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Risk for Acute Bacterial Meningitis in Children with Complex Febrile Seizure

Bacterial meningitis is uncommon in children who present with a first complex febrile seizure.

In a retrospective chart review, researchers examined the rate of acute bacterial meningitis (ABM) in 526 otherwise healthy children (age range, 6–60 months) who presented with their first complex febrile seizure (focal seizures, duration >15 minutes, multiple seizures within 24 hours) to a tertiary care pediatric emergency department in Boston between 1995 and 2008.

A total of 156 children (29%) were pretreated with antibiotics. Of 340 patients (65%) who underwent lumbar puncture (LP), 14 (2.7%) had cerebrospinal fluid (CSF) pleocytosis (white blood cell count >7 cells/µL). Three patients (0.9%) were diagnosed with ABM; two had Streptococcus pneumoniae in CSF culture and one, in whom LP was not successful, had S. pneumoniae in blood culture. One patient with ABM was nonresponsive at presentation, another had a bulging fontanelle and nuchal rigidity, and the third patient had two brief generalized seizures within 24 hours. Two patients with ABM presented before the introduction of the conjugate pneumococcal vaccine. Among the 161 (of 186) children who did not undergo LP and returned for follow-up, none had ABM.

Comment: Bacterial meningitis is uncommon in otherwise healthy children with a first complex febrile seizure. The authors concluded that "LP should be performed on the basis of clinical suspicion and additional signs and symptoms that are suggestive of meningitis." However, they do not provide specific suggestions about when to perform LP. The prevalence of acute bacterial meningitis in children who present with a first complex febrile seizure and no other signs and symptoms of meningitis is low. Thus, physicians could consider forgoing LP — after a period of observation — in well-appearing children without overt signs of meningitis whose neurological status returns to baseline.

— Howard Bauchner, MD, and Katherine Bakes, MD

Published in Journal Watch Pediatrics and Adolescent Medicine July 28, 2010

Citation(s):

Kimia A et al. Yield of lumbar puncture among children who present with their first complex febrile seizure. Pediatrics 2010 Jul; 126:62.

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