Diagnostic value of lumbar puncture among infants and children presenting with fever and convulsions
Keywords:
cerebrospinal fluid, meningitis, encephalitis, lumbar punctureAbstract
Introduction: Central nervous system (CNS) infections can be categorized according to the nature of the infectious pathogen into viral, bacterial, protozoan, or fungal. The diagnosis of diffuse CNS infections depends on examination of cerebrospinal fluid (CSF) obtained by lumbar puncture (LP). The aim of this work was to determine the diagnostic value of CSF analysis in infants and children presenting with fever and convulsions.
Methods: Detailed clinical data of infants and children included in this study were collected with special reference to the course and duration of the illness, description of the convulsions, consciousness level, signs of increased intracranial pressure, and signs of meningeal irritation. Lumbar puncture and chemical and bacteriological analyses of the obtained cerebrospinal fluid were done for all of the children.
Results: The total number of children included in the study was 85, they had a median age 19 months, and 88% of them had generalized convulsions. CSF examination revealed that 20% had abnormal physical findings, while 23.5% had abnormal white blood cell count (WBC) (CSF Pleocytosis). CSF cultures were done in three cases with the highest White blood cells (WBCs), and streptococcus pneumoniae was present in all three cases.
Conclusion: This study found that CNS infections are not uncommon in infants and children presenting with fever and convulsions in our locality, and acute bacterial meningitis cannot be excluded. However, its presence in the absence of clinical symptoms and signs of meningeal irritation is a remote possibility, but it should always be considered.
References
Sahu RN, Kumar R, Mahapatra AK. Central nervous system infection in the pediatric population. J Pediatr
Neurosci. 2009; 4(1): 20-4. doi: 10.4103/1817-1745.49102. PMID: 21887170, PMCID: PMC3162832.
Thomson RB Jr, Bertram H. Laboratory diagnosis of central nervous system infections. Infect Dis Clin
North Am. 2001; 15(4): 1047-71. doi: 10.1016/S0891-5520(05)70186-0. PMID: 11780267.
Dawson KG, Emerson JC, Burns JL. Fifteen years of experience with bacterial meningitis. Pediatr Infect
Dis J. 1999; 18(9): 816–22. doi: 10.1097/00006454-199909000-00014. PMID: 10493344.
Centers for Disease Control and Prevention (CDC). Progress toward eliminating Haemophilus influenza
type b disease among infants and children—United States, 1998–2000. Morb Mortal Wkly Rep. 2002;
(11): 234-7. PMID: 11925021.
El Bashir H, Laundy M, Booy R. Diagnosis and treatment of bacterial meningitis. Arch Dis Child. 2003;
(7): 615– 20. doi: 10.1136/adc.88.7.615. PMID: 12818910, PMCID: PMC1763168.
Freedman SB, Marrocco A, Pirie J, Dick PT. Predictors of bacterial meningitis in the era after Haemophilus
influenzae. Arch Pediatr Adolesc Med. 2001; 155(12): 1301–6. doi: 10.1001/archpedi.155.12.1301. PMID:
Llorens SX, McCracken GH Jr. Bacterial meningitis in children. Lancet. 2003; 361(9375): 2139-48. doi:
1016/S0140-6736(03)13693-8.
Sturgis CD, Peterson LR, Warren JR. Cerebrospinal fluid broth culture isolates: their significance for
antibiotic treatment. Am J Clin Pathol. 1997; 108(2): 217–21. doi: 10.1093/ajcp/108.2.217. PMID:
Solomon T, Hart IJ, Beeching NJ. Viral encephalitis: a clinician’s guide. Pract Neurol. 2007; 7(5): 288–
doi: 10.1136/jnnp.2007.129098. PMID: 17885268.
Olofsson IA, Skov L, Miranda MJ. (Acute disseminated encephalomyelitis is an important differential
diagnosis in the acutely affected child). Ugeskr Laeger. 2015; 177(29).
Kneen R, Solomon T, Appleton R. The role of lumbar puncture in children with suspected central nervous
system infection. BMC Pediatr. 2002; 2: 8. doi: 10.1186/1471-2431-2-8. PMID: 12350236, PMCID:
PMC126268.
Chataway J, Davies NW, Farmer S, Howard RS, Thompson EJ, Ward KN. Herpes simplex encephalitis: an
audit of the use of laboratory diagnostic tests. QJM. 2004; 97(6): 325–30. doi: 10.1093/qjmed/hch058.
PMID: 15152105.
Maschke M, Kastrup O, Forsting M, Diener HC. Update on neuroimaging in infectious central nervous
system disease. Curr Opin Neurol. 2004; 17(4): 475-80. doi: 10.1097/01.wco.0000137540.29857.bf. PMID:
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(1): 62-9. doi:
1542/peds.2009-2741. PMID: 20566610.
Kimia AA, Capraro AJ, Hummel D, Johnston P, Harper MB. Utility of lumbar puncture for first simple
febrile seizure among children 6 to 18 months of age. Pediatrics. 2009; 123(1): 6-12. doi:
1542/peds.2007-3424. PMID: 19117854.
Ghotbi F, Shiva F. An assessment of the necessity of lumbar puncture in children with seizure and fever. J
Pak Med Assoc. 2009; 59(5): 292-5. PMID: 19438132.
Fletcher EM, Sharieff G. Necessity of lumbar puncture in patients presenting with new onset complex
febrile seizures. West J Emerg Med. 2013; 14(3): 206-11. doi: 10.5811/westjem.2012.8.12872. PMID:
, PMCID: PMC3656699.
Akpede GO, Sykes RM. Convulsions with fever as a presenting feature of bacterial meningitis among
preschool children in developing countries. Dev Med Child Neurol. 1992; 34(6): 524-9. doi:
1111/j.1469-8749.1992.tb11473.x. PMID: 1612211.
Joshi Batajoo R, Rayamaihi A, Mahaseth C. Children with first episode of fever with seizure: is lumbar
puncture necessary? Nepal Med Assoc. 2008; 47(171): 109-12. PMID: 19079373.
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