Comparing the use of, and considering the need for, lumbar puncture in children with influenza or other respiratory virus infections

• Published in: Influenza and other respiratory viruses 2013-11, Vol.7 (6), p.932-937
• Main Authors: Khandaker, Gulam, Heron, Leon, Rashid, Harunor, Li‐Kim‐Moy, Jean, Lester‐Smith, David, Kesson, Alison, McCaskill, Mary, Jones, Cheryl, Zurynski, Yvonne, Elliott, Elizabeth J., Dwyer, Dominic E., Booy, Robert
• Format: Article
• Language: English
• Subjects: Adolescent; Australia; Bacteremia; Bacteremia - diagnosis; Bacterial meningitis; Child; Child, Preschool; children; Diagnosis, Differential; Female; Humans; Infant; Infant, Newborn; influenza; lumbar puncture; Male; Meningitis, Bacterial - diagnosis; Original; Part 1; Respiratory syncytial virus; Respiratory Tract Infections - diagnosis; respiratory viral infection; Retrospective Studies; Spinal Puncture - utilization; Virus Diseases - diagnosis; Young Adult
• ISSN: 1750-2640; 1750-2659
• DOI: 10.1111/irv.12039

Please cite this paper as: Khandaker et al. (2012) Comparing the use of, and considering the need for, lumbar puncture in children with influenza or other respiratory virus infections. Influenza and Other Respiratory Viruses DOI:10.1111/irv.12039. Background  The clinical presentation of influenza in infancy may be similar to serious bacterial infection and be investigated with invasive procedures like lumbar puncture (LP), despite very limited evidence that influenza occurs concomitantly with bacterial meningitis, perhaps because the diagnosis of influenza is very often not established when the decision to perform LP is being considered. Methods  A retrospective medical record review was undertaken in all children presenting to the Children’s Hospital at Westmead, Sydney, Australia, in one winter season with laboratory‐confirmed influenza or other respiratory virus infections (ORVIs) but excluding respiratory syncytial virus, to compare the use of, and reflect on the need for, the performance of invasive diagnostic procedures, principally LP, but also blood culture, in influenza and non‐influenza cases. We also determined the rate of concomitant bacterial meningitis or bacteraemia. Findings  Of 294 children, 51% had laboratory‐confirmed influenza and 49% had ORVIs such as parainfluenza viruses (34%) and adenoviruses (15%). Of those with influenza, 18% had a LP and 71% had a blood culture performed compared with 6·3% and 55·5% in the ORVI group (for both P