Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran.
Pediatric Emergency Department, Tehran University of Medical Sciences, Tehran, Iran.
BMC Pediatr. 2023 Jun 22;23(1):316. doi: 10.1186/s12887-023-04120-z.
Febrile seizures are one of the most common diseases that physicians encounter in pediatric emergency departments. Two important aspects of managing patients presenting with a febrile seizure are meningitis exclusion and co-infection investigation. This study was designed to determine any infection that occurs concomitantly with a febrile seizure episode and also to assess the frequency of meningitis among children presenting with febrile seizures.
This retrospective cross-sectional study was conducted at the Children's Medical Center, an Iranian pediatric referral hospital. All patients aged 6 months to 5 years presenting with febrile seizures from 2020 to 2021 were included. Patients' data were collected from the medical report files. The presence of respiratory, gastrointestinal, and urinary infections was evaluated. Moreover, the detection of SARS-CoV-2 using reverse transcription polymerase chain reaction (RT-PCR) was performed for suspicious cases. The results of urine and stool analysis, as well as blood, urine, and stool cultures were checked. The frequency of lumbar puncture (LP) performance and its results were studied. The relationship between white blood cells (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein in meningitis was evaluated.
A total of 290 patients were referred to the Children's Medical Center, Tehran, Iran, due to fever and seizures. The mean age of the patients was 21.5 ± 13.0 months, and 134 (46.2%) were female. Out of 290 patients, 17% presented with respiratory infections. Nasopharyngeal SARS-CoV-2 RT-PCR was requested for 50 patients (17%), of which nine (3%) were reported positive and two patients had multi-inflammatory syndrome in children (MIS-C). Fever without local signs, gastroenteritis, and urinary tract infections were found in 40%, 19%, and 14% of the patients, respectively. LP was requested for 97 participants (33.4%) to evaluate central nervous system infection, of which 22 cases were suggestive of aseptic meningitis. Among laboratory tests, leukocytosis was significantly related to aseptic meningitis (odds ratio = 11.1, 95% CI = 3.0- 41.5). The blood culture testing result was positive in seven patients; all of them were due to skin contamination.
Evaluation of patients for possible meningitis is necessary for febrile seizure management. Although the prevalence of bacterial meningitis in these patients is not high, according to this study and other studies conducted in Iran, aseptic meningitis, especially after Measles, Mumps, and Rubella (MMR) vaccination should be considered. Leukocytosis and increased CRP can predict the occurrence of aseptic meningitis in these patients. However, further studies with a larger sample size are highly recommended. Moreover, during the COVID-19 pandemic, it is recommended to pay attention to an acute COVID-19 infection or evidence of MIS-C in children with fever and seizure.
热性惊厥是儿科急诊医生最常见的疾病之一。管理出现热性惊厥的患者的两个重要方面是排除脑膜炎和合并感染的调查。本研究旨在确定热性惊厥发作时同时发生的任何感染，并评估热性惊厥患儿中脑膜炎的发生率。
这是一项在伊朗儿科转诊医院儿童医疗中心进行的回顾性横断面研究。纳入 2020 年至 2021 年期间因热性惊厥就诊的年龄在 6 个月至 5 岁的所有患者。从病历档案中收集患者数据。评估呼吸道、胃肠道和尿路感染的存在情况。此外，对疑似病例进行了使用逆转录聚合酶链反应 (RT-PCR) 的 SARS-CoV-2 检测。检查尿液和粪便分析以及血液、尿液和粪便培养的结果。研究腰椎穿刺 (LP) 操作及其结果的频率。评估了脑膜炎中白细胞 (WBC)、红细胞沉降率 (ESR) 和 C 反应蛋白之间的关系。
共有 290 名患者因发热和抽搐被转诊至伊朗德黑兰的儿童医疗中心。患者的平均年龄为 21.5±13.0 个月，134 名（46.2%）为女性。290 名患者中有 17%存在呼吸道感染。对 50 名患者（17%）进行了鼻咽 SARS-CoV-2 RT-PCR 请求，其中 9 名（3%）报告阳性，2 名患者患有儿童多系统炎症综合征 (MIS-C)。发热无局部体征、胃肠炎和尿路感染分别在 40%、19%和 14%的患者中发现。为了评估中枢神经系统感染，97 名患者（33.4%）接受了 LP 请求，其中 22 例提示无菌性脑膜炎。在实验室检查中，白细胞增多与无菌性脑膜炎显著相关（比值比=11.1，95%CI=3.0-41.5）。血培养检测结果阳性的有 7 例，均为皮肤污染所致。
评估患者是否可能患有脑膜炎是热性惊厥管理的必要条件。尽管这些患者中细菌性脑膜炎的患病率不高，但根据本研究和伊朗进行的其他研究，应考虑无菌性脑膜炎，特别是在接种麻疹、腮腺炎和风疹 (MMR) 疫苗后。白细胞增多和 CRP 升高可预测这些患者发生无菌性脑膜炎。然而，强烈建议进行具有更大样本量的进一步研究。此外，在 COVID-19 大流行期间，建议关注发热和抽搐儿童的急性 COVID-19 感染或 MIS-C 的证据。
