Pattern of infections in children under-six years old presenting with convulsions associated with fever of acute onset in a children's emergency room in Benin City, Nigeria.

Five-hundred-and-twenty-two infants and children aged 1 month to 6 years presenting at the Children's Emergency Room of the University of Benin Teaching Hospital with convulsions associated with fever (CAF) of acute onset were prospectively evaluated to determine the pattern of infections. Twenty-six per cent had localized infections of which 38 per cent were intracranial (meningitis = 16 per cent, cerebral malaria = 19 per cent, and encephalitis = 3 per cent) and 62 per cent were extracranial with respiratory tract infections contributing 51 per cent. Although, the prevalence of meningitis was significantly higher in 1-6 months old infants when compared with older children (47 per cent v. 12 per cent; P < 0.005), it was, none-the-less, present in all the other age groups (with a prevalence of 8-17 per cent). Seventy-four per cent of the children had no localizing signs of infection. Of these 68 per cent had malaria, 4 per cent bacteraemia, and 7 per cent malaria with bacteraemia, while no infections were identified in 21 per cent. Among children with bacteraemia Staphylococcus aureus was the commonest single isolate (33 per cent) although, overall, enterobacteriaceae were the commonest. We conclude, first, that meningitis should be excluded in all children aged under 6 years who present with CAF of acute onset and, secondly, that although anticipatory treatment for malaria is justified in children with CAF of acute onset without localizing signs of infection, consideration should also be given to the problem of bacteraemia.