3. SOURCE
Professional Med J 2022; 28(1):42-46.
Department of Paediatric Medicine
The Children’s Hospital & ICH
Multan, Pakistan
Study Place
Authors
1. Saba Urooj
2. Maria Saleem
3. Asim Khurshid
4. OBJECTIVE
To find out the frequency of acute bacterial meningitis (ABM)
among children with 1st episode of febrile seizures (FS) at a
tertiary care hospital
5. INTRODUCTION
Febrile Seizures (FS) is the Commonest convulsive disease among children that affect 2-5% of
children aged 6-60 months. It is defined by febrile illness without CNS infections or electrolyte
abnormalities. A simple FS is isolated, brief as well as generalized whereas a complex FS has
focal onset occurring more than 1 time during febrile illness of the child or it lasts for > 10 to 15
minutes.
Associated Factors of FS are Developmental delays, younger age, male predominance, genetics,
and family history linked to prolonged FS. Viral infections, particularly respiratory tract infections,
commonly trigger FS. Respiratory tract infections (RTIs) contribute to most cases, followed by
gastroenteritis, roseola infantum, and urinary tract infections (UTIs).
Acute Bacterial Meningitis (ABM) is a life-threatening emergency; delayed treatment can lead to
severe neurodevelopmental issues. Cerebrospinal fluid (CSF) analysis is crucial to diagnose and
rule out meningitis suspicions
CONT…
6. Selection Criteria
• Children aged 6–60 months.
• Both genders (Male and Female) were included.
• Children presenting with their first-time episode of febrile seizures (FS), defined as fever >
100.4°F accompanied by convulsions (seizures) and a history of abnormal spontaneous
movements of any part of the body, with or without additional clinical symptoms such as
tongue bite, urinary incontinence, or fecal incontinence.
Inclusion Criteria
Exclusion Criteria
• Children diagnosed with developmental delay and cerebral palsy.Cases with chronic systemic
diseases such as cardiac, renal, metabolic, malignancy, or rheumatologic conditions.
8. Methodology
Sample Size :
1. 169 Cases
Data Collection:
1. Demographic information (name, age, gender, weight) recorded for the enrolled children.
2. Medical procedures performed included lumbar puncture (LM) and random blood sugar
investigation.
3. Cerebrospinal fluid (CSF) collection aimed at cell counts with differentials, proteins, and
glucose levels.
CONT…
9. Methodology
Diagnostic Criteria for Acute Bacterial Meningitis (ABM):
1. ABM defined based on specific CSF criteria: CSF pleocytosis (WBC count >5/μL), proteins
>40 mg%, and glucose <2/3rd of blood sugar level.
Data Analysis:
1. Statistical analysis conducted using SPSS version 20.
2. Computation of frequency and percentage for variables such as gender, family history of FS,
residential status, maternal education, and acute bacterial meningitis.
Control of Effect Modifiers and Statistical Testing:
1. Control of effect modifiers (age, gender, family history, residential status, maternal
education) through stratification.
2. Post-stratification chi-square test performed, considering a significance level of p-value
≤0.05.
10. Results
ABM was found in 10 (5.92%)
children, and it was not found in
remaining 159 (94.08%) children.
11. Study Variables
Acute Bacterial
Meningitis P-Value
Yes (n=10) No (n=159)
Age Groups
6-20 months 3 (30.0%) 79 (49.7%)
0.227
>20-60 months 7 (70.0%) 80 (50.3%)
Gender
Male 7 (70.0%) 93 (58.5%)
0.473
Female 3 (30.0%) 66 (41.5%)
Family History of
Febrile Seizure
Yes 2 (20.0%) 14 (8.8%)
0.2408
No 8 (80.0%) 145 (91.2%)
Maternal Education
Level
Illiterate 2 (20.0%) 57 (35.8%)
Primary 6 (60.0%) 72 (45.3%)
Secondary 1 (10.0%) 10 (6.2%)
Intermediate - 11 (6.9%) 0.26
Graduate 1 (10.0%) 7 (4.4%)
Post-Graduate - 2 (1.3%)
Area of Residence
Urban 4 (40.0%) 68 (42.8%)
0.864
Rural 6 (60.0%) 91 (47.2%)
Table-I. Stratification of study variables with respect to acute
bacterial meningitis (n==169)
Results
Demographics:
o Mean age of children: 24.44 ± 12.26 months (range:
6 to 60 months).
o Gender distribution: 100 (59.17%) male and 69
(40.83%) female children.
o Positive family history of FS: 16 (9.47%) children.
o Residential distribution: 97 (57.40%) from rural
areas and the rest from urban areas.
o Maternal education: 59 (34.91%) were illiterate, and
78 (46.2%) had primary education
12. Study Variables
Acute Bacterial
Meningitis P-Value
Yes (n=10) No (n=159)
Age Groups
6-20 months 3 (30.0%) 79 (49.7%)
0.227
>20-60 months 7 (70.0%) 80 (50.3%)
Gender
Male 7 (70.0%) 93 (58.5%)
0.473
Female 3 (30.0%) 66 (41.5%)
Family History of
Febrile Seizure
Yes 2 (20.0%) 14 (8.8%)
0.2408
No 8 (80.0%) 145 (91.2%)
Maternal Education
Level
Illiterate 2 (20.0%) 57 (35.8%)
Primary 6 (60.0%) 72 (45.3%)
Secondary 1 (10.0%) 10 (6.2%)
Intermediate - 11 (6.9%) 0.26
Graduate 1 (10.0%) 7 (4.4%)
Post-Graduate - 2 (1.3%)
Area of Residence
Urban 4 (40.0%) 68 (42.8%)
0.864
Rural 6 (60.0%) 91 (47.2%)
Table-I. Stratification of study variables with respect to acute
bacterial meningitis (n==169)
Results
Acute Bacterial Meningitis (ABM):
ABM prevalence: 10 (5.92%) children were diagnosed
with ABM, while 159 (94.08%) did not have
Stratification by Age:
o Among children aged 6-20 months: 3 (30.0%)
with ABM.
o Among children aged 21-60 months: 7 (70.0%)
with ABM.
o Comparison between ABM and non-ABM groups
by age showed an insignificant difference (p-
value = 0.227).
Stratification by Gender:
o ABM in 7 (70.0%) male children and 3 (30.0%)
female children.
o Comparison between ABM and non-ABM groups
by gender was statistically insignificant (p-value =
0.473).
13. Study Variables
Acute Bacterial
Meningitis P-Value
Yes (n=10) No (n=159)
Age Groups
6-20 months 3 (30.0%) 79 (49.7%)
0.227
>20-60 months 7 (70.0%) 80 (50.3%)
Gender
Male 7 (70.0%) 93 (58.5%)
0.473
Female 3 (30.0%) 66 (41.5%)
Family History of
Febrile Seizure
Yes 2 (20.0%) 14 (8.8%)
0.2408
No 8 (80.0%) 145 (91.2%)
Maternal Education
Level
Illiterate 2 (20.0%) 57 (35.8%)
Primary 6 (60.0%) 72 (45.3%)
Secondary 1 (10.0%) 10 (6.2%)
Intermediate - 11 (6.9%) 0.26
Graduate 1 (10.0%) 7 (4.4%)
Post-Graduate - 2 (1.3%)
Area of Residence
Urban 4 (40.0%) 68 (42.8%)
0.864
Rural 6 (60.0%) 91 (47.2%)
Table-I. Stratification of study variables with respect to acute
bacterial meningitis (n==169)
Results
Acute Bacterial Meningitis (ABM):
Stratification by Family History and Maternal
Education:
o No significant associations found between family
history of febrile seizures or maternal education
and the presence of ABM (p-value = 0.260).
Area of Residence:
o No significant association between rural or
urban residence and the presence of ABM (p-
value = 0.864).
14. DISCUSSION
Introduction of vaccines for Haemophilus influenzae type b (HiB) and Streptococcus
pneumoniae significantly reduced bacterial meningitis cases among young children.
The American Academy of Pediatrics (AAP) updated guidelines in 2011 regarding neuro-
diagnostic evaluations for simple febrile seizures (FS), emphasizing LP (lumbar puncture) for
incomplete or undetermined immunization status cases.
The relationship between seizures and bacterial meningitis underscores the need to rule out
meningitis before diagnosing FS, especially as FS could be the sole sign of meningitis in
infants.
Making decisions in acute situations regarding lumbar puncture for ruling out bacterial
meningitis remains a challenging aspect of care, especially when facing apparent febrile
seizures.
15. DISCUSSION
The study revealed a 5.92% diagnosis rate of bacterial meningitis in children experiencing their
first episode of acute febrile seizures. Comparable studies globally show varying rates, possibly
due to population differences and diagnostic criteria.
The study found no significant association between gender or age and the prevalence of
bacterial meningitis, aligning with previous research findings.
Lower prevalence rates of bacterial meningitis among febrile seizure cases are linked to
improved vaccination coverage worldwide.
16. LIMITATIONS
The study itself might have limitations related to its scope, sample size, or
methodology, impacting the generalizability of its findings to broader populations
or different healthcare settings.
17. Conclusion
Frequency of bacterial meningitis in children presented with febrile seizures is not high. Bacterial
meningitis was diagnosed in 5.92% children presenting with 1st episode of acute febrile seizures.
18. Cross Reference
Studies Highlighting ABM Cases in FS:
• Siddiqui et al.'s Study found 7.6% of cases with acute bacterial meningitis (ABM) among
children experiencing their first febrile seizure (FS).
• University of Benin Teaching Hospital's Study identified 4.2% of children, aged 1
month to 6 years, diagnosed with bacterial meningitis when presenting convulsions and
acute fever
• Ehsanipour F et al from Iran noted 3.6% cases of bacterial meningitis among children
with FS.
• Al-Eissa YA from Saudi Arabia observed a frequency of bacterial meningitis to be 3.5%
among children with FS.This percentage was further reduced to 1.5% in the 3 to 60 months
age group.
• Casasoprana A et al from France elaborated that the frequency of bacterial meningitis
was 1.9% among cases with the 1st FS and aged less than 18 months.
