DOI: 10.36347/sjams.2018.v06i01.006

Pages: 29-34

Fever with seizures is a common presentation in pediatric emergency department. In apparent first simple febrile seizures (FSFS) acute bacterial meningitis (ABM) should always be considered as a differential diagnosis. American academy of Pediatrics (AAP) guidelines of FSFS 1996 strongly recommended lumbar puncture (LP) in 3-12 months infants and advised to consider LP in children of 12 to 18 months age as signs and symptoms of meningitis are absent or subtle. In 2011 AAP changed the guidelines and LP was made an option in these children based on Hemophilus influenza type b (HIB) and Pneumococcal vaccine (PCV) status. Present study was intended to evaluate the credibility of AAP guidelines 2011 in developing / underdeveloped countries. 226 children of 3-18 months of age with apparent FSFS were evaluated by meningeal signs and LP findings. Among 3-12 months children 13 had meningitis but only 5 (38%)) presented with meningeal signs and 8 (62%) had no meningeal signs. In 12-18 months of age, meningitis was noticed in 11 children and 6 (55%) presented with meningeal signs and 5 (45%) had no meningeal signs. LP findings of 3-12 months children with meningitis (N-13) were suggestive of ABM in 10 (77%) and viral meningitis in 3 (23%) cases. Comparatively in 12-18 months children with meningitis (N-11) LP was suggestive of ABM in 8 (73%), viral meningitis in 2 (18%) and tuberculous meningitis in 1 (9%) of cases. Therefore, LP detected meningitis in remaining 62% infants in 3-12 months and 45% children in 12-18 months age group who could not be picked up by meningeal signs. Overall immunization coverage of HIB/PCV in our study was 64 (28.3%) and 11 (4.9%). In developing/under developed countries implementation of AAP recommendations 2011 need to wait till immunization coverage of HIB / PCV reaches more than 90 percent.