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326. Malaria vs. Bacterial Meningitis in Children With Spinal Tap in the Luanda Children’s Hospital, Angola

BACKGROUND: In Sub-Saharan Africa, both malaria (M), and bacterial meningitis (BM) cause fever and central nervous system (CNS) disturbance. We studied their prevalence, characteristics, outcome, and risk factors for poor outcome to better understand the clinical impact of suspected CNS infection in...

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Autores principales: Urtti, Suvi, Roine, Irmeli, Kyaw, Moe H, Cruzeiro, Manuel Leite, Barbosa, Elsa, Anjos, Elizabete Dos, Bernardino, Luis, Peltola, Heikki, Pelkonen, Tuula
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6255308/
http://dx.doi.org/10.1093/ofid/ofy210.337
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author Urtti, Suvi
Roine, Irmeli
Kyaw, Moe H
Cruzeiro, Manuel Leite
Barbosa, Elsa
Anjos, Elizabete Dos
Bernardino, Luis
Peltola, Heikki
Pelkonen, Tuula
author_facet Urtti, Suvi
Roine, Irmeli
Kyaw, Moe H
Cruzeiro, Manuel Leite
Barbosa, Elsa
Anjos, Elizabete Dos
Bernardino, Luis
Peltola, Heikki
Pelkonen, Tuula
author_sort Urtti, Suvi
collection PubMed
description BACKGROUND: In Sub-Saharan Africa, both malaria (M), and bacterial meningitis (BM) cause fever and central nervous system (CNS) disturbance. We studied their prevalence, characteristics, outcome, and risk factors for poor outcome to better understand the clinical impact of suspected CNS infection in children. METHODS: We conducted a prospective study in the Children’s Hospital (HPDB) in the capital of Angola which attends 300 new patients daily. Spinal tap (ST) was performed for children presenting with altered consciousness, convulsions, prostration, or meningism. The analysis included children aged 3 month to 15 years with confirmed discharge diagnosis in 2016–2017. RESULTS: Of 941 children, the diagnosis was M in 56% (525), BM in 12% (116), epilepsy/convulsions in 9% (88), and other infections in 6% (60). Of all children, 16% (150/941) died, 6% (45/733) had severe, 14% (93/655) any neurological sequelae, and 27% (243/897) either died or had neurological sequelae. In children with M, the corresponding figures were 7% (35/525), 1.5% (7/476), 4% (19/443), and 11% (54/514). In children with BM, the figures were 41% (47/116), 15% (8/54), 33% (11/33), and 55% (58/105), respectively. Comparing with M, children with BM were younger (median age (IQR) 28 (61) vs. 60 (68) months, P < 0.0001), had an underlying illness (23/97 vs. 19/374, P < 0.0001), like sickle-cell disease (18/96 vs. 9/372, P < 0.0001), longer duration of illness (4 (4) vs. 3 (3) days, P < 0.0001, dyspnea (70/119 vs. 210/463, P = 0.009), were dehydrated (36/113 vs. 67/441, P < 0.0001), or malnourished (38/115 vs. 75/447, P = 0.0001). Multivariate analysis revealed as independent risk factors for death or neurological sequelae age <12 months (OR 1.71, 95% CI 1.02–2.88, P < 0.0001), duration of illness >3 days (2.48, 1.68–3.64, P < 0.0001), malnutrition (1.92, 1.20–3.05, P = 0.006), and dehydration (1.92, 1.16–3.14, P = 0.01). When BM vs. M was included in the analysis, BM appeared as the most important risk factor (OR 8.06, 4.44–14.65, P < 0.0001) and age lost its significance. CONCLUSION: In suspected CNS infection, M was the final diagnosis of most children. However, BM caused more deaths and neurological sequelae. Amendable factors, such as delay in treatment, dehydration, and malnutrition, appeared as risk factors for poor outcome. DISCLOSURES: T. Pelkonen, sanofi pasteur: Investigator, Sanofi Paster funded this study. Paediatric Research Foundation, Helsinki, Finland: Grant Investigator, Grant recipient. Päivikki and Sakari Sohlberg Foundation, Helsinki, Finland: Grant Investigator, Grant recipient
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spelling pubmed-62553082018-11-28 326. Malaria vs. Bacterial Meningitis in Children With Spinal Tap in the Luanda Children’s Hospital, Angola Urtti, Suvi Roine, Irmeli Kyaw, Moe H Cruzeiro, Manuel Leite Barbosa, Elsa Anjos, Elizabete Dos Bernardino, Luis Peltola, Heikki Pelkonen, Tuula Open Forum Infect Dis Abstracts BACKGROUND: In Sub-Saharan Africa, both malaria (M), and bacterial meningitis (BM) cause fever and central nervous system (CNS) disturbance. We studied their prevalence, characteristics, outcome, and risk factors for poor outcome to better understand the clinical impact of suspected CNS infection in children. METHODS: We conducted a prospective study in the Children’s Hospital (HPDB) in the capital of Angola which attends 300 new patients daily. Spinal tap (ST) was performed for children presenting with altered consciousness, convulsions, prostration, or meningism. The analysis included children aged 3 month to 15 years with confirmed discharge diagnosis in 2016–2017. RESULTS: Of 941 children, the diagnosis was M in 56% (525), BM in 12% (116), epilepsy/convulsions in 9% (88), and other infections in 6% (60). Of all children, 16% (150/941) died, 6% (45/733) had severe, 14% (93/655) any neurological sequelae, and 27% (243/897) either died or had neurological sequelae. In children with M, the corresponding figures were 7% (35/525), 1.5% (7/476), 4% (19/443), and 11% (54/514). In children with BM, the figures were 41% (47/116), 15% (8/54), 33% (11/33), and 55% (58/105), respectively. Comparing with M, children with BM were younger (median age (IQR) 28 (61) vs. 60 (68) months, P < 0.0001), had an underlying illness (23/97 vs. 19/374, P < 0.0001), like sickle-cell disease (18/96 vs. 9/372, P < 0.0001), longer duration of illness (4 (4) vs. 3 (3) days, P < 0.0001, dyspnea (70/119 vs. 210/463, P = 0.009), were dehydrated (36/113 vs. 67/441, P < 0.0001), or malnourished (38/115 vs. 75/447, P = 0.0001). Multivariate analysis revealed as independent risk factors for death or neurological sequelae age <12 months (OR 1.71, 95% CI 1.02–2.88, P < 0.0001), duration of illness >3 days (2.48, 1.68–3.64, P < 0.0001), malnutrition (1.92, 1.20–3.05, P = 0.006), and dehydration (1.92, 1.16–3.14, P = 0.01). When BM vs. M was included in the analysis, BM appeared as the most important risk factor (OR 8.06, 4.44–14.65, P < 0.0001) and age lost its significance. CONCLUSION: In suspected CNS infection, M was the final diagnosis of most children. However, BM caused more deaths and neurological sequelae. Amendable factors, such as delay in treatment, dehydration, and malnutrition, appeared as risk factors for poor outcome. DISCLOSURES: T. Pelkonen, sanofi pasteur: Investigator, Sanofi Paster funded this study. Paediatric Research Foundation, Helsinki, Finland: Grant Investigator, Grant recipient. Päivikki and Sakari Sohlberg Foundation, Helsinki, Finland: Grant Investigator, Grant recipient Oxford University Press 2018-11-26 /pmc/articles/PMC6255308/ http://dx.doi.org/10.1093/ofid/ofy210.337 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Urtti, Suvi
Roine, Irmeli
Kyaw, Moe H
Cruzeiro, Manuel Leite
Barbosa, Elsa
Anjos, Elizabete Dos
Bernardino, Luis
Peltola, Heikki
Pelkonen, Tuula
326. Malaria vs. Bacterial Meningitis in Children With Spinal Tap in the Luanda Children’s Hospital, Angola
title 326. Malaria vs. Bacterial Meningitis in Children With Spinal Tap in the Luanda Children’s Hospital, Angola
title_full 326. Malaria vs. Bacterial Meningitis in Children With Spinal Tap in the Luanda Children’s Hospital, Angola
title_fullStr 326. Malaria vs. Bacterial Meningitis in Children With Spinal Tap in the Luanda Children’s Hospital, Angola
title_full_unstemmed 326. Malaria vs. Bacterial Meningitis in Children With Spinal Tap in the Luanda Children’s Hospital, Angola
title_short 326. Malaria vs. Bacterial Meningitis in Children With Spinal Tap in the Luanda Children’s Hospital, Angola
title_sort 326. malaria vs. bacterial meningitis in children with spinal tap in the luanda children’s hospital, angola
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6255308/
http://dx.doi.org/10.1093/ofid/ofy210.337
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