1. Non-traumatic coma in young children in Benin: are viral and bacterial infections gaining ground on cerebral malaria?
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Josselin, Brisset, Karl, Angendu Baki, Laurence, Watier, Elisée, Kinkpé, Justine, Bailly, Linda, Ayédadjou, Maroufou Jules, Alao, Ida, Dossou-Dagba, Gwladys I, Bertin, Michel, Cot, Farid, Boumédiène, Daniel, Ajzenberg, Agnès, Aubouy, Sandrine, Houzé, Jean-François, Faucher, Bertin, Vianou, Service des Maladies infectieuses et tropicales [CHU Limoges], CHU Limoges, Epidémiologie des Maladies Chroniques en zone tropicale (EpiMaCT), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-OmégaHealth (ΩHealth), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Epidémiologie et modélisation de la résistance aux antimicrobiens - Epidemiology and modelling of bacterial escape to antimicrobials (EMAE), Institut Pasteur [Paris] (IP)-Université Paris Cité (UPCité), Centre Hospitalier Universitaire de Zone d'Abomey Calavi / Sô-Ava (CHUZ / AS), Mère et enfant en milieu tropical : pathogènes, système de santé et transition épidémiologique (MERIT - UMR_D 261), Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Universitaire de la Mère et de l'Enfant Lagune (CHU-MEL), Service de Parasitologie Mycologie [CHU Limoges], Institut de Recherche Clinique du Bénin [Abomey-Calavi, Bénin] (IRCB), Pharmacochimie et Biologie pour le Développement (PHARMA-DEV), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), This work was funded by the French National Research Agency (ANR-17-CE17-0001)., NeuroCM group: Dissou Affolabi (Pediatric Department, Calavi Hospital, Calavi, Benin), Nicolas Argy (MERIT UMR 261, IRD, Université de Paris, Paris, France), Bibiane Biokou (Pediatric Department, Mother and Child University and Hospital Center (CHUMEL), Cotonou, Benin), Jean-Eudes Degbelo (Institut de Recherche Clinique du Bénin (IRCB), Calavi, Benin), Philippe Deloron (MERIT UMR 261, IRD, Université de Paris, Paris, France), Latifou Dramane (Institut de Recherche Clinique du Bénin (IRCB), Abomey Calavi, Benin), Jérémy Fraering (MERIT UMR 261, IRD, Université de Paris, Paris, France), Emilie Guillochon (MERIT UMR 261, IRD, Université de Paris, Paris, France), Sayeh Jafari-Guemouri (MERIT UMR 261, IRD, Université de Paris, Paris, France), Ludivine Houzé (MERIT UMR 261, IRD, Université de Paris, Paris, France), Valentin Joste (MERIT UMR 261, IRD, Université de Paris, Paris, France), Claire Kamaliddin (MERIT UMR 261, IRD, Université de Paris, Paris, France), Anaïs Labrunie (NET, INSERM, Université de Limoges, Limoges, France), Yélé Ladipo (Pediatric Department, Mother and Child University and Hospital Center (CHUMEL), Cotonou, Benin), Thomas Lathiere (Ophtalmology department, Limoges University Hospital, Limoges, France), Achille Massougbodji (Institut de Recherche Clinique du Bénin (IRCB), Abomey Calavi, Benin), Audrey Mowendabeka (Paediatric Department, Hopital de la Mère et de l'Enfant, Limoges, France), Jade Papin (MERIT UMR 261, IRD, Université de Paris, Paris, France), Bernard Pipy (PHARMADEV, Université de Toulouse, IRD, UPS, France), Pierre-Marie Preux (NET, INSERM, Université de Limoges, Limoges, France), Marie Raymondeau (NET, INSERM, Université de Limoges, Limoges, France), Jade Royo (PHARMADEV, Université de Toulouse, IRD, UPS, France), Darius Sossou (Institut de Recherche Clinique du Bénin (IRCB), Abomey Calavi, Benin), Brigitte Techer (MERIT UMR 261, IRD, Université de Paris, Paris, France), Bertin Vianou (Institut de Recherche Clinique du Bénin (IRCB), Abomey Calavi, Benin)., ANR-17-CE17-0001,NEUROCM,Identification des facteurs parasitaires et de l'hôte à l'origine de la neuroinflammation et de sa résolution dans un contexte de neuropaludisme(2017), Grelier, Elisabeth, Identification des facteurs parasitaires et de l'hôte à l'origine de la neuroinflammation et de sa résolution dans un contexte de neuropaludisme - - NEUROCM2017 - ANR-17-CE17-0001 - AAPG2017 - VALID, Mère et enfant en milieu tropical : pathogènes, système de santé et transition épidémiologique (MERIT - UMR_D 216), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT-FR 2599), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), and Université Fédérale Toulouse Midi-Pyrénées
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MESH: Bacterial Infections ,Malaria, Cerebral ,Non-traumatic coma ,MESH: Malaria, Cerebral ,[SDV.MHEP.PED] Life Sciences [q-bio]/Human health and pathology/Pediatrics ,MESH: Benin ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,MESH: Child ,West Africa ,Odds Ratio ,Benin ,Humans ,Prospective Studies ,[SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] ,Child ,Cerebral malaria ,[SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics ,MESH: Humans ,MESH: Child, Preschool ,Public Health, Environmental and Occupational Health ,Bacterial Infections ,General Medicine ,Central nervous system infection ,MESH: Odds Ratio ,MESH: Prospective Studies ,Co-infection ,Infectious Diseases ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,Child, Preschool ,[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,[SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie - Abstract
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.
- Published
- 2022
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