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Presenting features of bacterial meningitis in young infants
G O Akpede1, P O Abiodun, J P Ambe
1Department of Paediatrics, University of Maiduguri, Benin City, Nigeria.
Insights
Fever and seizures in young infants strongly suggest bacterial meningitis (BM). A lumbar puncture (LP) is crucial for diagnosing BM in febrile infants with seizures, especially when other symptoms are absent.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Acutely ill, febrile young infants require clearer management guidelines.
- Bacterial meningitis (BM) is a serious concern in this population.
Purpose of the Study:
- To evaluate the association between seizures and fever and the diagnosis of bacterial meningitis in young infants.
- To determine the diagnostic utility of lumbar puncture in febrile infants.
Main Methods:
- Retrospective analysis of 94 young infants undergoing lumbar puncture (LP).
- Comparison of clinical presentation between infants with and without bacterial meningitis.
- Assessment of presenting signs and symptoms, including seizures, fever, and bulging fontanelle.
Main Results:
- Bacterial meningitis was diagnosed in 43.3% of febrile infants with seizures versus 17.7% without seizures (RR 2.46, p=0.012).
- A bulging fontanelle and focal seizures were key indicators, but their absence did not rule out BM.
- Co-existing acute respiratory infections and malaria were noted in infants with BM.
Conclusions:
- Seizures with fever are a significant indicator of bacterial meningitis in young infants.
- Screening lumbar puncture is recommended for febrile infants presenting with seizures to rule out BM, barring contraindications.
Abstract:
More guidance is required in the management of acutely ill, febrile young infants. Of 94 young infants undergoing lumbar puncture (LP) as part of their management, 26 of the 60 (43.3%) presenting with seizures and fever and six of the 34 (17.7%) without seizures had bacterial meningitis (BM) (relative risk (95% confidence interval) = 2.46 (1.12, 5.37), p = 0.012). Except for the presence of a bulging fontanelle and focal seizures, no other presenting signs or symptoms were significantly associated with BM; seven of the 26 infants with BM who presented with seizures and two of the six without seizures lacked a bulging fontanelle. Overall, the ratio of BM to other illnesses was 1:1.94; of those with BM, 13 of the 32 (40.6%) had co-existing acute respiratory infections and four of the 32 (12.5%) had asexual malaria parasitaemia. Seizures with fever are an important presenting feature of BM in young infants and a screening LP should be considered mandatory to confirm or exclude BM in febrile young infants with seizures, unless certain contraindications apply.