Fever and Bulging Fontanelle: Not Necessarily Nefarious

Only 1 of 153 infants with fever and bulging fontanelles who underwent lumbar puncture had bacterial meningitis.

In infants with fever and bulging fontanelles, lumbar puncture is considered mandatory to rule out bacterial meningitis. To examine the etiology of such symptoms, researchers retrospectively reviewed the medical charts of 153 children (age range, 3–11 months) who underwent lumbar puncture to evaluate fever (rectal temperature, ≥38°C) and bulging anterior fontanelles during 2000 to 2008 at a single hospital in Israel.

Only one case of bacterial meningitis (Streptococcus pneumoniae) was identified; the child also had other symptoms, including vomiting and restlessness, and appeared septic and lethargic during the physical exam. Cerebrospinal fluid (CSF) showed pleocytosis in 27% of children (including the child with bacterial meningitis), was …

Reviewing Author

F. Bruder Stapleton, MD

Disclosures

Consultant/Advisory BoardCareer Physician

Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesAmerican Society of Pediatric Nephrology Foundation (Chair)

F. Bruder Stapleton, MD

Disclosures

Consultant/Advisory BoardCareer Physician

Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesAmerican Society of Pediatric Nephrology Foundation (Chair)

Fever and Bulging Fontanelle: Not Necessarily Nefarious

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Reviewing Author