Causes of Secondary and Prolonged Fever During Treatment of Bacterial Meningitis and Viral Encephalitis

The aim of the present study is to investigate causes of secondary and prolonged fever during treatment of viral encephalitis and bacterial meningitis in children aged from one month to 18 years .

Study Overview

• Status: Not yet recruiting
• Conditions: Meningitis in Children; Encephalitis in Children

Detailed Description

Fever is a common symptom in both viral encephalitis and bacterial meningitis. However, in some patients, fever may persist or recure during the course of treatment. This can be concerning and may indicate unresolved infection, secondary infections, inflammatory responses, or treatment complications. Understanding the underlying causes and adopting a structured approach to management is crucial for improving patient care. Prolonged fever means fever persisting beyond 8-10 days despite appropriate treatment. Secondary fever means fever occurring after an initial period of defervescence, meaning the fever had initially subsided for at least 48 hours before recurring or a new fever spike following an apparent resolution. The common and established causes of secondary and prolonged fever in pediatrics patients during the treatment of bacterial meningitis and viral encephalitis include, nosocomial infections, subdural effusion, phlebitis, pneumonia , drug fever, otitis media, gastroenteritis and urinary tract infection . Subdural effusion prolongs fever in patients with meningitis. It occurs as a complication due to persistent inflammation, secondary infection, or inadequate resolution of the infection within the subdural space. Urinary tract infections (especially in catheterized patients) is nosocomial or superimposed infections that cause secondary or prolonged fever in pediatric patients during the treatment of meningitis or encephalitis. Otitis media can cause secondary or prolonged fever during the treatment of meningitis and encephalitis in pediatric patients. This can occur due to persistent infection, suppurative complications (such as mastoiditis or subdural empyema), or an inadequate response to initial antimicrobial therapy. Pneumonia, including hospital-acquired pneumonia, can cause secondary or prolonged fever during the treatment of CNS infections in pediatric patients. This occurs due to superimposed bacterial infections, ventilator-associated pneumonia in critically ill children, or aspiration pneumonia in patients with neurological compromise. Gastro-entritis can occur in hospitalized children undergoing treatment for CNS infections due to concurrent infections, dehydration-related metabolic disturbances, or systemic inflammatory responses. Enteric pathogens such asRotavirus, Norovirus, or bacterial causes like Salmonella and Clostridioides difficile can contribute to prolonged fever in hospitalized children undergoing treatment for CNS infections. Phlebitis can cause secondary fever during the treatment of encephalitis and meningitis in pediatric patients. It is often associated with intravenous catheter use, leading to localized or systemic infections, including catheterrelated bloodstream infections, which can contribute to persistent or recurrent fever.

Drug fever is a well-recognized phenomenon where fever arises as an adverse reaction to medications, often without an identifiable infectious source. It typically resolves upon discontinuation of the offending drug. In the context of meningitis and encephalitis treatment, antibiotics (e.g., beta-lactams, sulfonamides, vancomycin), anticonvulsants, and antipyretics have been implicated. A relapse of encephalitis or meningitis occurs due to incomplete eradication of the infection, emergence of resistant pathogens, or host immune deficiencies. This can lead to persistent inflammation, ongoing infection, or secondary complications such as subdural effusion or vasculitis, which contribute to prolonged or recurrent fever.

• Study Type: Observational
• Enrollment (Estimated): 50

Contacts and Locations

• Study Contact: Name: Kerolos Atef Shafeek Tanious; Phone Number: +201278046794; Email: keroatef743@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Included children aged from one month to 18 years , who were diagnosed as bacterial meningitis or viral encephalitis and admitted to neurological department at AUCH and develop secondary or prolonged fever despite appropriate treatment .

Description

Inclusion Criteria:

• Children from one month to 18 years.
• Who were diagnosed with bacterial meningitis or viral encephalitis and admitted to neurological department at Assiut University Children's Hospital (AUCH).
• Develop secondary or prolonged fever despite appropriate treatment.

Exclusion Criteria:

• Pediatric patients with suspected autoimmune encephalitis.
• Patient on immunosuppressive therapy (e.g., post-organ transplant, chemotherapy).
• Pediatric patients suspected metabolic disorders.
• Those with suspected endocrine dysfunction.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Causes of secondary and prolonged fever during treatment of bacterial meningitis and viral encephalitis	Causes of secondary and prolonged fever during treatment of bacterial meningitis and viral encephalitis	Basline

Collaborators and Investigators

• Sponsor: Assiut University
• Investigators: Principal Investigator: Prof. Mostafa Shafeek Khalaf Tawfeek, Professor of Pediatrics, Assiut University; Principal Investigator: Dr. Khalaf Abd El-Aal Sayed Mohamed, Lecturer of Pediatrics, Assiut University

Publications and helpful links

General Publications

• Brouwer MC, McIntyre P, de Gans J, Prasad K, van de Beek D. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2010 Sep 8;(9):CD004405. doi: 10.1002/14651858.CD004405.pub3.

Study record dates

Study Major Dates

• Study Start (Estimated): May 1, 2025
• Primary Completion (Estimated): April 1, 2026
• Study Completion (Estimated): May 1, 2026

Study Registration Dates

• First Submitted: April 29, 2025
• First Submitted That Met QC Criteria: May 10, 2025
• First Posted (Actual): May 14, 2025

Study Record Updates

• Last Update Posted (Actual): May 14, 2025
• Last Update Submitted That Met QC Criteria: May 10, 2025
• Last Verified: May 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Infectious Encephalitis; Neuroinflammatory Diseases; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Infections; Virus Diseases; Bacterial Infections; Bacterial Infections and Mycoses; Central Nervous System Viral Diseases; Central Nervous System Infections; Central Nervous System Bacterial Infections; Meningitis; Encephalitis; Encephalitis, Viral; Meningitis, Bacterial
• Other Study ID Numbers: meningitis and encephalitis

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No