Scenario

You are asked to review a previously healthy 11-month-old boy who presented to the Accident and Emergency department following a generalised convulsion lasting 7 min. His parents tell you that he was started on oral amoxicillin by his general practitioner 2 days ago, the reason for which is unclear. Clinical examination reveals a drowsy child with a temperature of 38.8°C. In the absence of a clear focus of infection you decide to do a full septic screen, including a lumbar puncture (LP). Cerebrospinal fluid (CSF) analysis shows a white blood cell count (WCC) of 17×10⁶/l, a protein concentration within normal limits and no bacteria on a Gram stain. You wonder if the mild CSF pleocytosis indicates partially treated meningitis or can be attributed to the convulsion alone.

Structured clinical question

In a child with a febrile convulsion [patient], does the convulsion alone [intervention] cause CSF pleocytosis (defined as CSF WCC>7×10⁶/l) [outcome]?

Search strategy and outcome

Medline was searched with the PubMed interface (1950 to present, limited to publications in English) using the search terms: (epilepsy OR convulsion OR seizure) AND (cerebrospinal fluid OR lumbar puncture OR blood brain barrier) AND (leukocyte OR leukocytosis OR pleocytosis OR white blood cell OR cell count). This produced 357 matches, of which five were relevant.1,–,5

Searches of EMBASE (1970 to present; 1012 matches) and Scopus (1960 to present; 717 matches) using the same search strategy did not identify any additional papers. All relevant publications were hand-searched for further references, which identified a further four relevant reports.6,–,9

In instances where the original manuscript provided insufficient information, the authors were contacted for further details. The search date was 1 May 2011. The relevant papers are summarised …