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

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Infectious Diseases of Poverty 2022年第2期11卷 1-10页

作者： Josselin Brisset Karl Angendu Baki Laurence Watier Elisee Kinkpe Justine Bailly Linda Ayedadjou Maroufou Jules Alao Ida Dossou-Dagba Gwladys I.Bertin Michel Cot Farid Boumediene Daniel Ajzenberg Agnes Aubouy Sandrine Houze Jean-Francois Faucher neurocm group Infectious Diseases and Tropical Medicine Department Limoges University Hospital2 Avenue Martin Luther King87000 LimogesFrance Inserm UMR 1094 IRD U270EpiMaCT-Epidemiology of chronic diseases in tropical zoneInstitute of Epidemiology and Tropical NeurologyOmegaHealthUniv.LimogesCHU LimogesLimogesFrance Center for Research in Epidemiology and Population Health(CESP) INSERM U1018Paris-Saclay UniversityUVSQMontigny-Le-BretonneuxFrance Epidemiology and Modeling of Bacterial Evasion to Antibacterials Unit(EMEA) Institut Pasteur25-28Rue du Dr.Roux75724 Paris Cedex 15France Paediatric Department Calavi HospitalCalaviBenin UMR261 MERIT IRDUniversite de Paris75006 ParisFrance French Malaria Reference Center Hopital BichatAPHPParisFrance Paediatric Department Mother and Child University and Hospital Center(CHU-MEL)CotonouBenin Clinical Research Institute of Benin(IRCB) Abomey CalaviBenin UMR152 PHARMADEV Universite de ToulouseIRDUPSToulouseFrance Parasitology Laboratory Hopital Bichat-Claude-BernardAPHPParisFrance. 不详

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 *** 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 ***: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 *** were screened for malaria severity signs and assessed using a systematic diagnostic protocol,including blood cultures,malaria diagnostics,and cerebrospinal fluid analysis using multiplex *** determine factors associated with death,univariate and multivariate analyses were ***:From 3244 admissions,84 children were included:malaria was diagnosed in 78,eight of whom had a viral or bacterial *** children had a non-malarial infection or no identified *** mortality rate was 29.8%(25/84),with 20 children dying in the first 24 ***-infected children appeared to have a poorer *** the 76 children who consulted a healthcare professional before admission,only 5 were prescribed adequate antimalarial oral *** 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 ***:Infections were found in all children who died,and cerebral malaria was by far the most common cause of non-traumatic *** opportunities to receive early effective antimalarial treatment were *** central nervous system infections must be considered in their *** factors that proved to be protective against early death were unexpected.

关键词： Non-traumatic coma Cerebral malaria Co-infection Central nervous system infection West Africa

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