Background: Febrile seizures are the most common seizure disorder in children of Age 6 months to 60months and it is important to differentiate febrile seizure from meningitis to start appropriate management.AIM- To find out Incidence of Culture Positive Bacterial Meningitis in children of Febrile Seizure. Methods: This was a prospective observational hospital based study conducted at Medical college, Hospital& Research, Tertiary health care Centre in Department of Paediatrics. A total of 55 patients of Febrile Seizure were studied.Informed verbal and written Consent was taken from the parents of the patient or the accompanying person before enrolmentinto the study.Results: In present study shows out 55 Children with febrile seizure, Simple febrile seizures were present in 34 (61.82%)children, complex febrile seizure in 4 (7.27%), meningitis in 17 (30.91%). Out of 17 (30.91%) meningitis cases, 2 cases hadculture positive bacterial meningitis and 15 had culture negative bacterial meningitis. Conclusion: Acute bacterial meningitis (ABM) should always be considered as a differential diagnosis in children betweenage 6 months to 60 months who present's with Febrile Seizure.
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Febrile seizures are the most common type of seizurein children [1]. This may be due to febrile seizures or an ominous condition like meningitis. Seizures are common presentations for which a child may present to pediatricsEmergency Department. It may occur in 10% of children presentation to emergency department[2]. Occurrence of Convulsions due to meningitis fever in children aged 6 to 60 monthsvaries from 0.6% to 6.7% [3]. For children under 12 years of age clinical symptoms are usually absent during the febrile convulsive monthsmeningitis [4].
Febrile seizures, the most common seizure disorderIn childhood, most usually have an excellent prognosis. Cases are benign and self-limiting [5] but may also present a severe underlying acute infectious disease such as sepsis orBacterial meningitis. It is usually a generalized febrile seizure associated with core temperature that rises rapidly≥39 degrees. It is initially generalized and tonic-clonic in nature, lasting a fewseconds and rarely up to 15 minutes. followed by a brief a period of sleep and occursonly once every 24 hour [6,7]. Not intended for use during febrile convulsions.
Children with overt central nervous system infection or underlying seizure disorder[8]. With that in mind, we thought of conducting a study to determine the incidence of bacterial meningitis in children 6 months to 60 months with fever, seizure and evaluation for culture-positive bacterial meningitisand culture negative bacterial meningitis on CSFCulture analysis.
This one was a prospective observational hospital-based study conducted at Medical College, Hospital and Research, TertiaryHealth Care Center in Pediatric Department. Children of a febrile attack occurs between the ages of 6 months to 60 months in hospital was selected for the study. Data was collected from and was analyzed from July 2011 to Oct 2013 and the same periodduration. Informed verbal and written consent was obtained from before the patient's parent or accompanying personenrollment in studies. This study was approved by ethicscommittee.
Fifty (55) children aged 6 months to 60 months presentedwith febrile seizures were selected for the study. Children with other known neurological disorders such as cerebral palsy, history of meningitis with mental retardation, convulsions or ongoing
antibiotic for more than 48 hours before reporting the hospital was excluded from this study.
Children were considered as having fever if axillary temperature recorded atthe emergency is >100.40 F [8]. Children was considered ashaving meningitis if the Kerning's and or Brudzinski's sign waspresent [6,8].Inclusion criteria for this study was childrenhaving fever, mild grade (100.5–102.20 F) to high grade (104.1–106.0 F) with seizure.
Sample size is calculated by formula N=Z2PQ divided by e2 .
Inwhich N: Sample size, Z: Confidence level at 95% (Standardvalue of 1.96), pq: variance of population(0.501) and e:allowable error (5%).
CSF was cultured on specific media: trypticase soy agar,Chocolate Agar with Polyvitex, Columbia Sheep Blood Agarand hemoline operation two-phase aerobic (bottle).
Antibiotics susceptibility test was performed by Kirby-Baughermethod [9]. All creatures that were differentidentified by standard procedures and antibioticsSensitivity testing (AST) was performed according to CLSIguidelines [10]. Data regarding results of A/S is not available herepresent.
Statistical analysis
Statisticalanalysis was done by using descriptive andinferential statistics using z-test for single proportion. Thesoftware used in the analysis were SPSS 17.0 and Graph PadPrism 5.0 and p<0.05 was considered as level of significance.
Distributionof children according to their gender shows that32 (58.18%) of them were males and 23 (41.82%) were femalesrespectively. Mean and SD age of the male children was20.40±14.61 years and that of female children were25.56±16.21 years. Among the total 55 cases, Simple febrileseizures were present in 34 (61.82%) children, Complex febrileseizure in 4 (7.27%), Meningitis in 17 (30.91%).Meningitis were observed to be more in male gender 9(52.94%) as compared to females 8 (47.05%).Out of 17(30.91%) meningitis cases, 2 cases had culture positivebacterial meningitis and 15 had culture negative bacterialmeningitis. CSF culture growth was present in 3.64% of thechildren and absent in 96.36% of the children respectively.*The two organism isolated was Streptococcus pneumoniae.Gram stain of CSF was negative for all the patients.
Amongthe 55 cases, 17 had meningitis showing that almostone third of children presenting in the emergency room withapparent febrile seizure have meningitis. 02 cases had culturepositive meningitis while 15 cases had culture negativemeningitis based on CSF cell count, CSF Protein level andCSF Sugar level.It was observed that in the younger agegroup, there was significant probability of having meningitiswithout signs of meningeal irritation than in older children.Nine children altogether had meningitis without meningealsign.
Inconclusion, it was found that meningitis is a commonclinical diagnosis in the Paediatric emergency department inchildren who come with apparent febrile seizure, thusmeningitis should always be considered as a differentialdiagnosis.
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