Acute meningitis among infants and toddlers with febrile seizures: time for a reappraisal of the value of a lumbar puncture.

BACKGROUND: Since clinical signs of meningeal irritation in infants may be absent or misleading, the American Academy of Pediatrics in 1996 recommended that a lumbar puncture be performed in young children following a febrile seizure. Recent evidence supports a conservative approach in children who do not look ill at the time of the physician's assessment. Moreover, seizures as the presenting or sole symptom of bacterial meningitis are very rare. OBJECTIVES: To assess physicians' compliance with the Academy's recommendations and to determine the incidence of meningitis among febrile seizure patients, including those who did not undergo the puncture. METHODS: We conducted a retrospective analysis of the number of punctures obtained in febrile seizure patients aged 6-24 months, focusing on the clinician's indications for performing the procedure and on the clinical course of children who did not undergo the puncture. RESULTS: Among 278 patients (84% simple febrile seizure), 52 (18.7%) underwent the procedure. It was performed in 38% of 45 complex febrile seizure cases and in 48% of 91 infants younger than 12 months of age. Aseptic meningitis occurred in two infants, both with post-ictal apathy. Bacterial meningitis was not found and in none of the patients who did not undergo the puncture was meningitis later diagnosed. CONCLUSIONS: Compliance with the Academy's recommendations was low, as emergency room physicians based their decision whether to obtain a lumbar puncture solely on clinical grounds. No case of bacterial meningitis was detected among 278 young children with a febrile seizure, including those who did not undergo the puncture.

Child abuse suspicion masquerading new onset insulin dependent diabetes mellitus.

The identification and diagnosis of child abuse is a challenging task to the pediatrician. The increased awareness among both the public and medical personnel, while improving attentiveness to this important subject, can sometimes result in misdiagnosing medical conditions, thus causing distress and delay in required treatment. Numerous reports have described conditions mimicking non-accidental injuries; most of these include dermatological findings related to skin diseases, medical conditions causing pathological fractures, and rare diseases with unusual physical findings. We present a case of a 9.5-year-old child in which the workup for a suspected abusive event led to a delay in the diagnosis of insulin dependent diabetes mellitus later presented as diabetic ketoacidosis.

[Sports emergencies in the pediatric population].

In recent years there have been changes in the patterns of pediatric physical activity. Most children are now less physically active, and this fact leads to the emergence of childhood obesity and its complications. On the other hand, there is an increase in the number of children and adolescents participating in organized competitive sports. These changes have led to an increased number of children and adolescents seeking emergency evaluation and treatment due to sports-related injuries. Approximately one third of overall injuries in childhood and adolescence are sports-related injuries. Head, neck and chest injuries are among the most important sports-related injuries. In addition, sports participation could lead to severe injury and, rarely, even death in children with underlying heart diseases. Other conditions that may endanger children engaged in sports are related to heat illness or allergic reactions. This article reviews these sports-related emergencies, their diagnosis, treatment and ways of prevention.

A case of Jatropha multifida poisoning resembling organophosphate intoxication.

Four siblings presented with vomiting, diarrhea and miosis following ingestion of the plant. This is the first report of miosis as a presenting sign of Jatropha intoxication. The combination of vomiting, diarrhea and miosis resembles the clinical presentation of organophosphate poisoning. This fact warrants the consideration of Jatropha ingestion in the differential diagnosis of organophosphate ingestion. Treatment of Jatropha intoxication is supportive with emphasis on rehydration. Measurement of plasma acetylcholinesterase activity levels, which is normal after Jatropha ingestion and decreased following organophosphate poisoning, may help differentiate between the two.