider N, Khan Z. Frequency of acute bacterial meningitis in children with first episode of febrile seizures. JPMA. 2017; 8:1054-58. 18. Shrestha SK. Role of CSF analysis for the first episode of febrile seizure among children between six months to five years of age. J Nepal Paed Soc. 2010; 30:90-93.