Abstract
Febrile seizures (FS) affect up to 5% of children. The pathogen etiology in regard of viral loads has never been investigated. In a prospective cohort study we investigated the correlation between virus type and quantity in nasopharyngeal aspirates (NPAs) and the clinical characteristics in pediatric patients with a FS. From January 2014 to April 2016, 184 children with a FS were prospectively enrolled. The mean age of all included children was 26.7 ± 18.3 months with a male to female ratio of 1.4:1. Males with an acute disease and a short duration or absence of prior symptoms had a higher risk for complex FS. The majority of patients with FS presented with a generalized convulsion (180; 98%) and was admitted to hospital (178; 97%). Overall, 79 (43%) single and in 59 (32%) co-infections were detected. Human herpes virus 6 (HHV6), influenza, adenovirus (AV) and rhinovirus (RV) were the dominant pathogens, all detected with clinically significant high viral loads. HHV6 positive cases were significantly younger and less likely to have a positive family/personal history for FS. Influenza positives showed a higher rate of complex seizures, lower leukocyte and higher monocyte counts. AV positive cases were more likely to have a positive family history for FS and showed higher C-reactive protein values. In conclusion, a high viral load may contribute to the development of a FS in respiratory tract infections.
Highlights
Between 6 months and 5 years, febrile seizures (FS) affect 2–5% and are the most common neurologic disorder in children in Western Europe and North America [1]
12/33 males with complex FS and 1/7 females with complex FS had “symptoms before seizure”. This indicates that a short duration or absence of prior symptoms had a higher risk for complex FS
The main aim of this prospective study was to determine the dominant pathogens in children with FS and assess their viral loads
Summary
Between 6 months and 5 years, febrile seizures (FS) affect 2–5% and are the most common neurologic disorder in children in Western Europe and North America [1]. The known risk factors include fever, familiar predisposition and infections [2]. Children with febrile seizures frequently present as fever of unknown origin (FUO). A broad differential diagnosis needs to be considered. The most common cause of FUOs are infections with 37% to 59.3% depending on geographic, climatic, zoonotic and social factors. Non-infectious inflammatory diseases such as rheuma are the second differential diagnosis of FUO with around 14%, whereas malignancies are a rare but important cause of FUO [3,4,5]. FDG-PET/CT in children with FUO has gained in importance [6]
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