Clinical features and predictive factors of recurrent fever observed during the treatment of bacterial meningitis in children

Abstract

Recurrent fever often occurs during the treatment of bacterial meningitis in children. Few studies have focused on the difference between the patients with and without recurrent fever. The pathogenesis and clinical significance of recurrent fever remain to be elucidated. The objectives of this study were to clarify the clinical features of the patients with recurrent fever, and to identify the predictive factors for recurrent fever in childhood bacterial meningitis. We conducted a hospital-based retrospective chart review and confirmed 52 cases of bacterial meningitis. Recurrent fever was observed in 27 of 52 (52%) patients overall, and 27 of 47 (57%) patients with dexamethasone (DEX) therapy. All patients with recurrent fever received DEX therapy. The mean date of recurrent fever occurrence was 6.2 +/- 2.0 days after admission. The median duration of recurrent fever was 5 days (range 1-19 days). The proportion of patients < 2 years of age was higher in patients with recurrent fever than those without recurrent fever (p = 0.041). Initial peripheral white blood cell count was lower in patients with recurrent fever (p = 0.008). Of the 52 children, 10 (19%) showed neurological sequelae. Neurological sequelae were more frequent in patients with recurrent fever than those without recurrent fever, although this was not statistically significant (p = 0.078). Univariate and multivariate logistic regression analysis showed that the most powerful predictive factor for recurrent fever in patients with DEX therapy was young age (< 2 years) (adjusted odds ratio, 5.1; 95% confidence interval, 1.3-20.7). These results suggest that recurrent fever is related to the two known factors for sequelae, low peripheral white blood cell count and young age. Recurrent fever should be recognized as a possible risk factor for neurological sequelae.