Probability Of Meningitis Research Articles

Use of Lumbar Puncture for First Episode of Febrile Seizure among Children 6 Months to 18 Months of Age: A Cross Sectional Study

Introduction: Febrile seizure accounts for the majority cases of the pediatric seizure. Fever with seizure can be either due to febrile seizure or underlying serious infection as meningitis. As seizure may be the only manifestation of meningitis it is important to rule out meningitis in children presenting with fever and seizure.Objective: The objective of this study was to determine the incidence of meningitis among children aged 6 to 18 months presenting with first episode of febrile seizure.Methodology: A prospective observational study was conducted among 94 children with first episode of febrile seizure presenting to the emergency and observation wards of Kanti Childrens' Hospital and subjected to lumbar puncture (LP) as per the American Academy of Pediatrics (AAP) recommendations. The proportion of children with meningitis and no meningitis among the study population was determined, clinical characteristics were compared among these groups and the incidence of meningitis in simple febrile seizure and complex febrile seizure was calculated. The collected data was analysed using SPSS.Results: Twenty (21.3%) cases were diagnosed with meningitis among 94 children enrolled in our study. Meningitis was detected in 38.1% of the cases of complex febrile seizure and 7.7% of cases of simple febrile seizure. In the age group 6 to 12 months, 11 (17.4%) had meningitis while in 12 to 18 months of age, 9 (29%) were detected with meningitis. Meningitis was 7.38 times more likely in cases presenting with complex febrile seizure than simple febrile seizure (OR=7.58; 95% CI 2.24-24.4; p<0.001). Regarding the clinical characteristics, vomiting, fever of more than 48 hours duration prior to onset of seizure, impaired consciousness and complex features of seizure were found to be significantly associated with meningitis in our study.Conclusion: The probability of meningitis among children aged 6 to 18 months presenting with first episode of febrile seizure episode is high. In febrile convulsing children less than 18 months of age, meningitis should be considered even in the absence of signs of meningeal irritation. BJHS 2018;3(2)6:399-402.

Lumbar puncture in suspected neonatal sepsis

The importance of lumbar puncture (LP) as part of the evaluation of suspected neonatal sepsis is assessed, as it may be the only positive diagnostic test in about 10% of septic babies with meningitis but negative blood cultures. However, LP may compromise respiratory function, and the interpretation of cerebrospinal fluid (CSF) may not be straightforward. The clinical setting and the probability of meningitis are important determinants of the likely value of LP. For asymptomatic neonates with obstetric risk factors for sepsis, and for babies with early-onset respiratory distress alone, LP may be delayed and only performed later if blood cultures are positive. This is because hundreds of LP will be needed to diagnose a single case. However, infants with suspected late-onset sepsis should have an immediate LP because finding Gram-negative bacilli or fungi in the CSF will affect treatment choices.

Meningitis in premature infants with respiratory distress: Role of admission lumbar puncture

tress may be the only sign of sepsis, we would prefer to see more data on the yield of CSF examination in infants with respiratory distress before CSF examination is completely discarded, although a selective or delayed approach may be appropriate. Infants with bacteremia who are symptom free may have a sufficient concentration of organisms in the blood to seed the meninges.! ~ Lumbar puncture for sepsis workup of newborn infants currently has a yield of less than 3%. 1, z Therefore it seems appropriate to exclude a group of infants in whom the probability of meningitis is extremely small. In this review we found no cases of meningitis in 284 infants who were symptom free at the time lumbar puncture was performed. Although 284 is not a large number for statistical purposes, it represents only those infants who were examined. The denominator is larger if one includes all symptom-free infants with risk factors who did not undergo lumbar punctures and presumably did not have meningitis. The probability of meningitis in this group is less than 4:1000 and likely to be zero. We conclude that CSF examination is not indicated in the diagnostic evaluation of symptom-free infants born to mothers with chorioamnionitis or other risk factors for neonatal infection.