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Do All Children Who Present With a Complex Febrile Seizure Need a Lumbar Puncture?
Romain Guedj1, Hélène Chappuy2, Luigi Titomanlio3
1Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France; Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Pierre and Marie Curie Medical School, Pierre and Marie Curie University, Paris, France.
Insights
Bacterial meningitis and herpes simplex virus meningoencephalitis (HSV-ME) are rare in children with complex febrile seizures. These infections are unexpected when the clinical exam is not suggestive of meningitis or encephalitis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Complex febrile seizures in children can be concerning for serious central nervous system infections.
- Differentiating simple febrile seizures from more severe conditions like meningitis or encephalitis is crucial for appropriate management.
Purpose of the Study:
- To determine the prevalence of bacterial meningitis and herpes simplex virus meningoencephalitis (HSV-ME) in children presenting with complex febrile seizures.
- To specifically assess the prevalence of these infections in a subgroup with clinical examinations not suggestive of meningitis or encephalitis.
Main Methods:
- A multicenter retrospective study analyzed data from 7 pediatric emergency departments in Paris, France.
- Patients aged 6 months to 5 years with complex febrile seizures between 2007 and 2011 were included.
- Bacterial meningitis and HSV-ME were identified through clinical data, hospital visits, and parental follow-up.
Main Results:
- Out of 839 patients with complex febrile seizures, 5 cases (0.7%) of bacterial meningitis were identified; no cases of HSV-ME were found.
- In the subgroup of 630 children with clinical examinations not suggestive of meningitis or encephalitis, no cases of bacterial meningitis or HSV-ME were detected.
Conclusions:
- Bacterial meningitis and HSV-ME are infrequent occurrences in children with complex febrile seizures.
- When clinical examination following a complex febrile seizure does not suggest meningitis or encephalitis, the likelihood of these infections is very low.
Study Objective:
We assess the prevalences of bacterial meningitis and herpes simplex virus meningoencephalitis (HSV-ME) in children with a complex febrile seizure and determine these prevalences in the subgroup of children with a clinical examination result not suggestive of meningitis or encephalitis.
Methods:
This multicenter retrospective study was conducted in 7 pediatric emergency departments (EDs) in the region of Paris, France. Visits of patients aged 6 months to 5 years for a complex febrile seizure from January 2007 to December 2011 were analyzed. We defined a subgroup of patients whose clinical examination result was not suggestive of meningitis or encephalitis. Bacterial meningitis and HSV-ME were sequentially sought for by analyzing bacteriologic and viral data at the visit, looking for data from a second visit to the hospital after the index visit, and telephoning the child's parents.
Results:
From a total of 1,183,487 visits in the 7 pediatric EDs, 839 patients presented for a complex febrile seizure, of whom 260 (31.0%) had a lumbar puncture. The outcomes bacterial meningitis and HSV-ME were ascertainable for 715 (85%) and 657 (78.3%) visits, respectively, and we found 5 cases of bacterial meningitis (0.7% [95% confidence interval [CI] 0.2% to 1.6%]) and no HSV-ME (0% [95% CI 0% to 0.6%]). Among the 630 visits of children with a clinical examination result not suggesting meningitis or encephalitis, we found no bacterial meningitis (0% [95% CI 0% to 0.7%]) and no HSV-ME (0% [95% CI 0% to 0.8%]).
Conclusion:
In children with a complex febrile seizure, bacterial meningitis and HSV-ME are unexpected events when the clinical examination after complex febrile seizure is not suggestive of meningitis or encephalitis.
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