A Prospective Observational Study of Children with FS-Associated Hospitalization: The Implication and Outcomes of Pathogen Detection in Cerebrospinal Fluid

Fang Chen,* Fan Feng,* Dianping You, Yinghui Guo, Shuo Yang, Tong Zhao, Suzhen Sun,* Le Wang* Institute of Pediatric Research, Children’s Hospital of Hebei Province, Shijiazhuang, 050031, People’s Republic of China*These authors contributed equally to this workCorrespondence: Le Wang, Institute of Pediatric Research, Children’s Hospital of Hebei Province, 133 Jianhua South Street, Shijiazhuang, Hebei Province, 050031, People’s Republic of China, Tel +86-0311-85911389, Email luka_wl@163.comBackground: Febrile seizures (FS) are a common cause of paediatric emergencies, but research on their aetiology and epidemiology are limited. The aim of this study was to investigate the prevalence of central nervous system (CNS) pathogenic infections in patients with FS-associated hospitalization.Methods: A prospective observational study was conducted in children under 16 years of age with FS-associated hospitalization. Demographic, clinical and laboratory data were recorded. Multiplex-PCR was performed on cerebrospinal fluid (CSF) samples for nine viruses, nine bacteria and one fungus.Results: A total of 119 children were enrolled between June 2021 and June 2022. Of these, 83.2% had a final diagnosis of FS (69.7%) or FS plus (13.4%). In addition, epilepsy and encephalitis/meningitis were also found in 16.8% (20/119). Seven pathogens were identified from 9 CSF samples (7.6%), including viruses (EV, EBV, HHV-6) and bacteria (H. influenzae, S. pneumoniae, M. tuberculosis, S. putrefaciens). There were no significant clinical or laboratory differences between children who tested positive or negative for pathogens in the CSF, except for the presentation of herpes pharyngitis. Children with encephalitis/meningitis had longer hospital stays compared with those diagnosed with FS at discharge; abnormal EEG findings were significantly more common in patients with epilepsy.Conclusion: FS-associated hospitalized children may have viral or bacte