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. 2005 Jan;90(1):66–69. doi: 10.1136/adc.2003.038844

Meningitis is a common cause of convulsive status epilepticus with fever

R Chin 1, B Neville 1, R Scott 1
PMCID: PMC1720095  PMID: 15613516

Abstract

Aims: In children with convulsive status epilepticus (CSE) with fever, to determine the likelihood of acute bacterial meningitis (ABM), the proportion that are treated with antibiotics, and the proportion that have diagnostic CSF sampling.

Methods: Patients with an incident episode of CSE with fever were identified as part of an ongoing prospective population based study of CSE in childhood.

Results: There were 49 incident cases of CSE in the first six months. Ascertainment was 96%. Twenty four had CSE with fever, 16 had early parenteral antibiotics, nine had diagnostic CSF sampling, and four had ABM. The population risk of ABM in CSE with fever was significantly higher than that of short seizures with fever (17% v 1.2%).

Conclusions: The classical symptoms and signs of ABM may be absent in CSE with fever. A high index of suspicion for ABM in the child with CSE with fever is paramount. The most appropriate management is suggested to be early parenteral antibiotics and a lumbar puncture when there are no contraindications.

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Selected References

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  1. Appleton R., Choonara I., Martland T., Phillips B., Scott R., Whitehouse W. The treatment of convulsive status epilepticus in children. The Status Epilepticus Working Party, Members of the Status Epilepticus Working Party. Arch Dis Child. 2000 Nov;83(5):415–419. doi: 10.1136/adc.83.5.415. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Armon K., Stephenson T., MacFaul R., Hemingway P., Werneke U., Smith S. An evidence and consensus based guideline for the management of a child after a seizure. Emerg Med J. 2003 Jan;20(1):13–20. doi: 10.1136/emj.20.1.13. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Aronin S. I., Peduzzi P., Quagliarello V. J. Community-acquired bacterial meningitis: risk stratification for adverse clinical outcome and effect of antibiotic timing. Ann Intern Med. 1998 Dec 1;129(11):862–869. doi: 10.7326/0003-4819-129-11_part_1-199812010-00004. [DOI] [PubMed] [Google Scholar]
  4. Beaman Miles H., Wesselingh Steven L. 4: Acute community-acquired meningitis and encephalitis. Med J Aust. 2002 Apr 15;176(8):389–396. doi: 10.5694/j.1326-5377.2002.tb04462.x. [DOI] [PubMed] [Google Scholar]
  5. Brenner H. Use and limitations of the capture-recapture method in disease monitoring with two dependent sources. Epidemiology. 1995 Jan;6(1):42–48. doi: 10.1097/00001648-199501000-00009. [DOI] [PubMed] [Google Scholar]
  6. Brogan P. A., Raffles A. The management of fever and petechiae: making sense of rash decisions. Arch Dis Child. 2000 Dec;83(6):506–507. doi: 10.1136/adc.83.6.506. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Carroll W., Brookfield D. Lumbar puncture following febrile convulsion. Arch Dis Child. 2002 Sep;87(3):238–240. doi: 10.1136/adc.87.3.238. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. DODGE P. R., SWARTZ M. N. BACTERIAL MENINGITIS--A REVIEW OF SELECTED ASPECTS. II. SPECIAL NEUROLOGIC PROBLEMS, POSTMENINGITIC COMPLACATIONS AND CLINICOPATHOLOGICAL CORRELATIONS. N Engl J Med. 1965 May 6;272:954–CONTD. doi: 10.1056/NEJM196505062721806. [DOI] [PubMed] [Google Scholar]
  9. Green S. M., Rothrock S. G., Clem K. J., Zurcher R. F., Mellick L. Can seizures be the sole manifestation of meningitis in febrile children? Pediatrics. 1993 Oct;92(4):527–534. [PubMed] [Google Scholar]
  10. Joffe A., McCormick M., DeAngelis C. Which children with febrile seizures need lumbar puncture? A decision analysis approach. Am J Dis Child. 1983 Dec;137(12):1153–1156. doi: 10.1001/archpedi.1983.02140380013005. [DOI] [PubMed] [Google Scholar]
  11. Kneen R., Solomon T., Appleton R. The role of lumbar puncture in suspected CNS infection--a disappearing skill? Arch Dis Child. 2002 Sep;87(3):181–183. doi: 10.1136/adc.87.3.181. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Offringa M., Beishuizen A., Derksen-Lubsen G., Lubsen J. Seizures and fever: can we rule out meningitis on clinical grounds alone? Clin Pediatr (Phila) 1992 Sep;31(9):514–522. doi: 10.1177/000992289203100901. [DOI] [PubMed] [Google Scholar]
  13. Offringa M., Moyer V. A. Evidence based paediatrics: Evidence based management of seizures associated with fever. BMJ. 2001 Nov 10;323(7321):1111–1114. doi: 10.1136/bmj.323.7321.1111. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Pollard A. J., Britto J., Nadel S., DeMunter C., Habibi P., Levin M. Emergency management of meningococcal disease. Arch Dis Child. 1999 Mar;80(3):290–296. doi: 10.1136/adc.80.3.290. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Rahi J. S., Dezateux C., British Congenital Cataract Interest Group Measuring and interpreting the incidence of congenital ocular anomalies: lessons from a national study of congenital cataract in the UK. Invest Ophthalmol Vis Sci. 2001 Jun;42(7):1444–1448. [PubMed] [Google Scholar]
  16. Rennick G., Shann F., de Campo J. Cerebral herniation during bacterial meningitis in children. BMJ. 1993 Apr 10;306(6883):953–955. doi: 10.1136/bmj.306.6883.953. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Riordan F. A. I., Cant A. J. When to do a lumbar puncture. Arch Dis Child. 2002 Sep;87(3):235–237. doi: 10.1136/adc.87.3.235. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Verity C. M., Butler N. R., Golding J. Febrile convulsions in a national cohort followed up from birth. I--Prevalence and recurrence in the first five years of life. Br Med J (Clin Res Ed) 1985 May 4;290(6478):1307–1310. doi: 10.1136/bmj.290.6478.1307. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Welch S. B., Nadel S. Treatment of meningococcal infection. Arch Dis Child. 2003 Jul;88(7):608–614. doi: 10.1136/adc.88.7.608. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Wittes J. T., Colton T., Sidel V. W. Capture-recapture methods for assessing the completeness of case ascertainment when using multiple information sources. J Chronic Dis. 1974 Feb;27(1):25–36. doi: 10.1016/0021-9681(74)90005-8. [DOI] [PubMed] [Google Scholar]
  21. Wylie P. A., Stevens D., Drake W., 3rd, Stuart J., Cartwright K. Epidemiology and clinical management of meningococcal disease in west Gloucestershire: retrospective, population based study. BMJ. 1997 Sep 27;315(7111):774–779. doi: 10.1136/bmj.315.7111.774. [DOI] [PMC free article] [PubMed] [Google Scholar]

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