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Febrile seizures occur in children 6 months through 5 year olds. A complex febrile seizure occurs when the seizure is focal, prolonged (> 15 min), or occurs more than once in 24 hours.
The prevalence of bacterial meningitis in children with fever and seizure after the H flu and Strep pneumomoniae vaccine was introduced is 0.6% to 0.8%. The prevalence of bacterial meningitis is 5x higher after a complex than simple seizure.
From the study referenced, those children with complex febrile seizures who had meningitis all had clinical exam findings suggestive of meningitis. More studies are needed to provide definitive guidelines about when lumbar punctures are needed in these patients.
Additional Information
This study was a retrospective review of children aged 6 months to 5 years who had complex febrile seizures in France between 2007-2011.
Children were excluded if they had a simple febrile seizure, history of non-febrile seizure, conditions associated with a higher risk of seizure (cerebral malformations, genetic syndrome, trauma in the previous 24 hours) or predisposing to bacterial meningitis (sickle cell, cancer, immunosuppressive treatments). Outcomes were the diagnosis of bacterial or HSV meningitis at 7 days
The rate of bacterial meningitis was 0.7% (CI 0.2-1.6). There were no cases of HSV meningitis.
69% of the study patients did not have a lumbar puncture, however, follow up was done by repeat exam, phone and review of the meningitis and also death registry if the patient was lost to follow up.
The clinical exam in the 5 children with bacterial meningitis was suggestive of meningitis (irritability, altered mental status, bulging fontanel). In a subgroup of patients without physical exam findings suggestive of meningitis, there were no cases of bacterial meningitis.
References
Guedji R et al. Do All Children Who Present With a Complex Febrile Seizure Need a Lumbar Puncture? Annals of Emergency Medicine. 2017; 70 (1):52-62.