O.O. Jarrett1, O.J. Fatunde2, K, Osinusi1 and I.A. Lagunju1
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria.
- Department of Paediatrics, Texas Tech University, Texas, USA.
Background: Febrile seizures are common among children and these are known to result from the diverse aetiological factors, known to cause fever in children.
Objectives: To determine the prevalence of bacteraemia amongst children with febrile seizures at the children’s emergency room of the University College Hospital, Ibadan, Nigeria.
Methods: This was a prospective study involving 147 children who were presented with febrile seizures over a period of 13 months at the University College Hospital Ibadan. They all had their blood cultures sample taken under aseptic conditions. Other investigations performed on them included a packed cell volume, full blood count and blood film for malaria parasite.
Results: A total of 83 males and 64 females with febrile seizures were studied. Their ages ranged from 4 to 60 months with a mean age of 26.35 + 13.76 months. Bacteraemia was diagnosed in 32(21.8%) of the cases. The predominant organism isolated from the blood of these patients was Staphylococcus aureus .
Conclusion: Bacteraemia is a frequent finding in children with febrile seizures hence, it may be beneficial to carry out blood culture in such children on the suspicion of a probable bacterial infection.
Keywords: Seizures, Febrile, Bacteraemia.
Dr. O.O. Jarrett
Department of Paediatrics,
University College Hospital,
A febrile seizure is a seizure occurring in infancy or childhood usually between three months and five years of age associated with fever but without evidence of intracranial infection or a defined cause.1 The International League Against Epilepsy (ILAE) defines it further, as a seizure occurring in childhood after one month of age associated with a febrile illness not caused by an infection of the central nervous system, without previous neonatal seizures or a previous unprovoked seizure, and not meeting criteria for other acute symptomatic seizures.2 Febrile seizures are a common problem encountered in emergency Paediatrics practice, occurring in 2 to 5 percent of children six months to five years of age.3-5
There are various causes of fever in these children presenting with febrile seizure. Studies based in Nigeria, sub-Sahara Africa, reported malaria as the leading etiology of fever in such children.3, 6, 7 This finding is not surprising as malaria is endemic in Nigeria. However, bacteraemia is also an important cause of fever in these children. Decades ago, Familusi et al2 and Angyo et al6 reported bacteraemia in 3.3% and 3.7% respectively in a cohort of Nigerian febrile seizure children.3, 6 while James et al 8 and Teah et al 9 reported a prevalence of 5.4% and 2.9% respectively in Caucasians. More recent studies done on children with febrile seizures by Shah et al 10 reported a prevalence of bacteraemia to be 2.1%, while Trainor et al 11 in Chicago reported a low prevalence of 1.3%. More recent Nigerian studies on febrile seizures did not specifically mention the prevalence of bacteraemia in the children they studied.7, 12, 13
James et al 8 and Teah et al 9 studies were retrospective and not all the children studied had blood culture results. It is probable that some cases of bacteraemia would have been missed. Familusi et al 2 and Angyo et al 6 studies though prospective, however, did not carry out blood culture studies in all of the children studied also making prevalence obtained most likely not fully representative of the actual prevalence. Bacteraemia is detected more frequently in children who are admitted to hospital with febrile seizures when cultures are performed as a routine.14 The detection of bacteraemia and prevention of serious complications are important goals in the examination of febrile young children.10 Blood culture is the goal standard test for proving bacteraemia and for identifying bacteria and their antibiotic sensitivities.15 This study seeks to determine the prevalence of bacteraemia in children that present in the emergency room of the University College Hospital, Ibadan, with febrile seizures.