Non-traumatic coma in young children in Benin: are viral and bacterial infections gaining ground on cerebral malaria?

• 作者: Brisset Josselin Baki Karl Angendu Watier Laurence Kinkpé Elisée Bailly Justine Ayédadjou Linda Alao Maroufou Jules Dossou-Dagba Ida Bertin Gwladys I. Cot Michel Boumédiène Farid Ajzenberg Daniel Aubouy Agnès Houzé Sandrine Faucher Jean-Fran?ois NeuroCM Group
• 来源期刊: 贫困所致传染病（英文）
• 关键词: Non-traumatic coma Cerebral malaria Co-infection Central nervous system infection West Africa
• 年，卷（期）: 2022,（2）
• 所属期刊栏目: Research Article
• 页码范围: 1-10
• 页数: 10页
• 语种: 中文
• DOI: 10.1186/s40249-022-00956-2

摘要

Background::While malaria morbidity and mortality have declined since 2000, viral central nervous system infections appear to be an important, underestimated cause of coma in malaria-endemic Eastern Africa. We aimed to describe the etiology of non-traumatic comas in young children in Benin, as well as their management and early outcomes, and to identify factors associated with death .Methods::From March to November 2018, we enrolled all HIV-negative children aged between 2 and 6 years, with a Blantyre Coma Score ≤ 2, in this prospective observational study. Children were screened for malaria severity signs and assessed using a systematic diagnostic protocol, including blood cultures, malaria diagnostics, and cerebrospinal fluid analysis using multiplex PCR. To determine factors associated with death, univariate and multivariate analyses were performed.Results::From 3244 admissions, 84 children were included: malaria was diagnosed in 78, eight of whom had a viral or bacterial co-infection. Six children had a non-malarial infection or no identified cause. The mortality rate was 29.8% (25/84), with 20 children dying in the first 24 h. Co-infected children appeared to have a poorer prognosis. Of the 76 children who consulted a healthcare professional before admission, only 5 were prescribed adequate antimalarial oral therapy. Predictors of early death were jaundice or increased bilirubin [odd ratio ( OR)= 8.6; 95% confidential interval ( CI): 2.03–36.1] and lactate > 5 mmol/L ( OR= 5.1; 95% CI: 1.49–17.30). Antibiotic use before admission ( OR = 0.1; 95% CI: 0.02–0.85) and vaccination against yellow fever ( OR= 0.2, 95% CI: 0.05–0.79) protected against mortality. Conclusions::Infections were found in all children who died, and cerebral malaria was by far the most common cause of non-traumatic coma. Missed opportunities to receive early effective antimalarial treatment were common. Other central nervous system infections must be considered in their management. Some factors that proved to be protective against early death were unexpected.