Impact of Respiratory Viruses and SARS-CoV-2 on Febrile Seizures in Saudi Children: Insights into Etiologies, Gender, and Familial Associations

Abstract

BACKGROUND Childhood febrile seizures occur between 5 months and 6 years of age in children without a previous history of seizure and are associated with high temperature in the absence of intracranial infection. This retrospective study identified 71 children aged 6 months to 5 years with febrile seizures between 2017 and 2021 at a single center in Saudi Arabia and aimed to identify an association between common respiratory virus and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. MATERIAL AND METHODS Pediatric nasopharyngeal specimens were tested using a multiplex PCR respiratory panel detecting human coronaviruses (NL63, 229E, OC43, HKU1), influenza A/B, human adenovirus, parainfluenza viruses 1-4, respiratory syncytial virus, human metapneumovirus, rhinovirus/enterovirus, Middle East respiratory syndrome coronavirus, and, as of September 2021, SARS-CoV-2, confirmed using the Cepheid Xpert Xpress SARS-CoV2 RT-PCR kit. RESULTS In a cohort of 71 pediatric patients (median age, 19 months; 54.9% female), dominant pathogens included human rhinovirus/enterovirus (23.9%), influenza A/B (26.8%), and SARS-CoV-2 (14.1%). Concurrent infections were noted in 28.2%. Simple seizures occurred in 69%, and complex seizures in 31%. Females exhibited an 8.18-fold increased risk for complex seizures. Each additional fever day reduced complex seizure risk by 36%. Familial seizure history increased risk 8.76-fold. Human rhinovirus/enterovirus or parainfluenza infections inversely affected complex seizure likelihood compared with adenovirus. CONCLUSIONS In Saudi children with febrile seizures, distinct viral etiologies, sex, and familial links play pivotal roles. Given regional viral variations, region-tailored diagnostic and therapeutic strategies are paramount. A multicenter prospective cohort study is essential for comprehensive understanding.

Figure 1

Proportional representation of viral etiologies in the pediatric cohort (N=71). The chart shows the distribution of viral agents identified within the cohort of 71 pediatric patients. Values of each pie segment are given as numerical count and percentage of the total. (This chart was generated using Microsoft Excel 2021. Data points were inputted into an Excel spreadsheet).

Figure 2

Multivariate logistic regression analysis of febrile seizure types in pediatric cohort aged 6 months to 5 years. Key findings include the 8.18-fold risk of female sex for complex seizures (P=0.035); 36% reduced odds with each duration of fever (DOF) day (OR=0.64, P=0.031); 8.76-fold risk with family history (FamHis) (P=0.021); Reduced risk with human rhinovirus/enterovirus or parainfluenza vs adenovirus (OR=0.01, P=0.006; OR=0.04, P=0.047); 17.91-fold risk lumbar puncture for complex seizure (P=0.033). Factors like age, temperature on admission (TemonAd), maximum temperature (MaxTem), length of hospital stay (LOHS), co-infection (Coinf), and SARS-CoV-2 were non-significant. P<0.05 is statistically significant. (This figure created by ‘Finalfit’ R package, version 1.0.6, was published on January 14, 2023. The primary authors are Ewen Harrison, Tom Drake, and Riinu Ots).