Publicación Oficial de la Sociedad Ecuatoriana de Neurología, de la Liga Ecuatoriana Contra la Epilepsia y de la Sociedad Iberoamericana de Enfermedad Cerebrovascular

Febrile syndrome

 

Síndrome Febril sin Causa Aparente en Lactantes Menores de 3 Meses: Utilidad de la Punción Lumbar

Febrile syndrome without apparent focus in children under 3 months old is a common problem in clinical practice. Here, we evaluate the role of lumbar puncture  in this group of patients to assess the frequency of viral meningitis. We analyzed 253 medical records of patients hospitalized in the Seclusion Service of Roberto del Río Hospital from January 2001 to January 2003. The age ranged from 2 to 87 days; 55.7% of patients were younger that 28 days, and 86.6% were younger than 2 months. Most common manifestations were fever and poor appetite. Laboratory tests showed abnormal WBC in 28% of patients. CRP and ESR were impaired in 1.6% and 10.7% respectively. Blood cultures were positive in 3.2%, and urinalysis were abnormal in 30 patients. We performed lumbar puncture in 223 of 253 patients (88%). It yielded abnormal CSF findings in only 14 children. Viral meningitis was diagnosed in 10 patients and bacterial meningitis 4 patients.Pyelonephritis or occult bacteremia were confirmed in 11.8% and 4.7% respectively. Treatment was started in 125 patients, but only 62 completed it. We conclude that lumbar puncture is a diagnostic tool in febrile infants to rule out diseases having high morbidity and mortality rates, that must be receive prompt treatment. In febrile infants under 3 months of age with no apparent focus, bacterial disease must be suspected

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