Predicting factors and prevalence of meningitis in patients with first seizure and fever aged 6 to 18 months ============================================================================================================ * Farhad Heydarian * Farah Ashrafzadeh * Atefeh Rostazadeh ## Abstract **Objective:** To evaluate predicting factors and prevalence of meningitis in patients with first seizure and fever aged 6-18 months old. **Methods:** This cross-sectional study was performed on 800 patients aged 6-18 months old who had first attack of seizure with fever between March 2005 and March 2012 in the pediatric ward of Ghaem Hospital, Mashhad, Iran. **Results:** Among 800 patients, lumbar puncture (LP) was performed in 453 (56.6%) patients, of whom 80 cases had meningitis (17.6% of LP patients). Postictal drowsiness (*p*=0.003), neurologic deficit (*p*=0.000), and body temperature ≥38.5°C (*p*=0.035) were among the clinical signs, which were statistically significant predicting factors for meningitis. Laboratory tests including white blood count (WBC) ≥15000 mm3 (*p*=0.004), and hemoglobin (Hb) <10.5 gr/dl (*p*=0.020) also had statistical significance in predicting meningitis. **Conclusion:** Postictal drowsiness, neurological deficit, body temperature ≥38°5C, WBC ≥15000 mm3, and Hb <10.5 gr/dl were clinical and laboratory factors predictive of meningitis in cases with first attack of seizure and fever. Febrile seizure (FS) is the most common convulsive disorder in children with some probable risk factors that occur in 2-4% of children aged 6 months to 5 years old. It is defined as a seizure attack due to rising body temperature above 38°C in the absence of metabolic disease or CNS infection. It is divided into the simple form, which is single, less than 15 minutes with generalized seizure, and the others, known as the complex form.1-6 Seizure can be seen in meningitis in one out of 6 patients of whom one-third have no signs of meningeal involvement.7 Some predicting factors of meningitis in young children who present with seizure and fever may be seizure duration above 30 minutes, neurologic deficit, and postictal drowsiness.8 Prevalence of meningitis ranges between 2.4-17% in those children who have seizure and fever.8-10 In view of the paucity of previous studies, we undertook this study to evaluate the predicting factors and prevalence of meningitis in our patients with first attack of seizure with fever. ## Methods This cross-sectional study was performed on 800 patients aged 6-18 months old who had first attack of seizure with fever between March 2005 and March 2012 in the Pediatric Ward of Ghaem Hospital, Mashhad, Iran. Patients were divided into 2 groups. Those with simple FS with one tonic colonic seizure attack for less than 15 minutes. Those cases who had multiple attacks or seizures lasting more than 15 minutes, or had focal seizures were categorized as complex FS. The patient records were evaluated for LP for meningitis, which was defined as abnormal changes in cell count, protein, and sugar as well as positive culture result. Age, gender, seizure type and duration, postictal drowsiness, neurologic deficit, body temperature, previous family history of FS, white blood cell count (WBC), and hemoglobin (Hb) were also recorded. The inclusion criteria included patients aged 6-18 months old with first attack of convulsion and fever. Exclusion criteria included any history of FS or epilepsy, any neurological disorder including hydrocephaly, cerebral palsy, any metabolic disorder including hypoglycemia, hypocalcemia, hypomagnesemia, traumatized LP, and incomplete records. All cases that met the inclusion criteria were included. The Ethics Committee of Mashhad University of Medical Sciences approved the study, which was carried out according to the Principles of the Helsinki Declaration. A statistician calculated the sample size, and data were analyzed using the Statistical Package for Social Sciences version 11 (SPSS Inc., Chicago, IL, USA). Statistical tests including chi square and t test were used. Logistic regression analysis was used to evaluate predicting factors for meningitis. Statistical significance was set at a p-value <0.05. ## Results The mean age of patients was 12.76 months (standard deviation [SD] 3.98). Most of the cases (435 [54.4%]) were male. Among 800 patients, LP was performed in 453 (56.6%), of whom 80 cases had meningitis (17.6% of LP patients). Bacterial meningitis was detected in 5 (6.25%) including one pneumococcal, 3 Hemophilus influenza type b (Hib), and one enterococcus. A comparison of some of the clinical aspects of patients with and without meningitis is shown in **Table 1**. View this table: [Table 1](http://nsj.org.sa/content/19/4/297/T1) Table 1 Clinical aspects of first seizure patients aged 6-18 months with and without meningitis that underwent lumbar puncture. According to logistic regression analysis, independent variables for predicting meningitis were neurological deficits, postictal drowsiness, body temperature, level of Hb, and WBC (**Table 2**). The risk of meningitis was 30 times greater in cases who had neurological deficits than in those without. It was 3 times greater in those with postictal drowsiness, and 1.7 times greater in those with fever ≥38.5°C. The risk of meningitis was 2.3 times greater in cases with a WBC ≥15000 mm³, and 2 times greater in cases with Hb <10.5 gr/dl. View this table: [Table 2](http://nsj.org.sa/content/19/4/297/T2) Table 2 Independent variables for predicting meningitis among first seizure patients aged 6-18 months with and without meningitis. ## Discussion We found that postictal drowsiness, neurological deficit, body temperature ≥38.5°C, WBC ≥15000 mm3, and Hb <10.5 gr/dl are among predicting factors for meningitis in cases admitted for evaluating fever and seizure. Batra et al8 performed a study on children admitted with first attack of seizure and fever, and lumbar puncture was performed in 199 (40%) of cases. They detected that postictal drowsiness, duration of convulsion >30 minutes, and neurological deficit were among predicting factors for meningitis. However, apparent complex febrile seizure, leukocyte count ≥15000 mm3, and Hb level were not statistically significant between the meningitis and non-meningitis group. In another study by Joshi Batajoo et al10 on children admitted for first attack of seizure and fever, meningitis was revealed in 17% of cases. They detected that 4.5% had bacterial meningitis in patients aged 6-12 month, and the meningitis prevalence was higher in younger children. Ghotbi et al9 also conducted a study on children with first attack of seizure and fever, and LP was carried out in all patients. They found that age 38°5C, WBC ≥15000mm3, and Hb <10.5gr/dl. ## Footnotes * Disclosure Financial support was received from Mashhad University of Medical Sciences, Mashhad, Iran. * Received March 4, 2014. * Accepted July 8, 2014. * Copyright: © Neurosciences Neurosciences is an Open Access journal and articles published are distributed under the terms of the Creative Commons Attribution-NonCommercial License (CC BY-NC). Readers may copy, distribute, and display the work for non-commercial purposes with the proper citation of the original work. ## References 1. 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