Profile of Cerebrospinal Fluid Findings in Children Aged 3 Months to 12 Years With Fever and Convulsions at Kenyatta National Hospital

Abstract

Fever and convulsions in children can be caused by bacterial meningitis, encephalitis, severe malaria, febrile convulsions and other central nervous system pathologies. Performance of a lumbar puncture is important in order to differentiate the various clinical causes of fever, convulsions and altered consciousness. There is need to find out if there has been any change in the pathogens causing meningitis which is a leading cause of fever and convulsions in children in Kenyatta National Hospital (KNH) since the introduction of the Haemophilus influenzae type b (Hib) and pneumococcal vaccine. Information on current etiology of meningitis and antibiotic sensitivity of bacteriological organisms will go a long way in informing the health care workers on judicious use of antibiotics and general management of the child presenting with fever and convulsions. Methods This was a cross sectional study carried out at the Paediatric Emergency Unit and general paediatric wards of Kenyatta National Hospital from September 2016 to April 2017. The study population was children between the ages of 3 months to 12 years who presented with fever and convulsions at KNH. Children whose parents consented to have a lumbar puncture were included in the study. The following served as exclusion criteria; those with signs of raised intracranial pressure, those who needed cardiopulmonary resuscitation, a known history of epilepsy, head injury, cerebrovascular accident, brain tumour, coagulopathy, hydrocephalus and those who had a lumbar puncture performed at the referral facility. The following study procedures were followed. Children with fever and convulsions were recruited into the study and informed consent was sought from the care givers. Clinical history and physical examination was done and the findings were included in a questionnaire. The child had a lumbar puncture performed aseptically and CSF was ferried to the laboratory. A copy of the CSF results was put in the patients’ files. Data was entered and analyzed using SPSS. Results: Eighty-four children were enrolled into the study. An overall 69(82.1%) patients had normal CSF while 15(17.9%) patients had abnormal CSF findings. Five (5.9%) CSF

samples had organisms identified either on gram stain or culture. Three (3.6%) CSF samples had positive growth on culture. The organisms isolated on CSF culture were Haemophilus influenzae, Enterococcus and Escherichia coli and were all sensitive to meropenem. Fever for more than 24 hours, neck stiffness, irritability, lethargy and positive kerning sign were associated with abnormal CSF results. Multivariable logistic regression model showed that the odds of having abnormal CSF was eight fold higher (OR = 8, 95% CI 1.6-40.62) among children who had neck stiffness compared to those who did not have this sign. Conclusions: High index of suspicion for abnormal CSF is needed in children less than 2 years presenting with fever and convulsions especially if they have a stiff neck. Carrying out a lumbar puncture is important as CNS infections may present in a subtle manner