Routine lumbar puncture in children with febrile seizures in Ghana: should it continue?

Abstract

Objectives:Performing routine lumbar punctures in children with febrile seizures has been controversial. This study aimed to determine the positive yield of lumbar punctures in a setting where routine lumbar puncture is routinely carried out and to determine if any other parameter could help differentiate bacterial meningitis from the various other diagnoses of children who presented with a febrile seizure.Design:A prospective study was carried out among children aged three months to 15 years of age, hospitalized at the Komfo Anokye Teaching Hospital in Kumasi, Ghana, between July and August 2000.Results:There was a 10.2% (n = 19) positive yield for bacterial meningitis with a case fatality rate of 36.8% (n = 7). Cerebral malaria, which is not easily distinguishable from bacterial meningitis, accounted for 16.1% (n = 30) of the children. Twenty percent of bacterial meningitis patients had a positive blood smear for malaria. The indication for doing a lumbar puncture was similar in both cerebral malaria and bacterial meningitis patients. Signs of meningism were not the primary reason for carrying out a lumbar puncture, even in the group of children who had bacterial meningitis.Conclusion:Performing routine lumbar punctures may still have a role to play in the management of children with febrile seizures. Performing routine lumbar punctures in children with febrile seizures has been controversial. This study aimed to determine the positive yield of lumbar punctures in a setting where routine lumbar puncture is routinely carried out and to determine if any other parameter could help differentiate bacterial meningitis from the various other diagnoses of children who presented with a febrile seizure. A prospective study was carried out among children aged three months to 15 years of age, hospitalized at the Komfo Anokye Teaching Hospital in Kumasi, Ghana, between July and August 2000. There was a 10.2% (n = 19) positive yield for bacterial meningitis with a case fatality rate of 36.8% (n = 7). Cerebral malaria, which is not easily distinguishable from bacterial meningitis, accounted for 16.1% (n = 30) of the children. Twenty percent of bacterial meningitis patients had a positive blood smear for malaria. The indication for doing a lumbar puncture was similar in both cerebral malaria and bacterial meningitis patients. Signs of meningism were not the primary reason for carrying out a lumbar puncture, even in the group of children who had bacterial meningitis. Performing routine lumbar punctures may still have a role to play in the management of children with febrile seizures.