Relationship Between Respiratory Viral Infections And Febrile Seizures In Children

Object To explore the viruses associated with febrile seizures (FS) in the common respiratory viral infections and evaluate the risk factors of the viral infections as well as the related viral types to the development of FS, and then to prevent and control FS in a better way.Methods Consecutive FS patients and patients with upper respiratory infections (URIs) admitted respectively to the neurology department and the respiratory department of Suzhou children's hospital between June 2009 and February 2010 were prospectively surveyed. Secretions from the nasopharyngeal epithelium were aspirated in these hospitalized children on the next morning. Viral antigens including influenza A and B, parainfluenza, adenovirus and respiratory syncytial virus (RSV) were detected by rapid direct fluorescent test in the aspirated epithelia. Additionally, cerebrospinal fluid (CSF) tests were performed in those FS patients suspected with the intracranial infections, which helped to find the patients who had an actual center nervous infection but decked out in FS manifestations.Results (1) Among the 189 patients enrolled in the study, the URIs were the most common disease associated with FS, which accounted for 60.8%; and the simple FS was the most common type, which accounted for 60.3%. The influenza A was the most common virus in the FS children infected with respiratory viral infections and the incidence of influenza A infection was 19.6%, a proportion much higher than other respiratory viral infections including RSV, adenovirus and parainfluenza. (2)Among the patients suffered from the URIs, the incidence of influenza A infections was 29.6% in the FS patients, a proportion significantly higher than the incidence (13.1%) in the febrile patients but without seizures. When compared with non-influenza infected FS patients, the patients infected with influenza A had clinical characteristics of an older age, a higher body temperature at seizure occurrence and shorter seizure duration. On multiply logistic regression analysis, influenza A was associated with multiply seizures and adenovirus was associated with prolonged postictal impaired consciousness (PPIC). Two of 31 patients performed with cerebrospinal fluid tests were found a slightly elevated WBC and a normal protein, glucose and Chloride, and the two patients with abnormal CSF findings were mainly experienced a prolonged postictal drowsiness and then excluded from the FS patients. It is suggested that the diagnosis of FS is needed to exclude the intracranial infections.Conclusions (1) Influenza A is a relative risk factor to the development of FS, and influenza A infections are more common than other respiratory viruses including RSV, adenovirus and parainfluenza in FS patients.(2) Influenza A infections are more found in the elder FS patients aged 3 years or older. In the influenza epidemics, the vaccination administered in elder FS children especially with a past history, may be a new way to prevent FS. (3) In clinical practices, there may be a small part of FS patients involved in CNS infections. It is essential to perform a lumber puncture and a CSF test to differentiate intracranial infections from FS when necessarily.