Six-hundred-and-forty-two previously healthy children aged 1 month to 5 years with fever of acute onset, without localizing signs of infection, were prospectively recruited over 1 year. Sixty-three per cent had malaria, 4 per cent bacteraemia, and 7 per cent malaria and bacteraemia. Neither infection was identified in 27 per cent. Malaria was the predominant infection irrespective of season, temperature on presentation, or age (except under 6 months). Although Gram-negative bacteraemia was overall commoner than Gram-positive bacteraemia, Staphylococcus aureus was the commonest single organism (43 per cent) in bacteraemic patients. The prevalence of malaria increased with age while that of bacteraemia decreased with age (P < 0.0005). The prevalence of an identifiable infection increased with the temperature on presentation (P < 0.025). It is concluded that although malaria is the predominant infection in previously healthy under-5 children with acute fever without specific localizing signs of infection, bacteraemia (alone or associated with malaria) occur with an importantly high frequency. It is recommended that while presumptive treatment for malaria is justified in such children, evaluation for bacteraemia should be given consideration.

The pattern of epilepsy in children in Nigeria showed little difference from that seen in children in western countries, except that birth asphyxia was relatively common as a cause and there was a longer time between onset of seizures and parents seeking medical care. It was estimated that good control of seizures was achieved in 52.9% of children, but more than a quarter attended the clinic only once or twice and the reasons for this are not known. The response to medication was less satisfactory for children under 1 year, a result consistent with most other studies. Some uncommon forms and associations of epilepsy were recognised. An EEG was not essential for management but was useful for the diagnosis of syndromes. Treatment was equally effective when commenced 5 years or more after the onset of seizures. The anti-convulsant used for most children was phenobarbitone which had to be discontinued in only two cases because of side-effects. Phenobarbitone has been successfully used to treat epilepsy by primary health workers in rural Africa and this is expected to continue in the future.

Five-hundred-and-twenty-two infants and children aged 1 month to 6 years presenting at the Children's Emergency Room of the University of Benin Teaching Hospital with convulsions associated with fever (CAF) of acute onset were prospectively evaluated to determine the pattern of infections. Twenty-six per cent had localized infections of which 38 per cent were intracranial (meningitis = 16 per cent, cerebral malaria = 19 per cent, and encephalitis = 3 per cent) and 62 per cent were extracranial with respiratory tract infections contributing 51 per cent. Although, the prevalence of meningitis was significantly higher in 1-6 months old infants when compared with older children (47 per cent v. 12 per cent; P < 0.005), it was, none-the-less, present in all the other age groups (with a prevalence of 8-17 per cent). Seventy-four per cent of the children had no localizing signs of infection. Of these 68 per cent had malaria, 4 per cent bacteraemia, and 7 per cent malaria with bacteraemia, while no infections were identified in 21 per cent. Among children with bacteraemia Staphylococcus aureus was the commonest single isolate (33 per cent) although, overall, enterobacteriaceae were the commonest. We conclude, first, that meningitis should be excluded in all children aged under 6 years who present with CAF of acute onset and, secondly, that although anticipatory treatment for malaria is justified in children with CAF of acute onset without localizing signs of infection, consideration should also be given to the problem of bacteraemia.

There is a paucity of literature about the pattern of neurological diseases in children attending out-patient departments in Africa. In this study more boys than girls presented at our clinic. Almost all the principal diseases seen are eminently preventable. There appears to be no effective immunization programme. There is need for epidemiological studies to ascertain the true incidence of subacute sclerosing panencephalitis in view of the high incidence of measles in the community.

A total of 522 children, aged 1 month to 6 years, who presented with convulsions and fever of acute onset at the Children's Emergency Room of the University of Benin Teaching Hospital over a 1-year period, were prospectively evaluated. Bacterial meningitis was diagnosed in 22 (4.2%) on bacteriological and/or biochemical evidence. The causative organisms were cultured from the CSF in 13 (Neisseria meningitidis = 7, Streptococcus pneumoniae = 5 and Haemophilus influenzae = 1) and identified by Gram stain only in three (Gram-positive diplococci = 2 and Gram-negative diplococci = 1). No organisms were identified in the CSF of six of the children with meningitis. The prevalence of meningitis declined sharply after 6 months of age. Six of the children with bacterial meningitis lacked classical meningeal signs but had other indications for lumbar puncture. The following were significantly associated with meningitis: age under 6 months; focal or multiple seizures; absence of a past or family history of seizures; unrousable coma; and an extracranial focus of infection. It is concluded that bacterial meningitis occurs in a good proportion of children, even beyond infancy, with convulsions associated with fever of acute onset, and that decision on the need for lumbar puncture should be guided by clinical features such as age and the presence of complex febrile seizures.

A 3-year-old Nigerian boy was treated with phenobarbitone after having a nonfebrile seizure. Two weeks later his urine was found to contain porphobilinogen, indicating that latent acute intermittent porphyria had been unmasked by phenobarbitone. The drug was discontinued and carbamazepine was substituted. The urine became free of porphobilinogen and the patient remained well. In developing countries phenobarbitone is the most widely used anticonvulsant; it must be avoided in acute intermittent porphyria, and carbamazepine may be tolerated.

SUMMARY The authors report 522 infants and young children aged between one month and six years who presented with convulsions and fever as emergencies in Nigeria. 22 had bacterial meningitis, six of whom lacked the usual signs of meningitis. Although features of complex febrile convulsions were significantly associated with bacterial meningitis, it is concluded that, as an aid to the early diagnosis of bacterial meningitis, all preschool children convulsing with fever in developing countries should have a lumbar puncture. This may reduce the contribution of meningitis to chronic neurological disabilities. The necessity for such a policy is illustrated by a case report of a young infant with convulsions and fever caused by meningitis, seen at a general hospital. RÉSUMÉ Convulsions fébriles comme signe annonciateur de méningite bactérienne parmi les enfants d'âge préscolaire dans les pays en voie de développement Les auteurs décrivent 522 nourrissons et jeunes enfants âgés de un mois à six ans, s'adressant aux urgences du Nigéria, pour convulsions fébriles. 22 présentaient une méningite bactérienne dont six sans les signes habituels de méningite. Bien que les symptomes de convulsions fébriles complexes étaient significativement associés aux méningites bactériennes, la ponction lombaire s'impose chez tous les enfants d'âge préscolaire avec convulsions fébriles, dans les pays en voie de développement. Cela pourrait réduire la part des méningites dans les troubles neurologiques chroniques. La nécessite d'une telle politique est illustrée par un cas d'un jeune enfant avec convulsions fébriles, vu dans un hôpital général. ZUSAMMENFASSUNG Krämpfe bei Fieber als Symptom einer bakteriellen Meningitis bei Vorschulkindern in Entwicklungsländern Die Autoren berichten über 522 Säuglinge und Kleinkinder im Alter zwischen einem Monat und sechs Jahren, die mit Krämpfen und Fieber als Notfälle in Nigeria behandelt wurden. 22 hatten eine bakterielle Meningitis, sechs davon hatten keine üblichen Meningitiszeichen. Da die Symptome der komplexen Fieberkrämpfe und der bakteriellen Meningitis in engem Zusammenhang stehen, wird gefordert, daß in den Entwicklungsländern bei jedem Vorschulkind, das bei Fieber krampft, eine Lumbalpunktion durchgeführt werden sollte, urn eine Früdiagnose der bakteriellen Meningitis zu ermöglichen. Dadurch kann die Anzahl der chronischen neurologischen Behinderungen durch Meningitis verringert werden. Die Notwendigkeit dieser Maßnahme wird durch den Fallbericht eines Säuglings mit Krämpfen bei Fieber im Rahmen einer Meningitis veranschaulicht, der im Gerneral Hospital behandelt wurde. RESUMEN Convulsiones con fiebre como forma de presentación de una meningitis bacteriana en preescolares de un pais en vias de desarrollo Los autores refieren 522 lactantes y niños pequeños de un mes a seis años de edad que presentaron convulsiones y fiebre como signos de urgencia en Nigeria. 22 tenian una meningitis bacteriana y de ellos seis carecian de los signos usuales de meningitis. Aunque las caracteristicas de las convuls...

Evaluation of 446 infants and young children (6 months to 5 years olds) with malaria parasitaemia showed a significant relationship (P < 0.05- < 0.001) (a) between coma and age, pattern of convulsions, haematocrit, and blood glucose, and (b) between the severity of parasitaemia and risk of convulsions, prevalence of hepatosplenomegaly, and severe anaemia. No significant relationship was observed between convulsions and temperature or haematocrit. Comatose children were older and had a higher prevalence of repeated convulsions, severe anaemia, and hypoglycaemia than non-comatose children. Convulsions, hepatosplenomegaly, and severe anaemia were more prevalent in children with moderate-severe parasitaemia. It is concluded that convulsions with malaria are more often a manifestation of cerebral dysfunction rather than being simply febrile in nature. All forms of cerebral dysfunction in malaria, including repeated convulsions, should be managed as being clinical manifestations of cerebral malaria.