Frequency of Meningitis among Children with Complex Febrile Seizures Presenting to Saidu Group of Teaching Hospital, Swat

Aqal Zada; Ashfaq Ahmed; Asim Mehmood; Israr ul Haq; Khurshid Ali; . Rahimdad

doi:10.54112/bcsrj.v6i5.2368

Authors

Aqal Zada Department of Pediatrics, Saidu Group of Teaching Hospitals Swat, Pakistan
Ashfaq Ahmed Department of Pediatrics, Saidu Group of Teaching Hospitals Swat, Pakistan
Asim Mehmood Department of Pediatrics, Saidu Group of Teaching Hospitals Swat, Pakistan
Israr ul Haq Department of Pediatrics, Saidu Group of Teaching Hospitals Swat, Pakistan
Khurshid Ali Department of Pediatrics, Bacha Khan Medical Complex Swabi, Pakistan
. Rahimdad Department of Pediatrics, Saidu Group of Teaching Hospitals Swat, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i5.2368

Keywords:

Complex Febrile Seizures, Meningitis, Cerebrospinal Fluid, Children

Abstract

Complex febrile seizures are a common neurological emergency in children and may occasionally be the initial manifestation of meningitis. Distinguishing children with meningitis from those with benign febrile seizures is essential for timely diagnosis and appropriate management. Determining the frequency of meningitis among children presenting with complex febrile seizures can guide decisions regarding cerebrospinal fluid evaluation and treatment. Objective: To determine the frequency of meningitis among children presenting with complex febrile seizures at Saidu Group of Teaching Hospital, Swat. Methods: This cross-sectional study was conducted on 132 children aged 5–60 months of either gender presenting with complex febrile seizures from 12 January 2025 to 12 April 2025 in the Pediatric Department of Saidu Group of Teaching Hospitals, Swat. Children with neurological disorders, a history of head trauma, or those receiving antiepileptic medications were excluded. Meningitis was diagnosed based on clinical findings, including neck stiffness and fever (>38°C), together with cerebrospinal fluid analysis demonstrating a white blood cell count >1000 cells/µL, glucose <40 mg/dL, and protein >100 mg/dL. Data were analyzed using SPSS version 23. Descriptive statistics were used to summarize patient characteristics, while associations between meningitis and clinical variables were assessed using the chi-square test or Fisher's exact test. A p-value ≤0.05 was considered statistically significant. Results: The mean age of the children was 30.37 ± 15.84 months, with a mean body weight of 11.96 ± 3.79 kg. Of the 132 participants, 85 (64.4%) were male, and 47 (35.6%) were female. Meningitis was diagnosed in 11 (8.3%) children. Among these cases, viral meningitis accounted for 9 (81.8%), whereas bacterial meningitis was identified in 2 (18.2%). A statistically significant association was observed between meningitis and a positive family history of seizures (p = 0.005). Conclusion: The frequency of meningitis among children presenting with complex febrile seizures was 8.3%, with viral meningitis being considerably more common than bacterial meningitis. A positive family history of seizures was significantly associated with meningitis. Careful clinical evaluation and selective cerebrospinal fluid analysis remain important for the early diagnosis of meningitis in children presenting with complex febrile seizures.

Downloads

Download data is not yet available.

0

References

1. Rivas-García A, Ferrero-García-Loygorri C, Carrascón González-Pinto L, Mora-Capín AA, Lorente-Romero J, Vázquez-López P. Simple and complex febrile seizures: is there such a difference? Management and complications in an emergency department. Neurologia (Engl Ed). 2022;37(5):317–324.

2. Jongruk P, Wiwattanadittakul N, Katanyuwong K, Sanguansermsri C. Risk factors of epilepsy in children with complex febrile seizures: a retrospective cohort study. Pediatr Int. 2022;64(1):e14926.

3. Tanaka T, Yamaguchi H, Ishida Y, Tomioka K, Nishiyama M, Toyoshima D, et al. Clinical and laboratory characteristics of complex febrile seizures in the acute phase: a case-series study in Japan. BMC Neurol. 2023;23(1):28.

4. Wright C, Blake N, Glennie L, Smith V, Bender R, Kyu H, et al. The global burden of meningitis in children: challenges with interpreting global health estimates. Microorganisms. 2021;9(2):377.

5. Tracy A, Waterfield T. How to use clinical signs of meningitis. Arch Dis Child Educ Pract Ed. 2020;105(1):46–49.

6. Svendsen MB, Ring Kofoed I, Nielsen H, Schønheyder HC, Bodilsen J. Neurological sequelae remain frequent after bacterial meningitis in children. Acta Paediatr. 2020;109(2):361–367.

7. Zimmermann P, Curtis N. Bacterial meningitis in the absence of pleocytosis in children: a systematic review. Pediatr Infect Dis J. 2021;40(6):582–587.

8. Bekele F, Ahmed A, Kedir A, Sheleme T. Treatment outcome and associated factors of bacterial meningitis at pediatric wards of southwestern Ethiopian hospital: a prospective observational study. J Pharm Health Care Sci. 2021;7(1):41.

9. Zhang L, Ma L, Zhou X, Meng J, Wen J, Huang R, et al. Diagnostic value of procalcitonin for bacterial meningitis in children: a comparison analysis between serum and cerebrospinal fluid procalcitonin levels. Clin Pediatr (Phila). 2019;58(2):159–165.

10. Nawaz S, Kumar R, Bhushan A, Sharma P, Shagufta. Assessment of clinico-etiological profile in children with atypical febrile seizures at a tertiary care hospital. Int J Acad Med Pharm. 2023;5(1):734–736.

11. Zeb R, Rauf S, Munir A, Kashif M, Ullah H, Tahir M. Meningitis in patients presented with first episode of febrile fits. Rawal Med J. 2020;45(3):616–618.

12. Urooj S, Saleem M, Khurshid A. Acute bacterial meningitis in children with 1st episode of febrile seizures. Professional Med J. 2021;28(1):42–46.

13. Kimia A, Ben-Joseph EP, Rudloe T, Capraro A, Sarco D, Hummel D, et al. Yield of lumbar puncture among children who present with their first complex febrile seizure. Pediatrics. 2010;126(1):62–69.

14. Eldardear A, Alhejaili FAD, Alharbi AMD, Alrehaili FSS, Mohammed KTA, Binladin AKA, et al. Incidence of meningitis in patients presenting with febrile seizures. Cureus. 2020;12(12):e11941.

15. Soti Khiabani M, Mohammadi MS, Ashrafi MR, Haider SB, Haider SI, Mahmoudi S, et al. Evaluation of patients presenting with febrile seizures in an Iranian referral hospital: emphasis on the frequency of meningitis and co-infections. BMC Pediatr. 2023;23(1):316.

16. Alwahbi ZM, Alzahrani AA, Alqhtani MM, Asiri WI, Assiri MA. Evaluation of Saudi Arabian parent's attitude towards lumbar puncture in their children for diagnosis of meningitis. Egypt J Hosp Med. 2018;70(9):1582–1585.

17. Mahamuduzzaman ASM, Banu NA, Anowar AB, Hossain MD, Karim F, Qyuoom MA, et al. Frequency of meningitis among infants and young children with clinically diagnosed first time febrile seizure. Sir Salimullah Med Coll J. 2022;30(2):108–114.