@article{fdi:010084505,
  title = {{N}on-traumatic coma in young children in {B}enin : are viral and bacterial infections gaining ground on cerebral malaria ?},
  author = {{B}risset, {J}. and {B}aki, {K}. {A}. and {W}atier, {L}. and {K}inkpe, {E}. and {B}ailly, {J}ustine and {A}yedadjou, {L}. and {A}lao, {M}. {J}. and {D}ossou-{D}agba, {I}. and {B}ertin, {G}wladys and {C}ot, {M}ichel and {B}oumediene, {F}. and {A}jzenberg, {D}. and {A}ubouy, {A}gn{\`e}s and {H}ouze, {S}. and {F}aucher, {J}. {F}. and {N}euro{CM} {G}roup},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {W}hile 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 {E}astern {A}frica. {W}e aimed to describe the etiology of non-traumatic comas in young children in {B}enin, as well as their management and early outcomes, and to identify factors associated with death. {M}ethods {F}rom {M}arch to {N}ovember 2018, we enrolled all {HIV}-negative children aged between 2 and 6 years, with a {B}lantyre {C}oma {S}core <= 2, in this prospective observational study. {C}hildren 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}. {T}o determine factors associated with death, univariate and multivariate analyses were performed. {R}esults {F}rom 3244 admissions, 84 children were included: malaria was diagnosed in 78, eight of whom had a viral or bacterial co-infection. {S}ix children had a non-malarial infection or no identified cause. {T}he mortality rate was 29.8% (25/84), with 20 children dying in the first 24 h. {C}o-infected children appeared to have a poorer prognosis. {O}f the 76 children who consulted a healthcare professional before admission, only 5 were prescribed adequate antimalarial oral therapy. {P}redictors 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). {A}ntibiotic 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. {C}onclusions {I}nfections were found in all children who died, and cerebral malaria was by far the most common cause of non-traumatic coma. {M}issed opportunities to receive early effective antimalarial treatment were common. {O}ther central nervous system infections must be considered in their management. {S}ome factors that proved to be protective against early death were unexpected.},
  keywords = {{N}on-traumatic coma ; {C}erebral malaria ; {C}o-infection ; {C}entral nervous ; system infection ; {W}est {A}frica ; {BENIN}},
  booktitle = {},
  journal = {{I}nfectious {D}iseases of {P}overty},
  volume = {11},
  numero = {1},
  pages = {29 [10 ]},
  ISSN = {2095-5162},
  year = {2022},
  DOI = {10.1186/s40249-022-00956-2},
  URL = {https://www.documentation.ird.fr/hor/fdi:010084505},
}