الفهرس 
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Abstract
Infants and children presenting with fever and convulsions represent a relatively common emergency presented to outpatients as well as emergency pediatric department. The main question to be answered in this situation is whether the child has meningitis.
Examination of cerebrospinal fluid (CSF) is very essential for accurate diagnosis of acute bacterial meningitis (ABM). However performing lumber puncture to obtain CSF is a risky procedure. Therefore there is a worldwide debate about the necessity of lumber puncture in cases of fever and convulsions.
This is a prospective cohort observational study done in Sohag university hospital in the period between 1st of December 2012 to 30th of November 2013 on infants and children from the age of one month to 12 years old who presented with fever and convulsions to the pediatric emergency department, the inpatient department and the intermediate care unit at the pediatric department during the period of the study. Neonates and cases with contraindications to lumbar puncture were excluded from the study.
We performed a clinical analysis and reviewing the data of 85 infants and children having fever and convulsions and investigated them by lumbar puncture with special consideration to findings in the clinical assessment of the patients that are suggestive of CNS infections.
We found that CNS infections as a broad term are common in our locality and acute bacterial meningitis is not exclusion. However its presence in the absence of clinical symptoms and signs of meningeal irritation is a remote possibility, but it should always be considered. So lumbar puncture should be done for cases with clinical manifestations of meningitis or in the presence of risk factors.
Making the diagnosis of CNS infection was common among infants and children presenting with fever and convulsions, however ABM was only confirmed in the cases with additional finding of signs of meningeal irritation.
Our recommendation is to inform pediatricians in our locality to raise their clinical suspicion for CNS infections especially ABM in all cases presenting with fever and convulsions in different age groups and to lower their threshold to perform lumbar puncture to exclude this diagnosis and as an aid to the early diagnosis. This may reduce the contribution of meningitis to chronic neurological disabilities.
Another important recommendation is that, based on the common occurrence of CNS infections and ABM in our locality, the immunization program in Egypt should be Up-to-date and consistent with that in developed countries where immunization with the Haemophilus, pneumococcal, and meningococcal conjugate vaccines has had a significant impact on the incidence of invasive diseases in children caused by these organisms (Peltola, 2000) either as a routine practice or for children at risk.
We also recommend that this idea of research should be repeated in the future on a larger number of cases including different age groups in our locality and with better facilities and resources.