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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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Epidemiological, Clinical and Etiological Aspects of non-traumatic comas in Children at the Pediatric Teaching Hospital in Bangui

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Open Journal of Pediatrics 2022年第3期12卷 489-506页

作者： Olivier Brice Bogning Mejiozem Moyen Engoba Evodie Pierrette Bogning Kakounguere Jean Chrysostome Gody Centre Hospitalier Universitaire Pédiatrique de Bangui Bangui Central African Republic Université Marien Ngouabi Brazzaville Republic of the Congo Faculté des Sciences de la Santé de l’Université de Bangui Bangui Central African Republic

Background: non-traumatic coma is the most common pediatric medical emergency. Its clinical diagnosis is easy. The difficulty lies in finding the etiology. Objective: To determine the prevalence and clinical profiles of non-traumatic coma at the Centre Hospitalier Universitaire Pédiatrique de Bangui (CHUPB). Methodology: This was a descriptive and analytical cross-sectional study conducted between January 1 and June 31, 2021, at CHUPB. Children aged 1 month to 15 years, admitted to the emergency room with a Glasgow score less than or equal to 8 without any traumatism were included. The variables studied were sociodemographic, clinical and paraclinical. Data were entered and analyzed using SPSS 20.0 statistical software. The statistical test used was Pearson’s chi2, any p-value Results: Of 8551 children hospitalized during the study period, 370 were hospitalized for non-traumatic coma: 4.32%. They were divided into 57.5% (n = 213) boys and 42.44% (n = 157) girls, giving a sex ratio of 1.35. Their mean age was 35.95 ± 27.21 months. Children aged 1 to 24 months represented 54.59% (n = 202) of cases. The mean time to the consultation was 2.91 days ± 1.8. Fever 86.48% (n = 320) and convulsions 80% (n = 296) were the main reasons for consultation. coma stages II - III and IV represented 52.44% (n = 194), 42.97% (n = 159) and 4.59% (n = 17) respectively. Neuromalaria (29.72%;n = 110), meningitis-meningoencephalitis-encephalitis (30%;n = 111), sepsis (19.72%;n = 73) and acidosis coma (5.40%;n = 20) were the main etiologies. Conclusion: non-traumatic coma is common at CHUPB. Infections were the main etiology, particularly cerebral malaria. The reduction of its frequency requires, among others, the strengthening of the national monitoring malaria program. The strengthening of the technical platform for a good etiological diagnosis constitutes the other axis of prevention.

关键词： non-traumatic coma Child Epidemiological-Clinical Etiological CHUPB

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