What could cause fever and seizures in a 1-year-old?

Question

Hello doctor,

My one-year-old daughter had a fever for four days, with one episode of seizure on the fourth day which lasted less than a minute. There was no post-ictal confusion or drowsiness. At first, the doctors started with Ceftriaxone and Amikacin for four days, then a lumbar puncture was done showing leucocytes. The report said 135 with 80 percent lymphocytes and 20 percent monocytes. The day before the lumbar puncture, she was started on Vancomycin.

The blood culture done before starting Ceftriaxone showed Staphylococcus growth with 50 thousand colonies. They said it may be contaminated. Urine culture showed enterococcus faecium, but a repeat test came back negative. All subsequent tests came back negative.

Now the child is doing well, without fever for four days. They stopped both Vancomycin and Amikacin and were told to continue Ceftriaxone for two weeks. I am awaiting the CSF culture reports. My concern is whether it is right not to give Vancomycin. Please advise.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concerns.

From the symptoms and investigations, your child is most probably having meningitis (an infection and inflammation of the membranes that cover the brain and spinal cord).

The first line of treatment is Ceftriaxone and Amikacin. This covers the most common organism for meningitis at this age. The blood culture which showed Staphylococcus is most probably a contaminant because a Staphylococcus infection spreads very rapidly. In most of the conditions, the blood culture takes into account the skin contaminant.

We have to look at it from a clinical point of view. Clinically, the child does not seem to have a staphylococcal infection. In this case, the condition becomes much worse in a very short time. I think that your child is getting treated correctly, and there is no need to add Vancomycin.

I hope this helps.

Please let me know if you need any help.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

This is absolutely fine. A seven-day course of Amikacin and a 14-day course of Ceftriaxone (antibiotics) will ensure complete eradication of the causative organism.

There is nothing to worry.

I hope that you get your answer.

Please let me know if you need any help.

Thank you.