326. Malaria vs. Bacterial Meningitis in Children with Spinal Tap in the Luanda Children´s Hospital, Angola
Session: Poster Abstract Session: CNS Infections
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • Poster, Malaria vs. bacterial meningitis, IDWeek 2018, Pelkonen.pdf (272.0 kB)
  • 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 < .0001), had an underlying illness (23/97 vs 19/374, p < .0001), like sickle-cell disease (18/96 vs 9/372, p < .0001), longer duration of illness (4 (4) vs 3 (3) days, p < .0001, dyspnea (70/119 vs 210/463, p = .009), were dehydrated (36/113 vs 67/441, p < .0001), or malnourished (38/115 vs 75/447, p = .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 < .0001), duration of illness > 3 days (2.48, 1.68 – 3.64, p < .0001), malnutrition (1.92, 1.20 – 3.05, p = .006), and dehydration (1.92, 1.16 – 3.14, p = .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 < .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.

    Suvi Urtti, MD1,2, Irmeli Roine, MD, PhD3, Moe H. Kyaw, PhD4, Manuel Leite Cruzeiro, MD5, Elsa Barbosa, MD5, Elizabete Dos Anjos, Lic.A Psych5, Luis Bernardino, MD5, Heikki Peltola, MD, PhD, Professor6 and Tuula Pelkonen, MD, PhD5,6, (1)Children´s Hospital, Helsinki University Hospital, Helsinki, Finland, (2)University of Helsinki, Helsinki, Finland, (3)Faculty of Medicine, University Diego Portales, Santiago, Chile, (4)Sanofi Pasteur, Swiftwater, PA, (5)Hospital Pediátrico David Bernardino, Luanda, Angola, (6)Children’s Hospital, Helsinki University Hospital, and the University of Helsinki, Helsinki, Finland

    Disclosures:

    S. Urtti, None

    I. Roine, None

    M. H. Kyaw, None

    M. Leite Cruzeiro, None

    E. Barbosa, None

    E. Dos Anjos, None

    L. Bernardino, None

    H. Peltola, None

    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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