Diagnostic value of lumbar puncture among infants and children presenting with fever and convulsions

Abstract

Introduction: Central nervous system (CNS) infections can be categorized according to the nature of the infectious pathogen into viral, bacterial, protozoan, or fungal. The diagnosis of diffuse CNS infections depends on examination of cerebrospinal fluid (CSF) obtained by lumbar puncture (LP). The aim of this work was to determine the diagnostic value of CSF analysis in infants and children presenting with fever and convulsions. Methods: Detailed clinical data of infants and children included in this study were collected with special reference to the course and duration of the illness, description of the convulsions, consciousness level, signs of increased intracranial pressure, and signs of meningeal irritation. Lumbar puncture and chemical and bacteriological analyses of the obtained cerebrospinal fluid were done for all of the children. Results: The total number of children included in the study was 85, they had a median age 19 months, and 88% of them had generalized convulsions. CSF examination revealed that 20% had abnormal physical findings, while 23.5% had abnormal white blood cell count (WBC) (CSF Pleocytosis). CSF cultures were done in three cases with the highest White blood cells (WBCs), and streptococcus pneumoniae was present in all three cases. Conclusion: This study found that CNS infections are not uncommon in infants and children presenting with fever and convulsions in our locality, and acute bacterial meningitis cannot be excluded. However, its presence in the absence of clinical symptoms and signs of meningeal irritation is a remote possibility, but it should always be considered. 1. Introduction Infection of the CNS is the most common cause of fever associated with signs and symptoms of CNS disease in children. Many different pathogens can invade and damage the developing or mature CNS. Nonetheless, specific pathogens are identifiable and are influenced by the age and immune status of the host and the epidemiology of the pathogen. In general, viral infections of the CNS are much more common than bacterial infections, which, in turn, are more common than fungal and parasitic infections (1). Regardless of etiology, most patients with CNS infections have similar clinical manifestations. Common symptoms include headache, nausea, vomiting, anorexia, restlessness, altered state of consciousness, and irritability; most of these symptoms are nonspecific. Furthermore, common signs of CNS infections include fever, photophobia, neck pain and rigidity, obtundation, stupor, coma, seizures, and focal neurologic deficits (1). In general terms, CNS infections can be categorized according to the nature of the infectious pathogen into viral, bacterial, protozoan, or fungal and by the location of the infection, whether parenchymal,